Abstract
About 430 post-mortem examinations performed at the Department of Pathology of Kyorin University between April 1978 and December 1980 were reviewed. Lungs from patients who died of hemorrhage numbered twenty-nine, 11 cases of those were ruptured esophageal varices and 10 were gastric hemorrhage. Microscopically, the vacuole formation of endothelial cells was seen in 34% of the cases, adhesion (or plugging) of leukocytes in venules and capillaries was seen in 72%, bone marrow embolus due to heart massage was seen in 40% and the perivascular edema was observed in 76%. The occurrence of microthrombi was rare compared to other forms of shock.
Hemorrhagic shock in the rabbit was produced by arterial bleeding. Mean arterial blood pressure was maintained at 40-50mmHg for 1.5 hours during blood loss amounting to 3.6-2.3% of body weight. Histologically, the intravascular sticking of leukocytes and perivascular edema occurred in the lung. Electron microscopic examinations showed edematous swelling of the cytoplasm of type I pneumocytes, alteration of lamellar bodies and cristalysis of mitochondria of the type II pneumocytes.
It seems probable that the initial lesions of the lung in hemorrhagic shock are intravascular adhesion of leukocytes and perivascular edema. The rare occurrence of microthrombi is a striking feature of this cases in comparision to traumatic or septic shock.
