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Vol. 44. Issue 8.
Pages 428-436 (January 2008)
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Vol. 44. Issue 8.
Pages 428-436 (January 2008)
Review Article
DOI: 10.1016/S1579-2129(08)60076-2
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Diffuse Alveolar Hemorrhage
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José Javier Gómez-Román
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apagrj@humv.es

Correspondence: Dr J.J. Gómez-Román Departamento de Anatomía Patológica Hospital Universitario Marqués de Valdecilla Avda Valdecilla, s/n 39008 Santander, Cantabria, Spain
Departamento de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Diffuse alveolar hemorrhage is a clinical syndrome that can be life threatening if not diagnosed and treated in time. In most cases it occurs largely as a result of small-vessel vasculitis of the lungs. The many different forms can be classified into 3 large groups: a) pauciimmune disease, which generally involves pulmonary capillaritis and is associated with the presence of antineutrophil cytoplasmic antibodies; b) syndromes caused by immune deposits, which can be detected by immunofluorescence; and c) a large miscellaneous group that includes drug reactions, infections, and idiopathic disease. Diagnosis is based on a combination of signs, symptoms, serology, and histology. Biopsy with video-assisted thoracoscopy should be recommended in patients with diffuse alveolar hemorrhage without known cause and with no prior diagnosis of systemic disease, in whom serology studies do not reveal conclusive data, and in general in those patients for whom there is a high level of suspicion of diffuse alveolar hemorrhage. In all such cases, the fresh biopsy material should be sent to the pathology laboratory for preparation of frozen sections to be used for immunofluorescence.

Key words:
Diffuse alveolar hemorrhage
Diagnosis
Lung biopsy

Las hemorragias alveolares difusas son cuadros clínicos que pueden ser catastróficos si no se diagnostican y tratan a tiempo. Suelen estar causadas en gran parte por vasculitis de vasos pequeños pulmonares. Existen 3 grandes grupos: a) las pauciinmunitarias, generalmente asociadas a capilaritis y anticuerpos citoplásmicos antineutrófilos; b) las producidas por depósitos inmunológicos, que pueden detectarse mediante inmunofluorescencia, y c) un gran grupo misceláneo, que incluye toxicidad por fármacos, infecciones y causas idiopáticas. El diagnóstico se basa en la integración de signos, síntomas, estudios serológicos y morfológicos. Se debe recomendar la realización de una biopsia por videotoracoscopia en los pacientes con hemorragia alveolar difusa de causa inexplicada, sin un diagnóstico previo de enfermedad sistémica, en la que los estudios serológicos no proporcionan datos concluyentes, y en general en aquellos pacientes con un elevado índice de sospecha de que estén desarrollando una hemorragia alveolar difusa. En todos estos casos, la biopsia debe remitirse en fresco a los servicios de anatomía patológica para permitir la congelación de un fragmento tisular, que será utilizado para el estudio por inmunofluorescencia.

Palabras clave:
Hemorragia alveolar difusa
Diagnóstico
Biopsia pulmonar
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This review was presented in part as a paper at the XXV SOCALPAR Congress in Segovia, Spain, in May 2006.

Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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