Gross features: The lungs were heavy (right transplanted lung, 660 g, native left lung, 600 g). The right lung was congested but otherwise normal. The left lung was shrunken and firm.

A slice of the postmortem, native left lung shows a variegated appearance. The pleura is thin. Most of the normal parenchyma (dark patches in the upper half of the upper lobe and superior segment of the lower lobe) has been replaced by pale fibrosis that is firmer to palpation than the normal lung. The lower half of the lung has honeycombed spaces up to 1.5 cm in diameter, although most are less than 0.5 cm. The arteries (arrow shows one) have thick walls.

 

Many of the honeycombed spaces represent respiratory bronchioles and alveolar ducts that are dilated as a result of collapse of the surrounding alveoli and increased traction on the airway walls (traction bronchiolectasis) (arrow). Some of the larger cystic spaces represent similar changes in bronchi--traction bronchiectasis.

Note the diaphragmatic pleural surface. It has a bumpy, cobblestoning caused by the fibrosis between bulging, pale, cystic spaces.

Clinical summary Image 2

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