Alexandre de Matos Soeiro, Edwin Roger Parra, Mauro Canzian,
Cecília Farhat, Vera Luiza Capelozzi
Objective: To present the pulmonary histopathological alterations found in the autopsies of patients with acute respiratory failure (ARF)
and determine whether underlying diseases and certain associated risk factors increase the incidence of these histopathological patterns.
Methods: Final autopsy reports were reviewed, and 3030 autopsies of patients > 1 year of age with an underlying disease and associated
risk factors were selected. All had developed diffuse infiltrates and died of ARF-related pulmonary alterations. Results: The principal
pulmonary histopathological alterations resulting in immediate death were diffuse alveolar damage (DAD), pulmonary edema, lymphocytic
interstitial pneumonia (LIP) and alveolar hemorrhage. The principal underlying diseases were AIDS, bronchopneumonia, sepsis, liver cirrhosis,
pulmonary thromboembolism, acute myocardial infarction (AMI), cerebrovascular accident, tuberculosis, cancer, chronic kidney failure and
leukemia. The principal associated risk factors were as follows: age ≥ 50 years; arterial hypertension; congestive heart failure; chronic
obstructive pulmonary disease; and diabetes mellitus. These risk factors and AIDS correlated with a high risk of developing LIP; these same
risk factors, if concomitant with sepsis or liver cirrhosis, correlated with a risk of developing DAD; thromboembolism and these risk factors
correlated with a risk of developing alveolar hemorrhage; these risk factors and AMI correlated with a risk of developing pulmonary edema.
Conclusion: Pulmonary findings in patients who died of ARF presented four histopathological patterns: DAD, pulmonary edema, LIP and
alveolar hemorrhage. Underlying diseases and certain associated risk factors correlated positively with specific histopathological findings on
autopsy.
Keywords: Respiratory insufficiency; Autopsy; Lung diseases, interstitial; Pulmonary edema; Hemorrhage.