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Histologic Identification of Prominent Intrapulmonary Anastomotic Vessels in Severe Congenital Diaphragmatic Hernia.
[congenital diaphragmatic hernia]
To
determine
whether
prominent
intrapulmonary
anastomotic
vessels
(
IPAVs
)
or
bronchopulmonary
"
shunt
"
vessels
can
be
identified
in
lungs
from
infants
with
fatal
congenital
diaphragmatic
hernia
(
CDH
)
.
We
performed
histology
with
immunostaining
for
CD
31
(
endothelium
)
and
D
2
-
40
(
lymphatics
)
,
along
with
high
-precision
3
-
dimensional
(
3
D
)
reconstruction
on
lung
tissue
from
9
patients
who
died
with
CDH
.
E
ach
patient
with
CDH
required
mechanical
ventilation
,
cardiotonic
support
,
and
pulmonary
hypertension
(
PH
)
-
targeted
drug
therapy
.
All
patients
were
diagnosed
with
severe
PH
by
echocardiography
,
and
5
received
extracorporeal
membrane
oxygenation
therapy
.
Death
occurred
at
a
median
age
of
24
Â
days
(
range
,
10
-
150
Â
days
)
from
refractory
hypoxemia
with
severe
PH
,
pneumonia
,
or
tension
pneumothorax
.
Histology
showed
decreased
alveolarization
with
pulmonary
vascular
disease
.
In
each
patient
,
prominent
IPAVs
were
identified
as
engorged
,
thin
-walled
vessels
that
connected
pulmonary
veins
with
microvessels
surrounding
pulmonary
arteries
and
airways
in
lungs
ipsilateral
and
contralateral
to
the
CDH
.
Prominent
anastomoses
between
pulmonary
arteries
and
bronchial
arteries
were
noted
as
well
.
The
3
D
reconstruction
studies
demonstrated
that
IPAVs
connect
pulmonary
vasculature
to
systemic
(
bronchial
)
vessels
both
at
the
arterial
and
venous
side
.
Histology
and
3
D
reconstruction
identified
prominent
bronchopulmonary
vascular
anastamoses
in
the
lungs
of
infants
who
died
with
severe
CDH
.
We
speculate
that
IPAVs
connecting
pulmonary
and
bronchial
arteries
contribute
to
refractory
hypoxemia
in
severe
CDH
.
Diseases
Validation
Diseases presenting
"pneumonia"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
allergic bronchopulmonary aspergillosis
alpha-thalassemia
classical phenylketonuria
cohen syndrome
congenital diaphragmatic hernia
heparin-induced thrombocytopenia
hydrocephalus with stenosis of the aqueduct of sylvius
junctional epidermolysis bullosa
lamellar ichthyosis
legionellosis
liposarcoma
lymphangioleiomyomatosis
monosomy 21
oculocutaneous albinism
omenn syndrome
pleomorphic liposarcoma
primary effusion lymphoma
proteus syndrome
pyomyositis
scrub typhus
severe combined immunodeficiency
triple a syndrome
waldenström macroglobulinemia
wiskott-aldrich syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated