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Flashcards in Lung Deck (452)
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120

Hypersensitivity pneumonitis vs. nonspecific interstitial pneumonia.

NSIP: No giant cells, no granulomas.

Clinical history may be required to make the distinction.

121

Hypersensitivity pneumonitis vs. sarcoidosis.

Sarcoidosis:

− Well-formed granulomas with hyalinized rim and location along bronchovascular bundles.
− No UIP- or NSIP-like changes.

122

Eosinophilic lung diseases: Unknown etiology (3)

Simple eosinophilic pneumonia.

Acute eosinophilic pneumonia.

Chronic eosinophilic pneumonia.

123

Eosinophilic lung diseases: Known etiology (4).

Allergic bronchopulmonary aspergillosis.

Bronchocentric granulomatosis.

Parasitic infections.

Drugs.

124

Eosinophilic lung diseases: Vasculitic causes (2).

Allergic angiitis.

Churg-Strauss syndrome.

125

Eosinophilic lung disease: How to diagnose without tissue or cytology.

Demonstrate pulmonary opacities and peripheral eosinophilia.

126

Acute eosinophilic pneumonia:

A. Clinical presentation.
B. Associations (2).

A. Acute respiratory distress that mimics infectious pneumonia.

B. Cigarettes, dust.

127

Acute eosinophilic pneumonia: Histology (3).

Resembles acute phase of DAD but with alveolar and interstitial eosinophils.

Hypertrophied and detached type 2 pneumocytes.

Intact basal lamina.

128

Acute eosinophilic pneumonia: Prognosis.

Rapid and complete response to corticosteroids.

129

Acute eosinophilic pneumonia: Degree of eosinophilia.

BAL: More than 25%.

Peripheral blood: Often no eosinophilia at first.

130

Chronic eosinophilic pneumonia: Radiography.

Peripheral consolidation mainly involving middle and lower zones.

131

Chronic eosinophilic pneumonia: Laboratory abnormalities (2).

Peripheral eosinophilia.

Elevated IgE in 7% of patients.

132

Chronic eosinophilic pneumonia: Histology.

Intraalveolar and interstitial eosinophils (single or in aggregates) and eosinophilic giant cells.

Damage to basal lamina, leading to fibrosis.

133

Parasites that can cause eosinophilic lung disease: Allergic reaction (3).

Entamoeba.

Toxocara.

Clonorchis sinensis.

134

Parasites that can cause eosinophilic lung disease: Direct invasion (4).

Ascaris lumbricoides.

Ankylostoma duodenale.

Paragonimus westermani.

Schistosomes.

135

Parasites that can cause eosinophilic lung disease: Others (3).

Strongyloides stercoralis.

Microfilariae.

Dirofilaria immitis.

136

Sarcoidosis: Frequency of pulmonary disease.

90-95%.

137

Pulmonary sarcoidosis: Clinical course (2).

Abrupt, acute illness with a better prognosis.

Chronic, insidious illness with persistent, progressive course.

138

Pulmonary sarcoidosis: Distribution of lesions (3).

Around the lymphatic vessels in the pleura, the interlobular septa, and the bronchovascular bundles.

139

Histology of pulmonary sarcoidosis:

A. Periphery of granulomas.
B. Tissues involved by granulomas.

A. Concentric fibrosis often; usually no cuff of lymphocytes.

B. Vessels, pleura.

140

Histology of pulmonary sarcoidosis: Inclusions that can be confused for microorganisms (2).

Hamazaki-Wesenberg bodies: GMS (+), AFB (+); mimic fungi.

Microcalcifications: Mimic fungi or P. jiroveci.

141

Sarcoidosis vs. hypersensitivity pneumonitis.

Hypersensitivity pneumonitis:

− Granulomas are less well formed.
− More inflammation in the interstitium.

142

Types of disease associated with a sarcoidosis-like disorder (2).

Malignancies.

Collagen-vascular disorders.

143

Idiopathic pulmonary hemosiderosis: Age group.

Children and adolescents.

144

Idiopathic pulmonary hemosiderosis:

A. Clinical manifestations (4).
B. Clinical course.

A. Cough, hemoptysis, iron-deficiency anemia, weight loss.

B. Subject to spontaneous remission or exacerbation.

145

Idiopathic pulmonary hemosiderosis: Associations (3).

IgA nephropathy.

Dermatitis herpetiformis.

Celiac disease.

146

Idiopathic pulmonary hemosiderosis: Gross pathology.

Heavy, red-brown lung tissue.

147

Idiopathic pulmonary hemosiderosis: Histology (2).

Intraalveolar dense groups of hemosiderin-laden macrophages, or frank hemorrhage.

Loss or hyperplasia of alveolar epithelium.

148

Idiopathic pulmonary hemosiderosis: Pertinent negative findings (5).

Granulomas.

Vasculitis.

Infarction.

Infection.

Immune complexes or immunoglobulins.

149

Idiopathic pulmonary hemosiderosis: Treatment.

Immunosuppression.