Figure 2

Postmortem findings in two patients. (A)–(D) show findings in a 77-year old patient who died 42 days after ICU admission. (A) Frontal reconstruction of lung CT showing large basal, left-sided cavity (corresponding to cross-sectional CT scan in Fig. 1B). Macroscopic findings during subsequent preparation steps show (B) opened lung cavity with necrotic lining (arrowheads), (C) direct connection of an opened bronchus with the cavity (dotted line), corresponding to positive aerogram on CT (A) and (D) a pulmonary artery branch (stippled line), directly connected with the necrotic cavity. A thrombotic vessel occlusion is indicated by white arrows. (E) and (F) show macro- and microscopic findings in a 69-year old patient, who died 33 days after ICU admission. (E) Opened pulmonary artery branches with subtotal (left) and total (right) occlusion of the vessel lumen (black arrows), and a directly adjacent lung cavity, suggesting that the large thrombus on the right has caused liquefactive infarct necrosis of the lung parenchyma. The necrotic area has gained access to the bronchial system (white arrow). The adjacent lung parenchyma shows a combined anemic and hemorrhagic infarct (arrowheads) that has not undergone cavitary transformation. (F) Histological sectioning (HE) shows multiple thrombotic occlusions (arrowheads) of pulmonary artery branches with consecutive anemic infarct necrosis (light red zones) with entrapment of bronchial airways (asterisks). Dark red zones around the bronchial airways represent hemorrhagic necrosis. The black dotted line delineates a small area of vital lung parenchyma.