Medicina

The Scientific World Journal Volume 2012, Article ID 657316, 6 pages doi:10.1100/2012/657316

The cientificWorldJOURNAL

Research Article Diffuse Alveolar Damage of the Lungs in Forensic Autopsies: Assessment of Histopathological Stages and Causes of Death
Halide Nur Urer,1 Gokhan Ersoy,2 and Emine Dilek Yılmazbayhan3
1 Department 2 Department

of Pathology, Yedikule Teaching Hospital forChest Diseases and Thoracic Surgery, 34020 Istanbul, Turkey of Forensic Pathology, Istanbul University, Institute of Forensic Medicine, 34452 Istanbul, Turkey 3 Department of Pathology, Istanbul Medical Faculty, Istanbul University, 34452 Istanbul, Turkey Correspondence should be addressed to Halide Nur Urer, nururer@gmail.com Received 23 July 2012; Accepted 2 September 2012 Academic Editors: J. M.Nesland, G. Pasquinelli, and K. Szuhai Copyright © 2012 Halide Nur Urer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Diffuse alveolar damage (DAD) is a morphological prototype of acute interstitial pneumonia.Hospital autopsies or open-lung biopsies are used to monitor common alveolar damage and hyaline membrane (HM) development histopathologically. The aim of this study was to detect histopathological profiles and frequency of DAD and HM in adult forensic autopsies. Materials and Methods. In total, 6813 reports with histopathological samples in 12,504 cases on which an autopsy was performed between2006 and 2008 were investigated. Sixty-six individuals >18 years of age who were diagnosed with DAD were included. Hematoxylin- and eosin-stained lung preparations were reexamined in line with the 2002 American Thoracic Society/European Respiratory Society idiopathic interstitial pneumonia consensus criteria. Results. Histopathological examination revealed that 50 cases (75.7%) were in the exudativephase and 16 (24.2%) were in the proliferative phase. Only the rate of alveolar exudate/oedema in exudative phase cases (P = 0.003); those of alveolar histiocytic desquamation (P = 0.037), alveolar fibrosis (P = 0.017), chronic inflammation (P = 0.02), and alveolar fibrin (P = 0.001) in proliferative cases were significantly higher. The presence of alveolar fibrin was the only independent variable infavour of proliferative cases (P = 0.016). Conclusion. The detection of all DAD morphological criteria with the same intensity is not always possible in each case. Forensic autopsies may provide a favourable means for expanding our knowledge about acute lung damage, DAD, and interstitial lung disease.

1. Introduction
Diffuse alveolar damage (DAD) is the morphological prototype of acuteinterstitial pneumonia and is characterised by a rapid and fatal clinical course. DAD manifests clinically as acute respiratory distress syndrome (ARDS). It can be seen in sepsis, shock, trauma, severe ARDS, and idiopathic cases with undetected aetiological factors as well as acute exacerbations of chronic interstitial lung diseases [1–3]. While diffuse bilateral opacity is observed on lung radiology, manycases display deep hypoxemia that requires mechanical ventilation; the mortality rate is 43–50% [4, 5]. In addition to experimental animal studies, hospital autopsies or open-lung biopsies are needed to histopathologically monitor common alveolar damage and hyaline membrane (HM) development. A reduction in the rate of alveolar

damage has been known for a long time [6, 7]. Due to the highmortality and morbidity risk during the acute phase of the disease, late or organising stage DAD is identified generally in the pathological samples of individuals undergoing open lung biopsy [8, 9]. An open biopsy may trigger acute attacks in patients with idiopathic pulmonary fibrosis [10]. Given the restrictions when performing an open-lung biopsy in patients with acute and severe respiratory...