Acute ischemic lung injury due to pulmonary vascular obstruction

Abstract

Aim of the study

We have encountered cases of a distinctive myxomatous alveolar wall thickening around pulmonary infarctions and have termed it acute ischemic lung injury (AILI). In this study we determined if pulmonary infarction is the only cause of AILI and have elucidated its histological features.

Materials and Methods

We examined 2941 cases that underwent lobectomy, surgical lung biopsies for nodular lesions, or autopsies between 1994 and 2014. Cases were divided into pulmonary infarction and non-infarction groups. The histological features of AILI sought were lobule-based alveolar wall thickening (myxomatous or fibrous) with epithelial metaplasia and negligible inflammation. In order to further characterize AILI, we performed immunohistochemical staining using several antibodies.

Results

Thirty-four out of 69 cases in the infarction group (mean age 57.1 years, 30 males) had AILI, whereas only 1 (but with vascular obstruction) out of the remaining 2,872 in the non-infraction group had AILI. AILI was located around infarctions. Separation of the epithelial and endothelial basement membranes of the alveolar wall was observed in 75% of cases.

Conclusions

AILI is almost exclusively associated with lung infarction, presumably caused by vascular obstruction. We consider AILI to represent a distinct lung lesion other than pulmonary hemorrhage and infarction.

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