There are components of infection, infarction, and pulmonary sequestration. A slow and only partial response to antibiotics or anticoagulation compared with the treatment of pneumonia or pulmonary infarction in otherwise normal people suggests a more complex pathology; it is likely that primary infections are complicated by areas of secondary infarction and vice versa. A third pathological process is sequestration in the pulmonary capillaries which may lead to a rapid clinical deterioration. Once started, sequestration impairs oxygen absorption from the alveoli, leading to a vicious circle of red cell deoxygenation, further sickling, and further sequestration. Its reversal may be complete and rapid following exchange transfusion, implying a vascular phenomenon without evidence of either infection or infarction. Infarction of the sternum or ribs, which limits chest movement and ventilation, may be associated with secondary areas of lung collapse or consolidation, the incidence of which can be markedly reduced by incentive spirometry. Fat embolism has also been recognized recently as a common pathology.

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