Almost all of the lung parenchyma shows dark, hemorrhagic, consolidated tissue. There is a thin rim of normal lung on the left. Huge numbers of leukemic cells block pulmonary arteries. This pulmonary artery is almost completely occluded by intimal and muscular medial proliferation. This is a severe degree of pulmonary hypertensive change, reducing perfusion.
Trichrome stain shows obliteration by purple smooth muscle.
Proximal parts have broken walls, with coalescence of the alveolar ducts into large spaces. The alveoli are of normal size. Bullous emphysema in patients with alpha-1 antitrypsin deficiency. Pleural surfaces show air-filled blebs. Cut surface of lung in panacinar emphysema.