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Lungengerüstveränderungen beim plötzlichen Kindestod (SIDS)

The connective tissue framework of the lung in SIDS

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Summary

Light microscopy findings are reported on the interstitial connective tissue framework of 45 lungs from babies who died within the first 2 years of life. Thirty were confirmed cases of SIDS and 15 were controls of similar age who died of known causes. The stains applied were H & E, PAS, Prussian blue, Elastica van Gieson, Trichrom (Masson-Goldner), Gomori's silver methenamine and Picro-Sirius polarization (modified). Particular attention was paid to type I and type III collagen, reticulin fibers and ground substance. All investigated cases showed evidence of chronic recurrent interstitial edema in a highly significant frequency and intensity in contrast to the controls. Areas of recent and persistent lymphedema were observed, some of them with reactive fibroplastic activity, which tended towards gradual fibrosis. These changes were irregularly distributed and frequently involved the mural interstitium. Considering the effects of such changes on expansibility, ventilation and perfusion of the lungs, as well as the impairment of gas diffusion, the findings described could be significant in the forensic evaluation of the signs of asphyxia found in most cases of SIDS.

Zusammenfassung

Es wird über lichtmikroskopische Befunde am Lungeninterstitium von 45 Kindern berichtet, die in den beiden ersten Lebensjahren verstorben sind. Bei 30 Fällen handelt es sich um plötzlichen Kindestod, in 15 Kontrollfällen mit gleicher Altersverteilung war die Todesursache bekannt. Folgende Färbungen wurden verwendet: HE, PAS, Berliner Blau, Elastica van Gieson, Trichrom nach Masson-Goldner, Versilberung nach Gomori und Picro-Sirius-Polarisation (modifiziert), wobei besonders Augenmerk auf Kollagen Typ I und Typ III, Reticulinfasern und Grundsubstanz gerichtet wurde. Sowohl sämtliche SIDS-Fälle als auch alle Kontrollfälle wiesen frische Alveolarschädigungen verschiedenen Ausprägungsgrades auf. Unterschiede zwischen SIDS-Fällen und Kontrollfällen fanden sich im Interstitium: die Fälle von plötzlichem Kindestod zeigten im Vergleich zu den Kontrollfällen hochsignifikant häufiger und stärker ausgeprägt Zeichen eines chronisch rezidivierenden interstitiellen Lungenödems; es fanden sich frische und ältere Lymphödeme mit reaktiver fibroplastischer Aktivität unterschiedlichen Grades bis hin zu schleichender Fibrose; die Kollagenfasern waren vermehrt, das Verhältnis von Kollagen Typ I und Typ III gestört. Diese Lungengerüstveränderungen bei den SIDS-Fällen waren ungleichmäßig und herdförmig über das Lungengewebe verteilt und reichten bis in das murale Interstitium. Derartige interstitielle Schäden können infolge Störung der Gasdiffusion und durch Veränderung der mechanischen Eigenschaften des Lungengerüstes die Lungenfunktion beeinträchtigen.

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  1. Gerichtlich-medizinisches Institut der Universität Bern, Bühlstrasse 20, CH-3012, Bern, Schweiz

    S. Ogbuihi & P. Zink

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Ogbuihi, S., Zink, P. Lungengerüstveränderungen beim plötzlichen Kindestod (SIDS). Z Rechtsmed 98, 191–205 (1987). https://doi.org/10.1007/BF00200342

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