Published ahead of print on July 3, 2003, doi:10.1164/rccm.200304-528OC Am. J. Respir. Crit. Care Med., Volume 168, Number 5, September 2003, 549-555 A more recent version of this article appeared on September 1, 2003
Submitted on April 21, 2003 Histological, immunohistochemical and ultra-structural findings in human blast lung injuryMichael Tsokos1*,1 Institute of Legal Medicine, University of Hamburg, Hamburg, Germany, 2 Institute of Anatomy, University of Kiel, Kiel, Germany, 3 Institute of Pathology, University of Hamburg, Hamburg, Germany, 4 Institute of Legal Medicine, University of Bonn, Bonn, Germany * To whom correspondence should be addressed. 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 micromorphological equivalents of human blast lung injury can be summarized as follows: diffuse alveolar overdistension, circumscribed interstitial hemorrhages showing a cuff-like 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 have to 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, has to be emphasized since 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 artefact. Key words: Blast lung injury, Air embolism, Pulmonary fat embolism, Acute respiratory distress syndrome
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