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Flashcards in Lung Deck (452)
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90

Usual interstitial pneumonia: How to diagnose cases that contain findings of other interstitial lung diseases.

As usual interstitial pneumonia.

91

Nonspecific interstitial pneumonia:

A. Clinical presentation.
B. Duration.

A. Dyspnea, cough, fever.

B. Subacute.

92

Nonspecific interstitial pneumonia: Associations (5).

Cigarettes.

Drugs.

Immunodeficiency.

Collagen-vascular diseases.

Hypersensitivity pneumonitis.

93

Nonspecific interstitial pneumonia: Distribution of lesions.

Subpleural.

Lower lobes.

94

Nonspecific interstitial pneumonia: Radiography.

Peribronchial ground-glass opacities.

Reticular opacities.

95

Nonspecific interstitial pneumonia: Long-term prognosis.

Cellular type: Excellent.

Fibrotic type: Poor.

96

Nonspecific interstitial pneumonia, cellular type: Histology (3).

Diffuse interstitial infiltrate of lymphocytes and plasma cells.

Preservation of the pulmonary architecture.

Hyperplasia of type 2 pneumocytes.

97

Nonspecific interstitial pneumonia, fibrotic type: Histology (4).

Loose to dense interstitial fibrosis that thickens the alveolar walls.

Fibrosis shows temporal homogeneity.

Preservation of the pulmonary architecture.

Mild or moderate chronic inflammation.

98

Nonspecific interstitial pneumonia: Histological clue to an association.

Abundance of lymphoid aggregates suggests collagen-vascular disease.

99

Nonspecific interstitial pneumonia: What should not be seen histologically (3).

Significant honeycombing.

Many fibroblastic foci.

Granulomas.

100

Nonspecific interstitial pneumonia vs. lymphoid interstitial pneumonia.

LIP:

− Denser inflammatory infiltrate.
− Architectural distortion.

101

Desquamative interstitial pneumonia: Clinical presentation.

Dyspnea, cough, chest pain.

102

Desquamative interstitial pneumonia: Duration.

Subacute.

103

Desquamative interstitial pneumonia: Distribution of lesions.

Subpleural.

104

Desquamative interstitial pneumonia:

A. Frequent association.
B. Infrequent associations (2).

A. Cigarette smoking, even years after cessation.

B. Sirolimus; mutations in SP-C, the gene for surfactant protein C.

105

Desquamative interstitial pneumonia: Radiography.

Ground-glass opacities.

Thin-walled cysts.

Reticular opacities.

106

Desquamative interstitial pneumonia: Histology (3).

Pigmented macrophages (originally thought to be "desquamated" pneumocytes) fill alveoli.

Intraalveolar laminated basophilic concretions ("blue bodies") sometimes present.

No significant fibrosis.

107

Desquamative interstitial pneumonia: Special stain.

Prussian blue highlights the finely granular pigment within the macrophages.

108

Desquamative interstitial pneumonia vs. respiratory bronchiolitis-interstitial lung disease.

RB-ILD: Macrophages fill the bronchioles but not the distal airspaces.

109

Lymphoid interstitial pneumonia: Associations.

Children: AIDS.

Adults: Immunocompromise, including AIDS.

110

Lymphoid interstitial pneumonia: Clinical presentation in children.

Manifestations of AIDS: Recurrent infections, parotiditis, failure to thrive.

Respiratory failure occasionally.

111

Lymphoid interstitial pneumonia: Radiography (2).

Children: Miliary reticulonodular infiltrates.

Adults: The same plus alveolar consolidation.

112

Lymphoid interstitial pneumonia: Histology (2).

Dense mononuclear inflammation of the interstitium, sometimes with germinal centers.

Partial obliteration of architecture.

113

Lymphoid interstitial pneumonia: Microbiological association.

ISH detects EBV in most cases.

114

Lymphoid interstitial pneumonia: Clinical course.

No progression to fibrosis.

115

Hypersensitivity pneumonitis:

A. Associations.
B. Distribution of lesions.

A. Various organic antigens, esp. those of thermophilic actinomycetes and birds.

B. Upper lobes, peribronchiolar.

116

Hypersensitivity pneumonitis: Phases (3).

Acute: Exposure to high concentrations of antigen; onset in 4-8 hours; resolution in 24-48 hours.

Subacute: Continuous or intermittent exposure to low concentrations of antigen; responds to steroids or to withdrawal of antigen.

Chronic: Subacute plus fibrosis; worse prognosis.

117

Hypersensitivity pneumonitis, subacute phase: Histology (2).

Small, poorly formed granulomas and mononuclear inflammation next to bronchioles.

Foamy histiocytes in alveoli and interstitium.

118

Hypersensitivity pneumonitis, chronic phase: Histologic patterns (3).

NSIP-like pattern: Homogeneous fibrosis with architectural preservation.

UIP-like: Patchy subpleural fibrosis with architectural distortion.

Irregular peribronchiolar pattern: UIP-like plus peribronchiolar fibrosis.

119

Hypersensitivity pneumonitis vs. usual interstitial pneumonia.

UIP:

− No giant cells, no granulomas.
− Mainly subpleural and in lower lobes.