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
