Which gross findings are characteristic of lung transplantation-related pathology?

Updated: Jun 06, 2019
  • Author: Aliya N Husain, MBBS, MD; Chief Editor: Philip T Cagle, MD  more...
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Answer

Answer

A quick intraoperative gross examination of the lung allograft may reveal previously unrecognized lesions, the nature of which could be addressed with frozen section analysis. Although rare, pulmonary embolism, infections, or neoplasms in the allograft may be diagnosed in this manner, which would affect the decision to use the donor lung.

Explanted lungs should be fixed in formalin (preferably by inflating through the main bronchus) for 8-12 hours and sliced at 1-cm intervals. The cut surface shows the characteristic findings of the disease for which lung transplantation was indicated.

Emphysema is end stage and generalized by the time the patient needs transplantation. Patchy fibrosis with greater involvement of the lower lobes and subpleural regions is readily apparent in idiopathic pulmonary fibrosis. In cystic fibrosis, the dilated bronchi are usually plugged by yellow-green mucopurulent material. The largest pulmonary arteries have small yellow atherosclerotic plaques in pulmonary arterial hypertension.


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