Postmortem changes in lungs in severe closed traumatic brain injury complicated by acute respiratory failure

Abstract

V.А. Tumanskіy, S.І. Ternishniy, L.M. Tumanskaya

Pathological changes in the lungs were studied in the work of 42 patiens who died from severe closed intracranial injury (SCII). It was complicated with acute respiratory insufficient (ARI). The most modified subpleural areas were selected from every lobe of the lungs for pathological studies. Prepared histological sections were stained by means of hemotoxylin and eosin and by Van Giеson for light microscopy.

The results of the investigation have shown absence of the significant difference of pathological changes in the lungs of patients who died from ARI because of severe brain injury and traumatic intracranial hemorrhage. Pathognomic pathological changes in the lungs as a result of acute lung injury syndrome (ALIS) were found in deceased patients on the third day since the SCII (n=8). There was a significant bilateral interstitial edema and mild alveolar edema with the presence of red and blood cells in the alveoli, vascular plethora of the septum interalveolar and stasis of blood in the capillaries, the slight pericapillary leukocyte infiltration, subpleural hemorrhage and laminar pulmonary atelectasis.

In deceased patients on 4-6 days after SCII that was complicated with ARI (n=14), morphological changes had been detected in the lungs. It was pathognomic for acute respiratory distress syndrome (ARDS) with local pneumonic to be layered. A significant interstitial pulmonary edema was observed in the respiratory part of the lungs. The edema has spread from the walls of the alveoli into the interstitial spaces of the bronchioles and blood vessels, and also less marked serous-hemorrhagic alveolar edema with presence of the fibrin in the alveoli and macrophages. The ways of intrapleural lymphatic drainage were dilatated.

Histopathological changes in the lungs of those who died on the 7-15^th days after severe closed craniocerebral injury with ARI to be complicated (n=12) have been indicative of two versions of the evolusion of ARDS, in 50% of deaths have been observed ARDS in fibroproliterative phase, in 50% of deceased patients – macrofocal pneumonia abscess against a background of ARDS with fibrotic changes in the lungs. By means of microscopy the fibroblasts, the bundles of collagen fibrils and the remains of edema fluid were detected into spread interstitial spaces of the visceral pleura, both septum interalveolar and interlobular and around vessels and bronchioles of the lungs as well. «Hyaline membranes» in the alveoli, as a rule, were not determined, the most of the alveoli were filled with multitude of the alveolar macrophages and fibrin deposits with a touch of plasma cells and fibroblasts. The sings of the interalveolar exudate organization were found in the parts of the alveoli, there were epithelial hyperplasia with appearance of cube-shaped cells that resemble alveolocytes type II in the other part of the alveoli, in the third part of the alveoli – intraalveolar fibrosis that is closely associated with fibrosis of septums interalveolar.

In 6 patients macrofocal abscess pneumonia has developed against this background, it is indicative of disclosure of significant field of the alveolocytes which are filled with lots of white blood cells and with fibrin to be mixed, and the presence of small abscesses containing leukocytes field in the place of destroyed alveoli.

Histopathological changes in the respiratory part of the lungs in deceased patients with ARI after severe SCII in the period from 16^th to 26^th day (n=6) have been indicative of a buildup of the alveolar – interstitial pulmonary fibrosis.

Thus, the results of the study showed that at the basis of ARI in case of severe SCII on the first 3 days is syndrome of acute lung injury. Pathegnomic for ARDC with layered focal pneumonia pathologic changes have been found out in the lungs of the patients who died on 4-6^th day after SCII with severe ARI with artificial lung ventilation (ALV). The pathologic sings of ARDS in the fibroproliferative fase have been detected in the lungs in 50% patients who died on 7-15 th day with SCII complicated with ARI and being carried out ALV. In 50% deceased patients – macrofocal abscess pneumonia with ARDC on the background of the developing alveolar – interstitial fibrosis, that is dominated in deceased patients on the 16-26^th day after SCII with respiratory failure in pulmonary, prevailing over the residual effects of the pulmonary edema and inflammation. A complex multicomponents mechanism of ARI with long-term treatment of SCII being indicative of perspective further research in the direction.