title: Diffuse alveolar damage of the lungs in forensic autopsies: assessment of histopathological stages and causes of death.
abstract: BACKGROUND
  Diffuse alveolar damage (DAD) is a morphological prototype of acute interstitial pneumonia. Hospital autopsies or open-lung biopsies are used to monitor common alveolar damage and hyaline membrane (HM) development histopathologically. The aim of this study was to detect histopathological profiles and frequency of DAD and HM in adult forensic autopsies.
  
  
  METHODS
  In total, 6813 reports with histopathological samples in 12,504 cases on which an autopsy was performed between 2006 and 2008 were investigated. Sixty-six individuals >18 years of age who were diagnosed with DAD were included. Hematoxylin- and eosin-stained lung preparations were reexamined in line with the 2002 American Thoracic Society/European Respiratory Society idiopathic interstitial pneumonia consensus criteria.
  
  
  RESULTS
  Histopathological examination revealed that 50 cases (75.7%) were in the exudative phase and 16 (24.2%) were in the proliferative phase. Only the rate of alveolar exudate/oedema in exudative phase cases (P = 0.003); those of alveolar histiocytic desquamation (P = 0.037), alveolar fibrosis (P = 0.017), chronic inflammation (P = 0.02), and alveolar fibrin (P = 0.001) in proliferative cases were significantly higher. The presence of alveolar fibrin was the only independent variable in favour of proliferative cases (P = 0.016).
  
  
  CONCLUSIONS
  The detection of all DAD morphological criteria with the same intensity is not always possible in each case. Forensic autopsies may provide a favourable means for expanding our knowledge about acute lung damage, DAD, and interstitial lung disease.
authors.affiliation: Department of Pathology, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, 34020 Istanbul, Turkey. nururer@gmail.com
authors.forename: Halide
authors.initials: H
authors.lastname: Nur Urer
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ersoy
authors.forename: Emine Dilek
authors.initials: ED
authors.lastname: Yılmazbayhan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002423:Cause of Death; D018450:Disease Progression; D004801:Eosine Yellowish-(YS) / Q000378:metabolism; D005260:Female; D049429:Forensic Pathology / Q000379:methods*; D006416:Hematoxylin / Q000378:metabolism; D006801:Humans; D054988:Idiopathic Interstitial Pneumonias / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000473:pathology; D011650:Pulmonary Alveoli / Q000378:metabolism / Q000473:pathology*; D011654:Pulmonary Edema / Q000378:metabolism / Q000473:pathology; D011657:Pulmonary Eosinophilia / Q000473:pathology; D012720:Severity of Illness Index; D013194:Staining and Labeling; D055815:Young Adult
chemical_list: D004801:Eosine Yellowish-(YS); D006416:Hematoxylin