Acute respiratory distress syndrome: A study of autopsy findings

In this autopsy study, the various morphological patterns of acute respiratory distress syndrome (ARDS) have been analyzed and compared along with their etiopathogenesis.

We aimed to study the prevalence and clinicopathological correlation of ARDS based on age, gender, hospital stay, symptoms, clinical diagnosis, gross, and microscopy findings.

Total 130 cases of ARDS were studied over a period of 5 years. Age, gender, hospital stay duration, symptoms, clinical diagnosis, gross and microscopic lung finding, clinicopathological correlation, and cause of death were documented and analyzed. Special stains were done whenever required.

This is an observational study, and simple statistics such as mean, median, and standard deviation have been used for continuous variables.

The prevalence of ARDS among the adult autopsy was 6.05%. Majority of the cases were in the age group of 18-30 years (36.9%), with a male: female ratio of 1.7:1. Chief complaints were fever (71%), breathlessness (54.6%), and chills (43.8%). The main clinical diagnoses were ARDS (41.6%), sepsis (28.3%), acute febrile illness (17%), and lower respiratory tract infection (12.5%). Most of the patients had a hospital stay of <1 day. Associated conditions mostly included chronic alcoholism (16.1%), pregnancy (16.1%), and chronic smoking (10.7%). Major findings on gross examination were intrapulmonary hemorrhage (38.5%), ARDS (33%), pulmonary edema (13%), and pneumonia (15.3%).On microscopy, major findings were hyaline membrane (84.6%), intrapulmonary hemorrhage (76.1%), pulmonary edema (75.3%), organizing fibrin (55.3%), and bronchopneumonia (36.2%).

Infections were one of the major predisposing causes of ARDS. Due to the short interval, the underlying cause for ARDS often goes undiagnosed.