A clinicopathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation

W. D. Travis, T. V. Colby, C. Lombard, H. A. Carpenter

Research output: Contribution to journalArticle

231 Citations (Scopus)

Abstract

Based on a clinicopathologic study of 34 patients with biopsy-confirmed diffuse pulmonary hemorrhage (DPH), we present an approach to the differential diagnosis of DPH with attention to histologic features such as capillaritis and the importance of laboratory tests such as anticytoplasmic autoantibodies (ACPA). The following DPH syndromes were encountered: antibasement membrane antibody (ABMA) disease (four cases); idiopathic pulmonary hemorrhage (four cases); Wegener's granulomatosis (WG) (five cases); probable WG (six cases); systemic necrotizing vasculitis otherwise unclassified (three cases); systemic lupus erythematosus (two cases); rheumatoid arthritis (one case); seronegative juvenile rheumatoid arthritis (one case); IgA nephropathy (one case); idiopathic glomerulonephritis (two cases-one with and one without immune complexes); and unclassified pulmonary-renal syndromes (five cases). Capillaritis was found in lung biopsy samples from 30 of the 34 patients (88%) and included patients with every type of DPH syndrome. Serologic testing for ACPA was useful in the diagnosis of WG. Identification of ABMA in the serum, kidney, or lung was the defining feature for the diagnosis of ABMA-mediated disease. Subclassification of the cases could not be done solely on histologic grounds except for cases of WG that showed granulomatous inflammation, foci of necrosis, or vasculitis. Classification of the remaining cases required correlation with (a) clinical and laboratory data; (b) biopsy samples from other sites such as the kidney, nasal sinuses, or skin; and (c) results of immunofluorescence or electron microscopy of kidney or lung biopsy samples.

Original languageEnglish (US)
Pages (from-to)1112-1125
Number of pages14
JournalAmerican Journal of Surgical Pathology
Volume14
Issue number12
StatePublished - 1990
Externally publishedYes

Fingerprint

Hemorrhage
Biopsy
Lung
Granulomatosis with Polyangiitis
Kidney
Autoantibodies
Membranes
Antibodies
Systemic Vasculitis
Juvenile Arthritis
Paranasal Sinuses
Glomerulonephritis
Vasculitis
Antigen-Antibody Complex
Fluorescence Microscopy
Systemic Lupus Erythematosus
Immunoglobulin A
Rheumatoid Arthritis
Electron Microscopy
Differential Diagnosis

Keywords

  • Antineutrophil cytoplasmic antibody
  • Goodpasture's syndrome
  • Hemorrhage
  • Idiopathic glomerulonephritis
  • Idiopathic pulmonary hemosiderosis
  • IgA nephropathy
  • Lungs
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Vasculitis
  • Wegener's granulomatosis

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Travis, W. D., Colby, T. V., Lombard, C., & Carpenter, H. A. (1990). A clinicopathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation. American Journal of Surgical Pathology, 14(12), 1112-1125.

A clinicopathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation. / Travis, W. D.; Colby, T. V.; Lombard, C.; Carpenter, H. A.

In: American Journal of Surgical Pathology, Vol. 14, No. 12, 1990, p. 1112-1125.

Research output: Contribution to journalArticle

Travis, WD, Colby, TV, Lombard, C & Carpenter, HA 1990, 'A clinicopathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation', American Journal of Surgical Pathology, vol. 14, no. 12, pp. 1112-1125.
Travis, W. D. ; Colby, T. V. ; Lombard, C. ; Carpenter, H. A. / A clinicopathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation. In: American Journal of Surgical Pathology. 1990 ; Vol. 14, No. 12. pp. 1112-1125.
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