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Histologic, Immunohistochemical, and Ultrastructural Findings in Human Blast Lung Injury

Department of Forensic Pathology, Institute of Legal Medicine, and Institute of Pathology, University of Hamburg, Hamburg; Institute of Anatomy, University of Kiel, Kiel; and Institute of Legal Medicine, University of Bonn, Bonn, Germany

Correspondence and requests for reprints should be addressed to Michael Tsokos, M.D., Department of Forensic Pathology, Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany. E-mail: mtsokos{at}web.de

The objective of this autopsy-based study was to investigate the pathology of human blast lung injury using histology, Fat Red 7B staining, immunohistochemistry, and scanning electron microscopy on lung specimens from eight medicolegal autopsy cases of fatal close-range detonations of chemical explosives. The micromorphologic equivalents of human blast lung injury can be summarized as follows: diffuse alveolar overdistension, circumscribed interstitial hemorrhages showing a cufflike pattern around pulmonary vessels, venous air embolism, bone marrow embolism, and pulmonary fat embolism. Hemorrhages within the lung parenchyma that were present in this study in blast victims without coexisting blunt or penetrating chest trauma must be regarded as potentially life-threatening intrapulmonary bleeding sites in survivors. In addition, the potential clinical importance of the presence of massive pulmonary fat embolism, which has, to the best of our knowledge, not been described previously in human blast lung injury, must be emphasized because pulmonary fat embolism may be a leading cause of the rapid respiratory deterioration with progressive hypoxia and development of acute respiratory distress syndrome in blast victims who survive. Furthermore, this study provides evidence that air embolism presenting in blast victims is not a mere ventilation-induced artifact.

Key Words: acute respiratory distress syndrome • blast lung injury • air embolism • pulmonary fat embolism

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