Ferrer A, Castellano M, Bona M, Plaza L
Department of Legal Medicine and Toxicology, University of Zaragoza, Spain.
J Forensic Sci. 1988 Mar;33(2):480-9.
The results are presented of the pathological study of the lungs in 66 cases of violent death observing the more frequent types of lesions and establishing 4 different groups of postlesioned pulmonary condition. 1. Inflammatory alveolar lesions without a diffused interstitial involvement (IAL) including contusions or direct aggressions, lobular pneumonias, or bronchopneumonias with a predominance of intra-alveolar inflammatory exudation. 2. Inflammatory alveolar lesions with a diffuse interstitial involvement (IALW) including generalized affectation of the parenchyma with lesions in the capillary structure of the wall. 3. Edemohemorrhagic lesions (EHL) presenting phenomena of capillary congestion with hematic extravasation and interstitial and intra-alveolar edema, without inflammatory involvement. This is the most numerous group and it can constitute the preliminary stage of any other. 4. Unspecific chronic lesions (UCL) not related to the cause of death, being chronically inflammatory and fibrotic alterations of limited interest in our study. We emphasize the importance of the inflammatory involvement of the alveolar wall in the pathogenia of diffuse alveolar damage (DAD) and the aggravation of pulmonary lesions by capillary structure alteration, direct lesion of alveolar epithelium, presence of macrophages, and liberation of certain intracellular enzymes.
本文呈现了66例暴力死亡病例肺部的病理学研究结果，观察了较常见的病变类型，并确立了4种不同的损伤后肺部状况组。1. 无弥漫性间质受累的炎性肺泡病变（IAL），包括挫伤或直接侵袭、小叶性肺炎或支气管肺炎，以肺泡内炎性渗出为主。2. 伴有弥漫性间质受累的炎性肺泡病变（IALW），包括实质的广泛受累及壁毛细血管结构病变。3. 水肿出血性病变（EHL），表现为毛细血管充血伴血液外渗以及间质和肺泡内水肿，无炎症累及。这是数量最多的一组，且可能构成任何其他病变的初始阶段。4. 非特异性慢性病变（UCL），与死亡原因无关，是慢性炎症和纤维化改变，在我们的研究中兴趣有限。我们强调肺泡壁的炎症累及在弥漫性肺泡损伤（DAD）发病机制中的重要性，以及毛细血管结构改变、肺泡上皮直接损伤、巨噬细胞的存在和某些细胞内酶的释放对肺部病变的加重作用。
