title: Diffuse alveolar damage: uncommon manifestation of pulmonary involvement in patients with connective tissue diseases.
abstract: BACKGROUND
  Diffuse alveolar damage (DAD) is a relatively common finding on surgical lung biopsy and can result from a variety of causes.
  
  
  METHODS
  We studied nine consecutive patients with connective tissue disease (CTD) and DAD diagnosed on surgical lung biopsy to examine this association and clinical implications.
  
  
  RESULTS
  The median age was 63 years (range, 35 to 76 years), and seven of the patients were women (78%). Underlying CTDs included rheumatoid arthritis in five patients, polymyositis in two patients, and one patient each with systemic sclerosis and mixed CTD. In seven patients (78%), CTD had been diagnosed before the onset of DAD; six of these patients had a preexisting interstitial lung disease (ILD) related to their CTD. DAD was the presenting manifestation leading to a new CTD diagnosis in two patients (22%). CT of the chest revealed ground-glass opacities and/or consolidation bilaterally with or without honeycombing. In all patients, surgical lung biopsy revealed DAD for which no cause could be identified other than the underlying CTD. Seven patients (78%) were receiving mechanical ventilatory support at the time of the surgical lung biopsy. Four patients (44%) survived to hospital discharge and included one patient with preexisting ILD and all three patients without chronic ILD.
  
  
  CONCLUSIONS
  We conclude that DAD can complicate the clinical course of patients with CTD-related chronic ILD, or can occasionally occur as a presenting manifestation of CTDs. When DAD occurs in patients with CTDs, the outcome appears to be worse for those with preexisting chronic ILD compared to those without ILD.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Parambil
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Myers
authors.forename: Jay H
authors.initials: JH
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003240:Connective Tissue Diseases / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000000981:diagnostic imaging / Q000473:pathology*; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed