Experimental acute alveolar injury in the dog. Morphologic--mechanical correlations.

In 26 dogs, a single subcutaneous injection of N-nitroso-N-methylurethane produced acute lung injury characterized by tachypnea cyanosis, increased static lung recoil, and decreased lung compliance. During the first few days, light microscopic examination revealed widespread interstitial and perivascular edema and alveolar collapse. At the same time, electron microscopy showed the major alteration to be widespread necrosis of both types of alveolar epithelial cells without significant injury to the vascular endothelium. During recovery, new epithelial cells appeared which probably were derived from granular pneumocytes. These cells developed into mature granular pneumocytes through a phase in which they resembled fetal granular pneumocytes. The late stage was characterized by a picture resembling diffuse interstitial fibrosis but which was due to irreversible closure of clusters of small airspaces with no apparent increase in collagen. Elastic recoil of the lungs, as reflected by peak inspiratory airway pressure, increased during the acute phase and showed a return toward normal that was coincident with the appearance of mature granular pneumocytes in the regenerating epithelium. Lung compliance decreased during the acute phase and in most animals returned toward normal during the recovery phase. These observations strongly suggest that the alteration in lung mechanics is related to epithelial necrosis and that recovery is related to epithelial regeneration.