title: Pulmonary microvascular fracture in a patient with acute respiratory distress syndrome.
abstract: OBJECTIVE
  To present electron micrographs of lung tissue obtained from a patient exposed to high ventilatory pressures in the context of pulmonary dysfunction and pulmonary hypertension.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Adult intensive care unit of a university-affiliated teaching hospital.
  
  
  METHODS
  A patient exposed to high-pressure mechanical ventilation during support for acute respiratory distress syndrome; the acute respiratory distress syndrome in this case was secondary to septic shock.
  
  
  RESULTS
  Scanning electron micrographs of lung tissue, focusing on the internal alveolar surfaces.
  
  
  RESULTS
  Multiple gross disruptions of the alveolar walls, suggestive of stress fractures.
  
  
  CONCLUSIONS
  High-pressure mechanical ventilation may promote fracturing of the alveolar blood:airspace barrier.
authors.affiliation: Department of Critical Care Medicine, Regions Hospital and University of Minnesota Medical School, St. Paul, MN, USA
authors.forename: John R
authors.initials: JR
authors.lastname: Hotchkiss
authors.forename: Dana A
authors.initials: DA
authors.lastname: Simonson
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Marek
authors.forename: John J
authors.initials: JJ
authors.lastname: Marini
authors.forename: David J
authors.initials: DJ
authors.lastname: Dries
mesh_terms: D000368:Aged; D002196:Capillaries / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008855:Microscopy, Electron, Scanning; D011650:Pulmonary Alveoli / Q000098:blood supply* / Q000000981:diagnostic imaging; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000473:pathology* / Q000628:therapy; D014463:Ultrasonography