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Post-traumatic-shock lung: postmortem microangiographic and pathologic correlation

F Pinet, A Tabib, A Clermont

    AJR. American Journal of Roentgenology
    |September 1, 1982
    PubMed
    Summary
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    Post-traumatic shock lung involves increased pulmonary vascular resistance and hypertension. Microangiography revealed widespread alveolar capillary rupture, thrombi, and hypovascular areas contributing to respiratory failure.

    Area of Science:

    • Pulmonary Medicine
    • Pathology
    • Trauma Research

    Background:

    • Post-traumatic shock lung is characterized by elevated pulmonary vascular resistance and pulmonary hypertension.
    • Understanding the underlying vascular pathology is crucial for managing respiratory failure post-trauma.

    Purpose of the Study:

    • To investigate the microvascular changes in post-traumatic shock lung using postmortem microangiography.
    • To identify the mechanisms contributing to pulmonary hypertension and perfusion abnormalities.

    Main Methods:

    • Postmortem microangiography of lung specimens from 17 patients who died from respiratory failure after trauma.
    • Histopathological analysis to assess vascular integrity, thrombus formation, and lung tissue abnormalities.

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    Main Results:

    • Alveolar capillary rupture with contrast extravasation (20% of area) was observed in most specimens.
    • Pulmonary artery thrombi, hypovascular areas (40% of area) due to infection/hemorrhage, and microthrombi in small arteries were prevalent.
    • Lung tissue showed hematomas, cavities, and edema (5% of area) associated with vessel compression/occlusion.

    Conclusions:

    • Mechanisms including direct pulmonary trauma contribute to small blood vessel rupture and obstruction.
    • Small artery occlusion and compression are linked to hemorrhage, infarction, and infection in post-traumatic shock lung.
    • These vascular abnormalities significantly contribute to perfusion deficits and respiratory failure.