CORRELATION OF MORPHOLOGIC AND CLINICAL RADIOLOGIC ASSESSMENT OF LUNG DISEASE IN NEONATES

Abstract

We compared the morphologic appearance of the lung with the clinical and radiologic diagnosis in 6 infants with RDS (BW 0.7-1.6 kg), 6 with non-RDS lung disease > 35 wks gestation (BW 2.4-4.9 kg), and 2 infants born without respiratory disease (BW 2.9-3.5 kg). Morphologic assessment involved scanning electron microscopy (SEM) of whole lung and of methyl methacrylate corrosion casts of the pulmonary vascular bed.

In pre-term infants, a good correlation was observed between the clinical and radiologic diagnosis of RDS, the clinical course, and the morphologic appearance of the lung. Those infants with the most severe RDS had the most dramatic reduction in number of alveoli. In contrast, in infants with non-RDS lung disease, interpretation of the disease process by clinical and radiologic means lacked consistent correlation with morphologic features, particularly of the vascular bed. Abnormalities in lung parenchyma (septal wall thickness and alveolar development) appeared to vary independently from vascular abnormalities (extent of microvascular development and organization). The insight provided by SEM of the lung and its associated vascular bed explains why similar therapeutic manipulations, whether respiratory or pharmacologic, fail to result in similar clinical responses in all infants with a common clinical or radiological diagnosis. (Supported in part by NIH GM12675 and a PMA Fellowship.)

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