Diffuse alveolar damage

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[edit] Discussion of Diffuse alveolar damage

  • Diffuse alveolar damage (DAD) is a common manifestation of drug-induced lung injury that results from necrosis of type II pneumocytes and alveolar endothelial cells.
  • Histopathologically, DAD is divided into an acute exudative phase and a late reparative or proliferative phase.
    • The exudative phase, which is characterized by alveolar and interstitial edema and hyaline membranes, is most prominent in the 1st week after lung injury.
    • The reparative phase, which is characterized by proliferation of type II pneumocytes and interstitial fibrosis, typically occurs after 1 or 2 weeks.
  • Depending on the severity of the injury, fibrosis can improve significantly, remain stable, or progress to honeycomb lung.
  • Drugs that most commonly cause DAD are bleomycin, busulfan, carmustine (BCNU), cyclophosphamide, melphalan, mitomycin, and gold salts.
  • Affected patients present with dyspnea, cough, and occasionally fever. Diffusing capacity for carbon monoxide (DLCO) is characteristically decreased.

[edit] Imaging Findings for Diffuse alveolar damage

  • Chest radiographs show bilateral heterogeneous or homogeneous opacities, often in a mid and lower lung distribution.
  • Progression to diffuse opacification is common.
  • High-resolution computed tomography in early DAD typically shows scattered or diffuse areas of ground-glass opacity.
  • Fibrosis typically develops within 1 week but initially may not be evident on chest radiographs. With progressive fibrosis, however, marked architectural distortion and honeycomb lung can occur.

[edit] Images

Patient #1

[edit] See Also

[edit] External Links

Goldminer: Diffuse alveolar damage

[edit] References for Diffuse alveolar damage