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Atelactasis
Partial filling or collapse
Contraction, obstructive, compression
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Pulmonary Edema
- Hemodynamic or Alveolar (microvascular)
- Wet, heavy lungs
- Non-cardio = ARDS
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Acute Lung Injury/Acute Respiratory Distress Syndrome (ARDS)
- Abrupt onset significant hypoxemia and diffuse pulmonary infiltrates wit NO cardiac failure
- Diffuse alveolar damage
- "Acute interstitial pneumonia" when no known cause
- Heavy, firm, red, boggy lungs
- Type II pneumocyte damage, leads to fibrosis
- Imbalance NF-kB, IL-8...
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Neonatal Respiratory Distress Syndrome
- Most common cause of resp failure in newborn
- Deficiency of surfactant
- At risk: pre-term, male, maternal diabetes, c-section
- Solid, firm, rigid, airless, red-purple lungs
- Hyaline membrane formation
- Can develop: retinopathy (retrolental fibroplasia), bronchopulmonary dysplasia, PDA, intraventricular brain hemorrhage, necrotizing enterocolitis
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Pneumonia stages
- Congestion (heavy, engorged, fluid, bacteria)
- Red hepatization (red, solid, firm, airless, neutrophils)
- Grey hepatization (grey-brown, solid, firm, dry, lymphocytes and macrophages)
- Resolution (fibroblasts, fibrin)
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Lobar vs broncopneumonia
Whole lobe vs multifocal, poorly demarcated, grey-red to yellow
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Bacterial pneumonia
- Strep pneumoniae (#1)(lobar)
- H. influenzae (B encapsulated worst)(epiglottitis in kids)(necrotizing lobar)
- Staph aureus (2ndary)(bronchopneu)
- Strep other (lower lobes)
- Psudomonas aeruginosa (#1 nosocomial)
- Legionella pneumophila
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Viral and mycoplasmal pneumonias
- Intersitium inflammation
- Little to moderate sputum production
- Orthomyxioviridae H#N# (hyperemia, hemorrhage, edema, inc lymphocytes) (necrotizing bronchitis, diffuse alveolar damage)
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Aspiration pneumonia
- Usually aspiration of bacteria from upper GI (Bacteroides sp and Fusobacterium)
- Abscesses with maloderous sputum
- Bronchopneumonia
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Lung Abscess Causes
- Aspiration
- Bacterial infection (Strep, Staph aureus, gram neg bac, anaerobes)
- Septic embolism
- Obstruction
- Trauma
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Lung abscess
- Usually R side
- Cough, fever, smelly sputum, chest pain, weight loss, finger clubbing
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Chronic Pneumonia
- Granulomatous
- Bacterial or fungal
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MTb
- TB
- Enters macrophages and replicates inside the macrophage
- Primary: first exposure, --> latent or progressive primary TB in 5%, lower lobes, Ghon focus/complex --> Ranke complex
- Secondary: apical/upper lobes, less LN involvment, progressive (cavitation and cough), consolidation w cental caseation
- S/S: malaise, anorexia, weight loss, fever, night sweats, hemoptysis and pleuritic pain
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Fungal pneumonias
- Histoplasma (Ohio/MS river valley soil)(fibrosis and calcification = tree bark)
- Blastomycosis (central/se us, canada, mexico..)(1. pulmonary 2.disseminated 3.cutaneous) (Broad based budding)
- Coccidiomycosis (SW US)(non-budding spherules wi macrophage)
- Granulomatous inflam, all thermally dimorphic
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Immunocompromised pneumonia
- More common and severe
- Staph, strep, gram neg, TB, Pneumocysistis jiroveci, cryptococcus, candida, aspergillus, zygomycetes
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CMV
- Interstitial pneumonitis
- Hemorrhages and alveolar epithelial cells
- Introcytoplasmic/intranuclear inclusions
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Pneumocystis jirveci
- Fungus
- Cysts = crushed ping pong balls
- Pneumonia in immunocomp hosts
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Aspergillus
- A. fumigatus causes disease
- 1. colonization = fungus balls in lung cavities, 2. allergic, 3. invasive
- Septate hyphae with 45deg angles
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Zygomycetes
- Opportunistic
- Risk = Diabetes, immunocomp
- 1. rhinocerebral, 2. pulmonary, 3. GI
- Wide angle branching
- Poor prognosis
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Usual interstitial pneumonia/idopathic pulmonary fibrosis
- Patchy
- Temporally heterogeneous
- Lower lung
- Reticular pattern and honeycombing
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Non-specific interstitial pneumonia
- Better outcome than usual interstitial pneumonia
- Temporally homogenous
- Cellular and fibrosing histo patterns
- No fibroblastic foci or honeycombing
- Responsive to corticosteroids
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Organizing Pneumonia
- Excessive proliferations of granulation tissue within small airways
- Uni/bilateral consolidation; patchy or subpleural
- Intraluminal polypoid plugs of loosely arranged fibrous tissue occluding bronchioles, alveolar ducts, and alveoli
- Responds to corticosteroids
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Respiratory Bronchiolitis - Interstitial Lung Disease
- Mild
- Pigmented carbon macrophages in bronchioles and alveoli
- Ave age = 36
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Desquamative interstitial pneumonia
- Heavy smokers!
- Mnonuclear cell infiltration without dense fibrosis
- Pts 30s/40s
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Sarcoidosis
- Unknown cause
- Noncaseating granulomatous inflammation
- Involves: lungs, nodes, eyes, skins, spleen, bone marrow, heart, liver
- CXR: bilat sym hilar and mediastinal LN enlargement
- Early (small nodules) Late (Nodules with cavitation, fibrosis, honeycombing)
- DRB1
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Hypersensititivy Pneumonitis
- Diffuse interstitial granulomatous inflammatory pattern
- Bilat consolidation
- Neutrophils in alveoli and resp bronchioles
- Temporally unifor
- Noncaseating, poorly-formed granulomas
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Eosinophilic pneumonia
- Acute, simple, tropical, secondary, idiopathic chronic
- Lung (alv/interst) eosinophils >> blood
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Pulmonary Langerhans Cell Histiocytossi
- Chronic, progressive
- Prolif Langerhans cell infiltrates
- Multiple nodules centered on bronchioles with stellate borders
- Mixed inflamm infiltrate w prominent nuclear membrane grooves and Birbeck granules
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Pulmonary alveolar proteinosis
- Intra-alveolar accumulation of surfactant-derived lipid-rich material
- Consolidation perihilar and lower lung
- Lungs heavy with scattered firm white-yellow nodules
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