Lung Path

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  1. Atelactasis
    Partial filling or collapse

    Contraction, obstructive, compression
  2. Pulmonary Edema
    • Hemodynamic or Alveolar (microvascular)
    • Wet, heavy lungs
    • Non-cardio = ARDS
  3. 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...
  4. 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
  5. 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)
  6. Lobar vs broncopneumonia
    Whole lobe vs multifocal, poorly demarcated, grey-red to yellow
  7. 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
  8. Viral and mycoplasmal pneumonias
    • Intersitium inflammation
    • Little to moderate sputum production
    • Orthomyxioviridae H#N# (hyperemia, hemorrhage, edema, inc lymphocytes) (necrotizing bronchitis, diffuse alveolar damage)
  9. Aspiration pneumonia
    • Usually aspiration of bacteria from upper GI (Bacteroides sp and Fusobacterium)
    • Abscesses with maloderous sputum
    • Bronchopneumonia
  10. Lung Abscess Causes
    • Aspiration
    • Bacterial infection (Strep, Staph aureus, gram neg bac, anaerobes)
    • Septic embolism
    • Obstruction
    • Trauma
  11. Lung abscess
    • Usually R side
    • Cough, fever, smelly sputum, chest pain, weight loss, finger clubbing
  12. Chronic Pneumonia
    • Granulomatous
    • Bacterial or fungal
  13. 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
  14. 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
  15. Immunocompromised pneumonia
    • More common and severe
    • Staph, strep, gram neg, TB, Pneumocysistis jiroveci, cryptococcus, candida, aspergillus, zygomycetes
  16. CMV
    • Interstitial pneumonitis
    • Hemorrhages and alveolar epithelial cells
    • Introcytoplasmic/intranuclear inclusions
  17. Pneumocystis jirveci
    • Fungus
    • Cysts = crushed ping pong balls
    • Pneumonia in immunocomp hosts
  18. Aspergillus
    • A. fumigatus causes disease
    • 1. colonization = fungus balls in lung cavities, 2. allergic, 3. invasive
    • Septate hyphae with 45deg angles
  19. Zygomycetes
    • Opportunistic
    • Risk = Diabetes, immunocomp
    • 1. rhinocerebral, 2. pulmonary, 3. GI
    • Wide angle branching
    • Poor prognosis
  20. Usual interstitial pneumonia/idopathic pulmonary fibrosis
    • Patchy
    • Temporally heterogeneous
    • Lower lung
    • Reticular pattern and honeycombing
  21. 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
  22. 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
  23. Respiratory Bronchiolitis - Interstitial Lung Disease
    • Mild
    • Pigmented carbon macrophages in bronchioles and alveoli
    • Ave age = 36
  24. Desquamative interstitial pneumonia
    • Heavy smokers!
    • Mnonuclear cell infiltration without dense fibrosis
    • Pts 30s/40s
  25. 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
  26. Hypersensititivy Pneumonitis
    • Diffuse interstitial granulomatous inflammatory pattern
    • Bilat consolidation
    • Neutrophils in alveoli and resp bronchioles
    • Temporally unifor
    • Noncaseating, poorly-formed granulomas
  27. Eosinophilic pneumonia
    • Acute, simple, tropical, secondary, idiopathic chronic
    • Lung (alv/interst) eosinophils >> blood
  28. 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
  29. 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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Lung Path
2012-01-11 06:33:11
lung path

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