Fatal acute fibrinous and organizing pneumonia in an infant: The histopathologic variability of acute respiratory distress syndrome
Fatal acute fibrinous and organizing pneumonia in an infant: The histopathologic variability of acute respiratory distress syndrome
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DOI：
10.1097/01.pcc.0000269375.10806.60
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发表时间：
2007-07-01
影响因子：
4.1
通讯作者：
Peters, Mark J.
中科院分区：
文献类型：
--
作者：
Cincotta, Domenic R.;Sebire, Neil J.;Peters, Mark J.
Objective.最近在成人急性呼吸窘迫综合征（ARDS）病例中描述了急性化脓性和机化性肺炎（AFOP）的组织病理学模式，其不同于公认的经典弥漫性肺泡损伤（DAD）模式。本研究的目的是确定是否可以在婴儿ARDS中看到类似的表现。设计：病例报告和回顾性回顾1995- 2005年婴儿肺活检。设置：三级转诊中心的儿科和新生儿重症监护室。患者：无。干预措施：无。测量和主要结果：一名先前患有呼吸道合胞病毒肺炎继发性ARDS的早产儿，在开放性肺活检中具有AFOP的组织病理学特征。从1995年到2005年，9名婴儿有明确的DAD或AFOP组织学，并符合美国-欧洲共识会议诊断ARDS的标准。其中，7例患者存在经典的DAD结果，而2例患者具有AFOP和DAD的特征。提示病毒感染的特点在5名婴儿中进行了鉴定。结论：AFOP的组织病理学特征可以在一些婴儿ARDS病例中看到。ARDS组织病理学的变异性提出了关于这些不同模式的发病机制和临床相关性的问题。
Objective. The histopathologic pattern of acute fibrinous and organizing pneumonia (AFOP) has been described recently in cases of acute respiratory distress syndrome (ARDS) in adults and differs from the well-recognized pattern of classic diffuse alveolar damage (DAD). The objective of this study was to determine whether similar appearances can be seen in infant ARDS.Design: Case report and retrospective review of infant lung biopsies 1995-2005.Setting: Paediatric and neonatal intensive care units in a tertiary referral center.Patients: None.Interventions: None.Measurements and Main Results: A formerly premature infant with ARDS secondary to respiratory syncytial virus pneumonitis had histopathologic features of AFOP on open lung biopsy. Nine infants from 1995 to 2005 had definite histology of DAD or AFOP and fulfilled American-European Consensus Conference criteria for the diagnosis of ARDS. Of these, classic DAD findings were present in seven, whereas two had features of AFOP and DAD. Features suggesting viral infection were identified in five infants.Conclusions: The histopathologic features of AFOP may be seen in some cases of infant ARDS. The variability in the histopathology of ARDS raises questions as to the pathogenesis and clinical correlates of these different patterns.