A 62-year-old man is brought to the emergency department by a friend due to severe shortness of breath. He is agitated and gasping for air and is unable to provide history. His friend says the patient has a history of chronic alcohol use and attends Alcoholics Anonymous meetings. He is unaware of any other medical history. Temperature is 36.7 C (98 F), blood pressure is 110/70 mm Hg, pulse is 104/min, and respirations are 32/min. Due to worsening respiratory distress, immediate endotracheal intubation is performed and mechanical ventilation is begun. The patient is admitted to the intensive care unit and, despite appropriate therapy, dies several hours later. Autopsy examination is performed, and histopathology of the lungs reveals engorged pulmonary capillaries and intraalveolar, acellular, pink material that is more prominent at the bases. This patient most likely had which of the following conditions?

Question

A 62-year-old man is brought to the emergency department by a friend due to severe shortness of breath.  He is agitated and gasping for air and is unable to provide history.  His friend says the patient has a history of chronic alcohol use and attends Alcoholics Anonymous meetings.  He is unaware of any other medical history.  Temperature is 36.7 C (98 F), blood pressure is 110/70 mm Hg, pulse is 104/min, and respirations are 32/min.  Due to worsening respiratory distress, immediate endotracheal intubation is performed and mechanical ventilation is begun.  The patient is admitted to the intensive care unit and, despite appropriate therapy, dies several hours later.  Autopsy examination is performed, and histopathology of the lungs reveals engorged pulmonary capillaries and intraalveolar, acellular, pink material that is more prominent at the bases.  This patient most likely had which of the following conditions?

Quizplus · Accepted Answer

Engorged alveolar capillaries reflect increased pulmonary venous pressure, and pink, acellular material within the alveoli results from transudation of fluid plasma across the alveolar-capillary membrane. These histopathologic findings are most consistent with acute pulmonary edema caused by increased alveolar capillary hydrostatic pressure from left-sided heart failure. This patient likely had dilated cardiomyopathy due to chronic alcohol use and had an acute exacerbation of heart failure, resulting in cardiogenic shock with pulmonary edema and acute respiratory failure. (Choice A) Aspiration pneumonia may be chemical (eg, aspiration of gastric contents) or bacterial (eg, aspiration of oral flora). Histopathology shows neutrophil-rich, inflammatory exudates within the bronchioles and alveolar spaces. (Choice B) Centriacinar emphysema most commonly results from heavy smoking. Enlarged airspaces with macrophage-predominant infiltrates are expected. (Choice C) Hypersensitivity pneumonitis results from exposure to an environmental irritant (eg, mold). Histopathology shows lymphocyte-predominant, interstitial inflammation, sometimes accompanied by necrotizing granulomas and loose fibroelastic tissue within the small airways. (Choice D) Histopathology in pulmonary arterial hypertension typically shows hypertrophy of the pulmonary vascular smooth muscle. (Choice F) Pulmonary infarction yields hemorrhagic, ischemic necrosis of the lung parenchyma. Histopathology shows a well-demarcated area of alveolar and vascular wall necrosis with cells that lack nuclei, and the alveolar spaces may contain red blood cells. Educational objective: Acute cardiogenic pulmonary edema results from increased pulmonary venous pressure. The alveolar capillaries become engorged with blood and there is a transudation of fluid plasma across the alveolar-capillary membrane, appearing as pink, acellular material within the alveoli.

A 62-Year-Old Man Is Brought to the Emergency Department by a Friend