Histologic changes: A few airways, including this bronchus (A) showed chronic inflammation in the wall. The patchy loss of epithelium is a postmortem change. Luminal exudate is absent.

A

At higher magnification (B), a few eosinophils can be seen scattered among the lymphoid cells. The inflammation may be related to her asthma, but the lack of collagenosis (thickening) of the basement membrane (at top) and lack of smooth muscle hyperplasia argue against a diagnosis of asthmatic bronchitis. Wheeze is also a sign of sickle cell lung disease, because mucosal edema may accompany microvascular congestion. It is also possible that the inflammatory infiltrate is a manifestation of her upper respiratory infection.

B

Finally, a low power view of lung parenchyma (C) shows some mild distortion of alveolar architecture (patches of smaller alveoli upper middle and left middle) and dilation of lymphatics (L) in a scarred interlobular septum leading to a pleural indentation (lower right). In chronic disease, the dilated lymphatics may persist after acute episodes and account for increased interstitial markings that resemble fibrosis on plain radiographs.

C

Clinical summaryDiscussion

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