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Respiratory distress syndrome is differentiated from hyaline membrane disease by affecting both lungs symmetrically on radiographs
Progression from 'ground glass' density to 'white out' is a feature of hyaline membrane disease
Cardiac failure may be inseparable from hyaline membrane disease
The hyaline membranes characteristic of the acute phase gradually disappear as they become incorporated into the alveolar septa; however, residual hyaline membranes may be identifiable depending on the timing of the biopsy in the course of disease.
It has been postulated that the lack of hyaline membranes in many reported cases suggests a differing pathologic mechanism from DAD, which has warranted further study.
This finding helps explain the diffuse alveolar damage associated with hyaline membranes seen in severe cases of infection.
In contrast, lungs involved with diffuse alveolar damage exhibit widened alveolar septa, reduced numbers of aerated airspaces, and other histologic changes of injury, including the presence of hyaline membranes lying within airspaces, and type II pneumocyte hyperplasia (Figure 1, C through E).
On autopsy, HPS is marked by a constellation of findings, including large pleural effusions, severe fibrinous pulmonary edema with hyaline membranes, and an immunoblastic proliferation involving the reticuloendothelial system.
There was microscopic evidence of acute lung injury with numerous hyaline membranes, hemosiderin-laden macrophages, and desquamated reactive pneumocytes (Figure 3).