[Ultrastructure of the human lung in shock (author's transl)].

The material investigated was obtained by lung puncture with the aid of the Hausser needle. The puncture technique as well as the preparation of the biopsy material for electronmicroscopic diagnostics are described. The most outstanding criterion in all biopsies examined is the large number of polymorphonuclear, mainly neutrophile granulocytes in the capillary and precapillary arterioles. In contrast, hardly any platelets were found in pulmonary vessels. Also, our investigation of the material revealed no intravascular fibrin deposits while vessels are partly and sometimes completely occluded by fat droplets of different size. The vascular walls are markedly swollen. Fluid escape from smaller vessels results in an edematous swelling of varying degree in the perivascular space combined with fibrin uptake and partly or totally destroyed cell structures. The type I epithelial cells of the lung tissue are swollen and show poor cellular structures. There is in increase of the type II epithelial cells in the shock lung with their lamellary corpuscles partly transferred into the alveolar lumen. The pathomechanisms leading to these changes are discussed. We would like to point out that fibrin was never found intravascularly but was always seen in regions. These findings could indicate increased fibrinolytic activity in shock. Platelet aggregations in smaller vessels are of secondary significance in the material we examined while fat globules, however, play an important part due to their large surface extension. Our electronmicroscopic investigations prove that the lung biopsy method is of great importance for further information on the pathologenesis of early damages in the shock lung not easily discovered by light microscopy.