Open lung biopsies and explant or post-mortem with H&E staining for patient 2 (A and B) ages 5 weeks/4months and patient 4 (C – F) ages 3 weeks/10 months. Both patients demonstrate interval alveolar expansion but to a lesser extent than patient 4. Patient 4 also demonstrates a very unusual finding of severe intimal expansion with foamy macrophages in many vessels with near complete obliteration of the arteriolar lumen (E and F, outlined in black dashed lines with margins of vessel outlined in gray dashed line). Abbreviations: alveolus (Al), arteriole (Ar), bronchiole (Br), foamy macrophage (Fo), lumen (Lu), and vein (Ve).