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The diffuse alveolar hemorrhage syndromes

Marvin I Schwarz, MD
Section Editor
Talmadge E King, Jr, MD
Deputy Editor
Helen Hollingsworth, MD


Bleeding into the alveolar spaces of the lungs characterizes the syndrome of diffuse alveolar hemorrhage (DAH) and is due to disruption of the alveolar-capillary basement membrane. This disruption is caused by injury or inflammation of the arterioles, venules, or alveolar septal (alveolar wall or interstitial) capillaries. Hemoptysis is the usual presenting symptom; however it is not always present, even when hemorrhage is severe [1-3].

An overview of the diffuse alveolar hemorrhage syndromes will be presented here. The evaluation and treatment of hemoptysis are discussed separately. (See "Etiology and evaluation of hemoptysis in adults" and "Overview of massive hemoptysis" and "Massive hemoptysis: Causes" and "Massive hemoptysis: Initial management".)


A variety of diseases are associated with the development of the diffuse alveolar hemorrhage (DAH) syndrome (table 1) [1,3-20]. The underlying cause of DAH is generally reflected in the histopathologic pattern. One of three different histopathologic patterns may be seen: pulmonary capillaritis, bland pulmonary hemorrhage, and diffuse alveolar damage.

Pulmonary capillaritis — The pathologic pattern of pulmonary capillaritis, also referred to as alveolar capillaritis, is characterized by neutrophilic infiltration of the alveolar septa (lung interstitium) (picture 1A-B), which sequentially leads to necrosis of these structures, loss of capillary structural integrity, and spilling of red blood cells into the alveolar space and interstitium [3-6,21-24].

Many of the neutrophils undergo fragmentation and eventually become pyknotic, findings which support a pathogenetic role for neutrophil by-products (toxic oxygen radicals and proteolytic enzymes) in this form of lung injury. The fragmented neutrophils, nuclear dust, and fibrin also enter the alveolar spaces, and true fibrinoid necrosis of the interstitium may be seen.

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Literature review current through: Nov 2017. | This topic last updated: Jul 11, 2017.
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