Hemorragia alveolar fatal: estudo histológico detalhado de necropsias / Fatal alveolar hemorrhage: detailed histological analysis of necropsies




Alveolar haemorrhage is a syndrome presented by many diseases each one with its particular physiopathologic mechanism resulting in pulmonary bleeding. The detailed histological analysis of these patients can help understanding this syndrome. In this study we reviewed and described histological findings of lung slides and medical records from patients whose cause of death was alveolar haemorrhage between 1999 and 2004. Most patients presented diffuse (87,5%), mainly alveolar (79,2%) rather than interstitial and recent bleeding with no signs of recurrence (79,2%). We also observed the presence of: fibrin (81,3%), vasculitis (8,3%), intravascular thrombosis (27,1%), arterial sclerosis (31,3%), capillarity (41,7%), interstitial involvement (35,4%), venous involvement (41,7%), signs of infection on lung tissue (50%) and hyaline membrane (25%). Clinically we classified the patients as having one of the following syndromes: pulmonary oedema due to congestive heart failure (CHF- 29,17%), coagulation disorders (25%), sepsis (27,08%) and systemic inflammation (18,75%). After correlating clinical and histological data we found CHF to have lower presence of fibrin and interstitial involvement and a greater presence of focal bleeding. Coagulation disorders were characterized by no signs of recurrent bleeding and a lower presence of fibrin than infection and inflammation. Patients with clinical diagnosis of systemic inflammation had a greater presence of fibrin and arterial sclerosis than other clinical syndrome and patients with clinical diagnosis of sepsis showed presence of signs of infection in lung tissue no matter the clinical site of infection. In conclusion, our study suggests that some histological patterns happens more commonly in determined clinical syndromes and can help diagnosing the cause of bleeding .


alvéolos pulmonares/anatomia &histologia autópsia autopsy haemorrhage hemorragia lung/blood supply pulmão/irrigação sanguínea pulmonary alveoli/anatomy &histology

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