Pulmonary alveolar hemorrhage: A common finding in patients with severe cardiac disease

Abstract

In 89 (63 percent) of 141 autopsy cases of congenital (shunts) or acquired (valvular) cardiac disease, the patients had alveolar hemorrhage; 19 (13 percent) had pneumonia, and 9 (6 percent) had pulmonary emboli or infarcts. Alveolar hemorrhage was visible both grossly and histologically in 66 patients and on histologic examination only in 23 patients. Of the 113 patients without pulmonary emboli, pulmonary infarcts or pneumonia, alveolar hemorrhage occurred in 70 of 81 patients (86 percent) who died within 45 days after cardiac operations, and in 19 of 32 patients (50 percent) who died after recovery from operation or who had never been operated upon. Radiographic evidence of alveolar hemorrhage was present in 36 of 55 patients (65 percent) examined. A number of factors may be involved in the production of alveolar hemorrhage. The lesion may occur secondary to severe left-sided cardiac failure, but it may also be caused by shock, hypoxia and factors related to use of cardiopulmonary bypass or mechanical respirators.