Tuberc Respir Dis.  2012 Apr;72(4):386-389.

A Case of Asymptomatic, Localized, and Idiopathic Diffuse Alveolar Damage

• Jeon YD
• Hong HC
• Joh JS
• Jung JY
• Min JW
• Park SY
• Lee GR

Abstract

Diffuse alveolar damage (DAD) is a histological change in lung tissue, and is generally caused by an acute lung injury, which is characterized by bilateral and widespread damages. Localized DAD occurs very rarely. The causes for DAD are numerous, but the chief cause is acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia, in cases of idiopathic manifestation. The 82-year-old patient, in this case study, showed a DAD lesion in only 1 lobe. The patient was otherwise healthy, with no previous symptoms of DAD. He was admitted to our medical center owing to localized infiltration, observed on his chest radiograph. Laboratory studies showed no signs of infections. DAD was confirmed by a surgical lung biopsy. The patient received corticosteroid treatment and had gradually improved. We report the case of a patient with localized, idiopathic DAD that cannot be classified as acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia.

Keyword

Idiopathic Interstitial Pneumonias; Idiopathic Pulmonary Fibrosis; Lung Injury; Pathology

MeSH Terms

Acute Lung Injury
Aged, 80 and over
Biopsy
Humans
Idiopathic Interstitial Pneumonias
Idiopathic Pulmonary Fibrosis
Lung
Lung Diseases, Interstitial
Lung Injury
Thorax

Figure

• 

  Figure 1 Chest computed tomography. (A) Diffuse patchy consolidation and ground-glass opacification were observed on the left upper lobe. (B) Reticular opacification was observed on the both lower lobes. No bronchiedctasis or honeycombing was observed.

• 

  Figure 2 Histopathology of the biopsy specimen obtained from the left the upper lobe. (A) Proliferation of fibroblasts admixed with scattered mononuclear inflammatory cells involving the alveolar walls. (B) Hyaline membranes (A, B, H&E stain, ×100).

• 

  Figure 3 Chest radiograph. (A) Initial examination showed increased consolidation in the left upper lobe. (B) After 3 weeks, a follow-up examination showed almost complete disappearance of left upper lobe infiltration, although reticular opacities on both the lower lobes remained.

Reference

1. Kaarteenaho R, Kinnula VL. Diffuse alveolar damage: a common phenomenon in progressive interstitial lung disorders. Pulm Med. 2011. 2011:531302.

2. Gill JR, Sheng ZM, Ely SF, Guinee DG, Beasley MB, Suh J, et al. Pulmonary pathologic findings of fatal 2009 pandemic influenza A/H1N1 viral infections. Arch Pathol Lab Med. 2010. 134:235–243.

3. Yazdy AM, Tomashefski JF Jr, Yagan R, Kleinerman J. Regional alveolar damage (RAD): a localized counterpart of diffuse alveolar damage. Am J Clin Pathol. 1989. 92:10–15.

4. Castro CY. ARDS and diffuse alveolar damage: a pathologist's perspective. Semin Thorac Cardiovasc Surg. 2006. 18:13–19.

5. Collard HR, Moore BB, Flaherty KR, Brown KK, Kaner RJ, King TE Jr, et al. Acute exacerbations of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2007. 176:636–643.

6. Akira M, Kozuka T, Yamamoto S, Sakatani M. Computed tomography findings in acute exacerbation of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2008. 178:372–378.

7. King TE Jr. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Chapter 255. Interstitial lung disease. Harrison's principles of internal medicine. 2008. 17th ed. New York: McGraw-Hill Co, Inc.;1643–1651.

8. Sakamoto K, Taniguchi H, Kondoh Y, Ono K, Hasegawa Y, Kitaichi M. Acute exacerbation of idiopathic pulmonary fibrosis as the initial presentation of the disease. Eur Respir Rev. 2009. 18:129–132.

9. Suh GY, Kang EH, Chung MP, Lee KS, Han J, Kitaichi M, et al. Early intervention can improve clinical outcome of acute interstitial pneumonia. Chest. 2006. 129:753–761.

10. Papazian L, Doddoli C, Chetaille B, Gernez Y, Thirion X, Roch A, et al. A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients. Crit Care Med. 2007. 35:755–762.