Acute respiratory distress syndrome Quiz: Ace Your Exams

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A 62-year-old man is brought to the intensive care unit due to prolonged hypoxemic respiratory failure and sepsis due to perforated diverticulitis. He is intubated and undergoes rigid bronchoscopy with biopsy. A chest x-ray shows bilateral interstitial infiltrates. His echocardiography demonstrates a normal ejection fraction. The following histologic image is obtained from the bronchoscopy specimen:

A high magnification image of lung tissue with extensive areas of hemorrhage (red). Bronchioles and blood vessels are visible in the lower part of the image.

A high magnification image of lung tissue with extensive areas of hemorrhage (red). Bronchioles and blood vessels are visible in the lower part of the image.

Reproduced from: Wikipedia

Which of the following best describes the pathophysiology of this disease process?

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Diffuse alveolar damage and hyaline membrane formation

Pulmonary hemorrhage with formation of hemosiderin laden macrophages

Focal necrosis with an area of surrounding pulmonary hemorrhage

Transudative capillary leak with pink alveolar fluid

Non-necrotizing granulomas with a tightly packed central area composed of macrophages, epithelioid cells, multinucleated giant cells