Histologic, immunohistochemical, and ultrastructural findings in human blast lung injury.
The objective of this autopsy-based study was to investigate the pathology of human blast lung injury using histology, Fat Red 7B staining, immunohistochemistry, and scanning electron microscopy on lung specimens from eight medicolegal autopsy cases of fatal close-range detonations of chemical explosives. The micromorphologic equivalents of human blast lung injury can be summarized as follows: diffuse alveolar overdistension, circumscribed interstitial hemorrhages showing a cufflike pattern around pulmonary vessels, venous air embolism, bone marrow embolism, and pulmonary fat embolism. Hemorrhages within the lung parenchyma that were present in this study in blast victims without coexisting blunt or penetrating chest trauma must be regarded as potentially life-threatening intrapulmonary bleeding sites in survivors. In addition, the potential clinical importance of the presence of massive pulmonary fat embolism, which has, to the best of our knowledge, not been described previously in human blast lung injury, must be emphasized because pulmonary fat embolism may be a leading cause of the rapid respiratory deterioration with progressive hypoxia and development of acute respiratory distress syndrome in blast victims who survive. Furthermore, this study provides evidence that air embolism presenting in blast victims is not a mere ventilation-induced artifact.
Tsokos
Michael
M
Department of Forensic Pathology, Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529 Hamburg, Germany. mtsokos@web.de
Paulsen
Friedrich
F
Petri
Susan
S
Madea
Burkhard
B
Puschel
Klaus
K
Turk
Elisabeth E
EE
D000328:Adult; D000368:Aged; D001753:Blast Injuries / Q000150:complications / Q000276:immunology* / Q000473:pathology*; D004618:Embolism, Air / Q000209:etiology / Q000276:immunology* / Q000473:pathology*; D004620:Embolism, Fat / Q000209:etiology / Q000276:immunology* / Q000473:pathology*; D005107:Explosions; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology* / Q000648:ultrastructure; D055370:Lung Injury; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000276:immunology* / Q000473:pathology*; D015599:Trauma Severity Indices