Pneumosclerosis

Pneumosclerosis is a pathology in the lungs, characterized by the replacement of lung tissue with connective tissue.

This occurs as a result of inflammation, as well as dystrophy of the lung tissue, which causes the destruction of the elasticity and transport of gases in the lesions. Extracellular matrix, expanding in the main organs of respiration, deforms the branches of the respiratory throat, while the lung itself becomes denser and wrinkles. The result is airlessness, the lungs decrease in size.

[1], [2], [3]

Epidemiology

The incidence of pneumosclerosis is equally common among people of any age, a strong half of humanity is sick more often.

[4], [5]

Causes of the pneumosclerosis

Often, pneumosclerosis is an accompaniment and outcome of lung diseases:

• Infectious nature caused by the ingress of foreign substances into the lungs, inflammation of the lung tissue caused by a virus that is not resolved, pulmonary tuberculosis, fungal infections;
• Bronchitis with chronic course, inflammation of the tissue surrounding the bronchi, chronic obstructive diseases of the legs;
• Pneumoconjecoses that occurred after prolonged inhalation of dust and gases, by origin - industrial, caused by irradiation;
• Fibrozing and alveolitis caused by the action of an allergen;
• Pulmonary form of Beck's disease;
• Presence of extraneous thsarcoidosis in the branches of the pulmonary throat;
• Injuries resulting from injuries, trauma of thorax, lungs.
• Diseases of the lungs, betrayed by inheritance.

Ineffective and inadequate in volume and duration treatment of acute and chronic processes in the respiratory system can lead to the occurrence of pneumosclerosis.

Defects of blood flow of a small circle due to the erosion of the left atrioventricular orifice, lack of the left ventricle of the heart, pulmonary thrombosis may contribute to the onset of pneumosclerosis. Also, this pathology can be a consequence of ionizing radiation, after taking pneumotrophic drugs, which are toxic. Weakening of immunity can also contribute to the development of pneumosclerosis.

With incomplete resolution of the pulmonary inflammatory process, the restoration of lung tissue does not occur completely, connective tissue scars begin to expand, the alveolar lumens narrow, which can trigger the onset of pneumosclerosis. It was noted a very frequent occurrence of pneumosclerosis in patients who underwent staphylococcal pneumonia, which was accompanied by the formation of necrotic areas of pulmonary tissue and the appearance of an abscess, after healing, which marked the proliferation of fibrous tissue.

With pneumosclerosis, which has arisen against the background of tuberculosis, the connective tissue can form in the lungs, which can lead to the development of circumcirculatory emphysema.

Complication of chronic inflammation in the bronchi, such as bronchitis and bronchiolitis, is the occurrence of perilobular as well as peribronchial pneumosclerosis.

Pleurogenic pneumosclerosis can begin after multiple inflammations of the pleura, in which the superficial layers of the lung join the inflammatory process, its parenchyma turns out to be a compressed exudate.

Irradiation and Hummen-Rich syndrome often provoke sclerosis of the lungs of diffuse genesis and the appearance of a lung, reminiscent of honeycombs. Cardiac left-ventricular failure, as well as stenosis of the mitral valve, can lead to sweating of the fluid from the blood vessels, which can lead to the development of a cardiogenic pneumosclerosis.

Sometimes pneumosclerosis is due to the mechanism of its development. But the common mechanisms of various forms of etiology are those that result from pathology in lung ventilation, blood vessel defects, as well as lymph in the lung tissue, and the incompetence of pulmonary drainage capacity. Violation of the structure and alveolar destruction can lead to the replacement of lung tissue to connective tissue. Vascular, bronchial and pulmonary pathology often leads to impaired lymph circulation, as well as blood circulation, so there may be pneumosclerosis.

Other causes of pneumosclerosis:

1. Unresolved acute pneumonia, chronic pneumonia, bronchoectatic disease.
2. Chronic bronchitis, which is accompanied by peribronchitis and leads to the development of peribronchial sclerosis.
3. Pneumoconiosis of different genesis.
4. Stagnation in the lungs with a number of heart diseases and especially with defects of the mitral valve.
5. Atelectasis of the lung.
6. Prolonged and difficult exudative pleurisies lead to the development of pneumosclerosis due to the involvement of superficial layers of the lungs in the inflammatory process, as well as due to atelectasis, which occurs with prolonged compression of the parenchyma with exudate (pleurogenic cirrhosis).
7. Traumatic injury of the chest and the lung.
8. Tuberculosis of the lungs and pleura.
9. Treatment with some drugs (Cordarone, Apressin).
10. Systemic diseases of connective tissue.
11. Idiopathic fibrosing alveolitis.
12. The effect of ionizing radiation.
13. The defeat of the lungs with chemical warfare agents.

[6], [7]

Pathogenesis

The pathogenesis of pneumosclerosis depends on its etiology. However, for all its etiological forms, the most important pathogenetic mechanisms are violations of ventilation, drainage of the bronchi, blood and lymph circulation. The proliferation of connective tissue is associated with a disruption in the structure and destruction of specialized morphofunctional elements of the lung parenchyma. The disturbances of blood and lymph circulation that arise during pathological processes in the bronchopulmonary and vascular systems contribute to the development of pneumosclerosis.

There are diffuse and focal (local) pneumosclerosis, the latter is large and small-focal.

Depending on the severity of the proliferation of connective tissue, fibrosis, sclerosis, and cirrhosis are distinguished. With pneumofibrosis scar changes in the lungs are expressed moderately. With pneumosclerosis, a coarser substitution of the lungs with a connective tissue occurs. With cirrhosis, complete replacement of the alveoli, as well as partial bronchi and vessels with a disorganized connective tissue, is noted. Pneumosclerosis is a symptom or outcome of a number of diseases.

[8], [9], [10], [11], [12]

Symptoms of the pneumosclerosis

There are following symptoms of pneumosclerosis:

1. Signs of the underlying disease leading to pneumosclerosis (chronic bronchitis, chronic pneumonia, bronchiectasis, etc.).
2. Dyspnea with diffuse pneumosclerosis, first with exercise, then at rest; cough with separation of mucopurulent sputum; marked diffuse cyanosis.
3. Restriction of pulmonary margin mobility, sometimes shortening of percussion sound with percussion, weakened vesicular breathing with a hard shade, scattered dry, sometimes small bubbling rales in auscultation. As a rule, simultaneously with the clinic of pneumosclerosis there is a symptomatology of chronic bronchitis and emphysema of the lungs. Diffusive forms of pneumosclerosis are accompanied by precapillary hypertension of the small circulation and the development of pulmonary heart symptoms.
4. Clinical symptoms of cirrhosis of the lung : a sharp deformation of the chest, partial atrophy of the pectoral muscles, wrinkling of the intercostal spaces, displacement of the trachea, large vessels and heart towards the lesion, blunt sound with percussion, rapid weakening of breathing, dry and wet wheezing in auscultation.

Limited pneumosclerosis most often does not cause the patient virtually no sensations, except for a mild cough with an insignificant amount of sputum. If you look at the affected side, you can find that the thorax in this place has a kind of cavity.

The main symptom of diffuse-related pneumosclerosis is shortness of breath: firstly, with a physician, at later times - and at rest. The tissue of the alveoli is poorly ventilated, so the skin of such patients is cyanotic. The patient's fingers resemble drumsticks (a symptom of Hippocrates' fingers), which indicates an increase in respiratory failure.

Diffusive pneumosclerosis occurs with a chronic inflammation of the branches of the respiratory throat. The patient complains only of a cough - at first rare, which turns into an obsessive, strong with an abundant purulent discharge. The course of pneumosclerosis heavies the main ailment: bronchiectasis or chronic pneumonia.

The soreness of the aching nature in the thoracic area, sharp weight loss, such patients look weakened, they quickly get tired.

A clinic of pulmonary cirrhosis can develop: thorax is roughly deformed, the muscles of the intercostal space are atrophied, the respiratory throat, heart, large vessels are shifted to the affected side.

With diffuse pneumosclerosis, which developed due to a violation of blood flow in a small bloodstream, symptoms of the pulmonary heart can be observed.

How heavy the course will be depends on the size of the affected areas.

What percentage of lung tissue is already replaced by Pischinger space reflects the following classification of pneumosclerosis:

• Fibrosis, in which the limited affected areas of the lung tissue are strands, alternating with a healthy tissue filled with air;
• Sclerosis or actually pneumosclerosis is characterized by the presence of tissues of a more dense consistency, connective tissue replaces pulmonary;
• The heaviest of the degrees of pneumosclerosis, in which the connective tissue replaces completely pulmonary, and the pleura, alveoli and vessels thickens, the mediastinal organs move to the side where the affected area is called cirrhosis. Pneumosclerosis is divided into two types in terms of prevalence in the lung: diffuse and limited (local), which distinguish between small-focal and large-focal.

Macroscopically, the pneumosclerosis has the appearance of a denser lung tissue, this part of the lung is characterized by sharply reduced dimensions in comparison with the rest of the healthy areas of the lung. Focal pneumosclerosis has a special form - carnification - post-pneumatic sclerosis, characterized by the fact that the pulmonary parenchyma in the inflamed area is similar in appearance and resembles meat in its raw form. Microscopically, it is possible to detect areas of sclerosis and suppuration, fibrinous exudate, fibroidectasis, etc.

Diffuse pneumosclerosis is characterized by spread to the entire lung or both lungs. The affected organ appears denser, its size is much smaller than that of a healthy lung, the structure of the organ differs from healthy tissues.

Limited diffusive pneumosclerosis differs in that the gas exchange function does not suffer significantly under it, the lung remains elastic. With diffuse pneumosclerosis, the affected lung is rigid, its ventilation is reduced.

By primary lesion of various lung structures, pneumosclerosis can be divided into alveolar, peribronchial, perivascular, interstitial, perilobular.

For reasons of occurrence, pneumosclerosis is divided into discirculatory, postnecrotic, post-inflammatory and dystrophic.

Stages

Pneumosclerosis can occur in different stages, there are three of them:

• I. Compensated;
• II. Subcompensated;
• III. Decompensated.

[13], [14], [15], [16]

Forms

Emphysema of the lungs and pneumosclerosis

With pulmonary emphysema, the amount of air is marked in the lung tissues. Pneumosclerosis can be the result of inflammation of the lungs, proceeding chronically, while they have a great similarity in the clinic. The development of both emphysema and pneumosclerosis is affected by inflammation of the branches of the respiratory throat, infection of the bronchial wall, as well as obstructions to bronchial patency. Sputum accumulation occurs in the small bronchi, ventilation in this part of the lung can provoke the development of both emphysema and pneumosclerosis. Diseases that are accompanied by spasm of the bronchi, for example, bronchial asthma, can accelerate the development of these diseases.

Basal pneumosclerosis

Sometimes connective tissue grows in the basal parts of the lung. This condition is called basal pneumosclerosis. It appears against the background of processes of dystrophy or inflammation, leading to the fact that the lesion site is lost elasticity, it also breaks the gas exchange.

[17], [18]

Local pneumosclerosis

Local or limited pneumosclerosis can not manifest itself clinically for a long time, except that hard breathing is heard while auscultation, as well as small bubbling rales. To reveal it it is possible only radiologically: in a picture the site of the condensed tissue of a lung is appreciable. Local pneumosclerosis practically does not lead to pulmonary insufficiency.

Focal pneumosclerosis

Focal pneumosclerosis can develop due to the destruction of the pulmonary parenchyma due to lung abscess (infectious etiology) or caverns (with tuberculosis). The connective tissue can also grow on the site of already healed and still existing foci and cavities.

[19], [20], [21]

Apical pneumosclerosis

With apical pneumosclerosis, the lesion is located in the apex of the lung. As a result of inflammatory and destructive processes, the tissue of the lung is replaced by a connective one. In the beginning, the process resembles the phenomenon of bronchitis, which is the consequence of which it most often is, and is determined only by roentgenology.

[22]

Age-related pneumosclerosis

Age-related pneumosclerosis causes changes that occur due to aging of the body. Age-related pneumosclerosis develops in old age if they have stagnant phenomena with pulmonary hypertension, more often in men, especially long-term smokers. If the patient after 80 years on the roentgenogram is determined by pneumosclerosis in the absence of complaints, this is considered the norm, as it is the result of natural involutional changes in the human body.

[23], [24], [25],

Mescaline pneumosclerosis

If the volume of connective reticular tissue increases, the lungs lose their clarity and purity, it becomes reticular, like a web. Because of this set-up frequency, the normal pattern is almost invisible, it looks weakened. On the computer tomogram, the compression of the connective tissue is even more noticeable.

Basal pneumosclerosis

By basal pneumosclerosis is understood the replacement of the connective pulmonary tissue mainly in its basal regions. Often basal pneumosclerosis says transferred in the past lower lobar inflammation of the lungs. On roentgenism, the clarity of the lung tissues of the basal sections is increased, the pattern is strengthened.

[26], [27], [28]

Moderate pneumosclerosis

The connective tissue at the beginning of the development of pneumosclerosis often grows moderately. The altered lung tissue, characteristic of this form alternate with a healthy pulmonary parenchyma. This is often detected only on the X-ray, since it practically does not disturb the patient's condition.

Post pneumoniasis pneumosclerosis

Post pneumonic pneumosclerosis - carnification is a focus of inflamed pulmonary tissue, which is a complication of pneumonia. The inflamed area has the appearance of meat in its raw form. With macroscopy - this is a section of the lung that looks denser, this part of the lung is reduced in size.

Interstitial pneumosclerosis

Interstitial pneumosclerosis is characterized by the fact that the connective tissue mainly captures interalveolar peregods, tissues around the vessels and bronchi. It is the result of interstitial pneumonia.

Peribronchial pneumosclerosis

Peribronchial pneumosclerosis is characterized by localization around the bronchi. Around the affected bronchi there is a change in the lung tissue to the connective. The cause of its occurrence is most often chronic bronchitis. For a long time, the patient does not care about anything other than coughing, and in the future - with sputum secretion.

Posttuberculous pneumosclerosis

In post-tuberculosis pneumosclerosis, connective tissue proliferation occurs as a result of pulmonary tuberculosis. This condition can go to the so-called "post-TB disease", which is characterized by different nosological forms of nonspecific diseases, such as, for example, HNZL.

Complications and consequences

In case of pneumosclerosis morphological alteration of alveoli, bronchi and vessels is observed, which can complicate pneumosclerosis by disturbance of lung ventilation, reduction of vascular bed, arterial hypoxemia, chronic respiratory failure, pulmonary heart, inflammatory lung diseases, pulmonary emphysema.

[29], [30]

Diagnostics of the pneumosclerosis

The radiological picture is polymorphic, since it reflects the symptoms of both pneumosclerosis and concomitant diseases: chronic bronchitis, emphysema of the lung, bronchiectasis, etc. Characterized by strengthening, looseness and deformation of the pulmonary pattern along the course of bronchial branches due to compaction of bronchial walls, infiltration and sclerosis of peribronchial tissue.

Bronchography: convergence or deviation of the bronchi, narrowing and absence of small bronchi, deformation of the walls.

Spirography: reduction of the LIFE, FVC, Tiffno index.

Localization of the pathological process with pneumosclerosis is directly related to the result of physical examinations. Above the affected area, breathing is weakened, dry and wet rales are heard, percussion sound is blunted.

More reliable in the diagnosis can help radiographic examination of the lungs. Radiography is invaluable in detecting changes in the lungs with pneumosclerosis, which is asymptomatic, how widespread these changes are, their nature, degree of severity. More accurately assess the condition of unhealthy areas of lung tissue helps bronchography, MRI and CT of the lungs.

Manifestations of pneumosclerosis can not be X-rayed accurately, as they are affected not only by pneumosclerosis, but also by concomitant diseases such as lung emphysema, bronchiectasis, and chronic bronchitis. The affected lung on the radiograph is reduced in size, the pulmonary pattern in the course of the branches of the bronchi is strengthened, the loop and the joint are due to deformation of the walls of the bronchi, and also because the peribronchial tissue is sclerotized and infiltrated. Often the lungs in the lower parts become like a porous sponge - a "honeycomb lung".

On the bronchogram, we see rendezvous, as well as deflections of the bronchi, they are narrowed and deformed, small bronchi can not be determined.

During bronchoscopy, bronchiectasis and chronic bronchitis are often determined. With the help of the analysis of the cellular composition of flushing from the bronchi, the cause of the onset can be clarified, and what the activity of the pathological processes occurring in the bronchi is.

[31], [32]

Fluorography with pneumosclerosis

All patients who first applied to a polyclinic are offered to undergo a fluorographic examination of the chest organs. The annual medical examination, which is obligatory for all those who are 14 years old, involves mandatory passage of fluorography, which helps to identify a variety of diseases of the respiratory tract, including pneumosclerosis in the early stages, during which there is at first asymptomatic.

The vital capacity of the lungs with pneumosclerosis is reduced, the Tiffno index, which is an indicator of bronchial patency, is also low, which is revealed by spirometry and peakflowmetry.

Changes in the picture of blood with pneumosclerosis have a nonspecific character.

[33], [34], [35]

Treatment of the pneumosclerosis

The main thing in the treatment of pneumosclerosis is the fight against infection in the respiratory organs, improving the function of respiration and pulmonary circulation, strengthening the immunity of the patient.

Patients with pneumosclerosis are treated by a physician or pulmonologist.

Diet and diet

If a patient with pneumosclerosis has a high fever, he is assigned a bed rest, when the condition improves slightly - half-post, and then - the general. In the room, the air temperature should be 18-20 ° C, necessarily - airing. It is shown more to be in the fresh air.

Diet for pneumosclerosis should be aimed at increasing immunobiological, as well as oxidative processes in the patient's body, accelerate repair in the lungs, reduce protein loss with sputum, inflammatory exudation, improve hemopoiesis and cardiovascular system. Given the condition of the patient, the doctor prescribes a diet of 11 or 15 tables, which should include dishes with normal protein, carbohydrate and fat content, but at the same time, increase the number of foods containing calcium, vitamins A, B, ascorbic acid, salts potassium, folic acid and copper. Eat often, in small portions (up to five times). It is recommended to limit the amount of table salt - no more than four to six grams per day, since sodium has the property of retaining fluid in the body.

[36], [37]

Medication for pneumosclerosis

There is no specific treatment for pneumosclerosis. You need to treat the disease, which caused pneumosclerosis.

In case of pneumosclerosis, a long-term up to six to twelve months is recommended - administration of small doses of glucocorticoids: twenty to thirty mg per day is prescribed in an acute period, then maintenance therapy, whose daily dose is five to ten mg, is gradually reduced.

Antibacterial and anti-inflammatory therapy is indicated for bronchiectasis, frequently occurring pneumonia, bronchitis. With pneumosclerosis in the respiratory tract may be present about 23 species of different microorganisms, it is recommended to use antibiotics and chemotherapeutic drugs of different spectrum of action, combine these drugs, periodically replaced by others. The most common among other antimicrobial drugs in modern medicine in the treatment of pneumosclerosis and other serious pathologies of the respiratory tract are macrolides, in the first place among which is azithromycin, it must be taken on the first day of 0.5 g, 2-5 days - 0.25 g an hour before or two hours after a meal. Also popular in the treatment of this disease are cephalosporins II-III generation. For oral administration, among the second generation, 750 mg cefaclor is recommended in three divided doses, cefuroxime axetil 125-500 mg twice daily, from cephalosporins of the third generation a good effect is given by cefixime 400 mg once daily or 200 mg twice daily, cefpodoxime proksetil 400 mg 2 times a day, ceftibutene 200-400 mg per day.

A proven antimicrobial is metronidazole 0.5-1 intravenously drip for 30-40 minutes after eight hours.

Do not lose their relevance and antibiotics of a wide spectrum of action such as tetracycline, oletetrine and levomycetin at 2.0-1.0 g per day in four divided doses

With antimicrobial and anti-inflammatory valuation, sulfanilamide preparations are prescribed: sulfapiridazine 2.0 mg on the first day, further - 1, 0 mg 7-10 days.

Expectorant and thinning agents bromhexine 0.016 g three to four times a day, ambroxol one tablet (30 mg) three times a day, acetylcysteine - 200 milligrams three times a day, carbocysteine 2 capsules three times a day (1 capsule - 0.375 g of carbocysteine)

Bronchospasmolytic agents are used as inhalants (isadrin, euphyllin, atropine sulphate)

If there is circulatory insufficiency, cardiac glycosides are used: strobantine 0.05% solution 0.5-1.0 ml per 10-20 ml 5% -40% glucose or 0.9% sodium chloride, korglikon 0.5-1.0 ml , 0 ml of 0.6% solution on glucose 5-40% or on physiological solution 0.9%.

Vitaminotherapy: tocopherol acetate 100-200 mg once or twice a day, ritinol 700-900 mcg per day, ascorbic acid 250 mg once or twice a day, vitamins B (B1 -1,2 -2,1 mg in day, B6 - 100-200 mg per day, B12 - 100-200 mg per day)

Physiotherapy for Pneumosclerosis

The main goal of physiotherapeutic procedures for pneumosclerosis is to regress and stabilize the process in the active phase, to achieve the relief of the syndrome - in the inactive.

If there is no suspicion of pulmonary insufficiency, ionophoresis with novocaine, calcium chloride, ultrasound with novocaine is recommended.

In the compensated stage, it is useful to use diathermy and inductometry in the thoracic region. If the patient sputum is poorly separated, electrophoresis with iodine is shown by the method of Vermel. With poor nutrition, the total ultraviolet radiation. It is also used to irradiate the chest with a Sollux lamp every day or every other day, but it is less effective.

Oxygen therapy

A good effect for pneumosclerosis is obtained from oxygen therapy or oxygen treatment, which is supplied to the lungs in the volume in which it is contained in the atmosphere. This procedure saturates the lungs with oxygen, which improves the cellular metabolism.

Surgical treatment of pneumosclerosis

Surgical treatment of pneumosclerosis is carried out only with local forms in case of suppuration of the lung parenchyma, with destructive changes in lung tissue, with cirrhosis and lung fibrosis. This type of treatment consists in removing the damaged area of the lung tissue, in rare cases a decision is made to remove the entire lung.

Physiotherapy

Therapeutic exercise with pneumosclerosis is used to improve the functions of external respiration, to harden and strengthen the body. With compensated pneumosclerosis, special breathing exercises are used. These exercises should be simple, they should be performed easily, without straining, without hindering breathing, the pace should be average or even slow, rhythmically, the load should be gradually increased. Sports dosed exercises should preferably be performed outdoors. With severe emphysema, as well as cardiopulmonary insufficiency, gymnastics is done sitting, lying or standing, it should last fifteen to twenty minutes. When the patient is in a serious condition, at a temperature exceeding 37.5 ° C, therapeutic hemorrhage is contraindicated.

Treatment of pneumosclerosis by alternative methods

Alternative medicine offers to treat pneumosclerosis with such recipes: 

• In a thermos to fall asleep one tablespoon of one of the herbs: thyme creeping, eucalyptus blue or oats sowing. Pour half a liter of boiling water, leave to insist on all night. In the morning, the infusion should be filtered. Take small portions throughout the day in hot form. 
• In the evening, soak thoroughly dried fruits with water. Morning to eat them on an empty stomach. Do this every day. This recipe acts as a laxative, diuretic, thereby helping to relieve congestion in the lungs. 
• Two glasses of young red wine + two tablespoons of honey + two shredded aloe leaf perennial mixed together. First you need to cut off the leaves, rinse under running water, put it in the refrigerator for a week on the bottom shelf. After this, grind, mix with honey, add wine and mix thoroughly. Insists fourteen days in the fridge. Take up to four times a day, one tablespoon.

Treatment of pneumosclerosis in the home

If the patient treats pneumosclerosis at home, then the main condition for successful treatment here, perhaps, will be strictly to follow medical recommendations, as well as monitoring his condition by the doctor on an outpatient basis. In the right of the local therapist or pulmonologist to make a correction in the treatment, relying on the patient's condition. When treating at home, it is necessary to ensure the exclusion of a factor that provoked or can aggravate the course of pneumosclerosis. Therapeutic measures should be aimed at preventing the spread of infection, as well as the inflammatory process in the lung parenchyma.

Prevention

For the prevention of pneumosclerosis it is recommended to be attentive to the state of the respiratory system. During the treatment of colds, bronchitis, SARS and other pathology of the respiratory system.

It is also necessary to strengthen the immune system, take special funds to strengthen it - immunomodulators, temper the body.

Pneumosclerosis is a serious disease characterized by a prolonged course, severe complications. But almost any disease can be cured with timely treatment. Take care of your health, do not suffer the disease "on your feet", contact the specialists!

[38], [39]

Forecast

With timely detection, treatment, compliance with all recommendations, a healthy lifestyle, the patient can feel normal, lead an active life.

The prognosis for pneumosclerosis is associated with the progression of the lung lesions and on how quickly the insufficiency of the respiratory and cardiac systems develops.

A poor prognosis for pneumosclerosis can occur with the development of a "cellular lung" and with the attachment of a secondary infection.

If a "honeycomb lung" is formed, respiratory failure can go harder, in the pulmonary artery pressure rises and a pulmonary heart can develop. If secondary infection, tuberculosis, fungal infections join, a fatal outcome is possible.

[40], [41]