Bronchopulmonary dysplasia has been described by Northway et al. (1) as a disease of the lung, especially in infants with severe respiratory distress syndrome, who have been treated with prolonged artificial ventilation and 80 to 100 per cent concentration oxygen. It was represented as a prolongation of the healing phase of the respiratory distress syndrome combined with a generalized pulmonary oxygen toxicity, involving mucosal, alveolar, and vascular changes. Simultaneously, similar changes were described by Nash and his co-workers (2), associated with oxygen therapy and artificial ventilation in 70 patients who came to autopsy after prolonged artificial ventilation in a mechanical ventilator. The gross appearance of these lungs was particularly important in that they were extremely heavy, usually exceeding 1,700 g combined weight as against a control weight of less than 1,200 g and in that they were deeply congested, inelastic, noncrepitant with markedly increased consistency, retaining the lung shape without collapse. We have gathered 11 cases in adults from our autopsy population with similar microscopic and gross findings in the past eighteen months. In these, the pulmonary changes were characterized by a uniform increase in lung weight, uniform poor aeration of the lungs, and microscopic evidence of septal edema, hyperplasia of alveolar lining cells, and remnants of hyaline membranes, consistent with the findings of bronchopulmonary dysplasia and oxygen toxicity as described by Northway et al. and Nash et al. The microscopic appearance is exemplified by the accompanying illustration (Fig. 1) which shows a prominent intra-alveolar fibrin exudate, hyaline membrane formation, marked thickening of the alveolar and interlobular septa with edema, and an extremely cellular fibroblastic proliferation and deposition of reticulin. Radiographically there is a considerable consistency of appearance in our cases (Fig. 2). Here one sees dense opacification of lung bilaterally with numerous interposed pseudocystic bleb-like areas of lucency, which histologically represent emphysematous foci. Interestingly, two of our patients were not treated with oxygen therapy. In one of these, the lesions apparently resulted from massive irradiation (Figs. 1, A and 2, A) to the mediastinum, involving adjoining lung also, given in a mantle fashion in accordance with our lymphoma protocol. In the second case, where no oxygen therapy was employed, there was massive chemotherapy with busulfan (Myleran) (Figs. 1, Band 2, B). Interstitial fibrotic changes have been described previously with longterm busulfan therapy (3, 4). The published microscopic appearances closely resemble those of our present cases. In the other cases in our series oxygen therapy, chemotherapy with cytotoxic agents, or irradiation in varying amounts was administered as indicated in the accompanying table (TABLE I).
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