Acute respiratory distress syndrome: A study of autopsy findings

Abstract

Context: In this autopsy study, the various morphological patterns of acute respiratory distress syndrome (ARDS) have been analyzed and compared along with their etiopathogenesis. Aims: We aimed to study the prevalence and clinicopathological correlation of ARDS based on age, gender, hospital stay, symptoms, clinical diagnosis, gross, and microscopy findings. Subjects and Methods: Total 130 cases of ARDS were studied over a period of 5 years. Age, gender, hospital stay duration, symptoms, clinical diagnosis, gross and microscopic lung finding, clinicopathological correlation, and cause of death were documented and analyzed. Special stains were done whenever required. Statistical Analysis: This is an observational study, and simple statistics such as mean, median, and standard deviation have been used for continuous variables. Results: The prevalence of ARDS among the adult autopsy was 6.05%. Majority of the cases were in the age group of 18–30 years (36.9%), with a male: female ratio of 1.7:1. Chief complaints were fever (71%), breathlessness (54.6%), and chills (43.8%). The main clinical diagnoses were ARDS (41.6%), sepsis (28.3%), acute febrile illness (17%), and lower respiratory tract infection (12.5%). Most of the patients had a hospital stay of <1 day. Associated conditions mostly included chronic alcoholism (16.1%), pregnancy (16.1%), and chronic smoking (10.7%). Major findings on gross examination were intrapulmonary hemorrhage (38.5%), ARDS (33%), pulmonary edema (13%), and pneumonia (15.3%). On microscopy, major findings were hyaline membrane (84.6%), intrapulmonary hemorrhage (76.1%), pulmonary edema (75.3%), organizing fibrin (55.3%), and bronchopneumonia (36.2%). Conclusion: Infections were one of the major predisposing causes of ARDS. Due to the short interval, the underlying cause for ARDS often goes undiagnosed.

Heparin-Binding Protein Promotes Acute Lung Injury in Sepsis Mice by Blocking the Aryl Hydrocarbon Receptor Signaling Pathway

“…37 Our comparison of mice in the Control group with mice in the LPS group revealed that sepsis modeling significantly worsened the pulmonary edema of mice and significantly increased the pulmonary pathological damage score. These pathological changes were consistent with the conclusions of clinical studies 38,39 focusing on the pulmonary characteristics of patients with sepsis.…”

Organophosphorus Poisoning: Acute Respiratory Distress Syndrome (ARDS) and Cardiac Failure as Cause of Death in Hospitalized Patients

“…Macroscopic and microscopic autopsy findings in the lungs of those who died within the first 24 h after hospitalization were characterized by interstitial edema and hemorrhage in lungs [ 70 ] and tubular degeneration in the kidney (acute tubular necrosis); also, in those who died later after OP poisoning [ 75 , 76 , 77 , 78 , 79 , 80 ], the findings mostly resemble those observed in people who died of acute respiratory distress syndrome (ARDS) [ 81 , 82 ] of different causes, including viral infections of the upper respiratory tract [ 83 , 84 , 85 , 86 ] and also paraquat intoxication [ 87 ]. Similar histopathological (microscopic) changes can be induced in minipigs by bronchoscopic instillation of gastric juice containing OP (40% dimethoate 0.5 mL/kg) into the lung [ 88 ], simulating aspiration of gastric content, as may happen after ingestion of the insecticide mostly with suicidal intention.…”

“…Autopsies are seldom performed in patients who died because of AOPP, and in most cases, it is related to the search for the toxic agent [ 77 , 78 , 79 , 80 , 81 , 82 ] and less to mechanisms that lead to death such as cardiac arrest, especially in persons of young age.…”