Pulmonary Pathology I Flashcards Preview

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Flashcards in Pulmonary Pathology I Deck (31)
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1

Basic composition of airways

mucus glands, smooth muscle and ciliated columnar respiratory epithelium

 

2

Bronchi (general definition) + pathologies that can affect bronchi

  • bronchi = large airways w/cartilage
  • Acute bronchitis
  • Chronic bronchitis
  • Bronchiectasis
  • Asthma

3

Pathologic (histologic) changes in Acute Bronchitis

  • Neutrophils in the airway lumen and infiltrating the wall of the airway

  • Usually infectious

4

Pathologic (histologic) changes in Chronic Bronchitis

Chronic inflammation (mostly lymphocytes) in the airway wall

 

Squamous metaplasia of the epithelium (transformation of the ciliated columnar type cells to flattened polygonal squamous cells)

 

Mucus gland hypertrophy (too many glands making too much mucus)

5

Pathologic (histologic) changes in Bronchiectasis

  • Dilation of the airway compared to the neighboring vessel (should be roughly the same size)
  • Often the result of long-standing infection/inflammation

6

Pathologic (histologic) changes in Asthma

  • Thickened subbasal lamina
  • Eosinophilic inflammation
  • Mucus hypersecretion

7

Bronchioles (general definition) + pathology affecting bronchioles

  • broncioles = small airways w/out cartilage
  • chronic bronciolitis
  • follicular bronchiolitis
  • constrictive/obliterative bronchiolitis
  • granulomatous bronchiolitis

8

Structures indicated by arrows (A - D)

A. Mucus glands

B. Smooth muscle

C. Cartilage

D. Epithelium

9

Process occuring + likely dx

  • squamous metaplasia
  • chronic bronchitis

10

Process occuring + likely dx

  • mucus gland hyperplasia
  • dx: chronic bronchitis

11

Pathologic (histologic) changes in chronic bronchiolitis

  • Inflammation in the wall of small airways that do not contain cartilage.
  • Most common type of inflammation is chronic inflammation (lymphocyte predominate)

12

Pathologic (histologic) changes in follicular bronchiolitis

lymphoid aggregates with germinal centers

13

Pathologic (histologic) changes in constrictive/obliterative bronchiolitis

  • Fibrosis squeezing the airway lumen shut
  • May cause severe airtrapping in the downstream lung

14

Pathologic (histologic) changes in granulomatous bronchiolitis

  • Granulomas composed of clustered histiocytes and multinucleated giant cells
  • May be centrally necrotizing or nonnecrotizing
  • Necrotizing cases are usually infectious
  • Nonnecrotizing cases may be infection, sarcoid or chronic beryllium disease

15

Probable dx

constrictive bronciolitis

16

Probable dx

  • airway lume = completely obliterated by fibrosis ==>
  • obliterative bronchiolitis

17

Airspaces (general definition) + pathology affecting airspaces

  • Pneumonia: acute, aspiration, eosinophillic, organizing
  • Diffuse Alveolar Damage (DAD
  • Emphysema
  • Other smoking-related lung diseases:
    • Respiratory Bronchiolitis (RB)
    • Desquamative Interstitial Pneumonia (DIP)
  • Diffuse Alveolar Hemorrhage (DAH
  • Pulmonary Alveolar Proteinosis (PAP)

18

Pathologic (histologic) changes in Acute Pneumonia

Neutrophils, macrophages and fibrin within airspaces

Usually infectious

19

Pathologic (histologic) changes in Aspiration Pneumonia

Airspace foreign material (food)

Multinucleated giant cells

20

Pathologic (histologic) changes in Organizing Pneumonia

  • Plugs of loose myxoid fibroblastic tissue plugs in airspaces and small airways
  • Usually patchy and may have densely consolidated areas
  • May have a small amount of intermixed pink fibrin
  • A relatively non-specific finding consistent with an element of sub-acute lung injury
  • Also known as Bronchiolitis Obliterans Organizing Pneumonia (BOOP) or Cryptogenic Organizing Pneumonia (COP)

21

Pathologic (histologic) changes in Eosinophillic Pneumonia

Eosinophils, macrophages and fibrin within airspaces

22

Pathologic (histologic) changes in Diffuse Alveolar Damage (DAD)

  • Hyaline membranes (fibrin ribbons in the airspaces lining the alveolar septa)
  • Alveolar septa may be expanded by inflammation and fibroblastic tissue
  • The histologic pattern that corresponds to ARDS

23

Probable Dx

  • Diffuse Alveolar Damage ==> ARDS

24

Pathologic (histologic) changes in Emphysema

  • Enlarged airspaces
  • Broken alveolar septa (irreversible damage)
  • Subpleural blebs – may become very large and cause a pneumothorax if ruptured

25

Smoking emphysema vs. Alpha-1-antitrypsin pathologic features

  • Smoking-related emphysema is worse in the upper lobes and around bronchioles (centrilobular emphysema)
  • Alpha-1-antitrypin deficiency related emphysema is worse in the lower lobes and is NOT worse around the airways (panlobular emphysema)

26

Pathologic (histologic) changes in Respiratory Bronchiolitis

Brown pigmented macrophages in small bronchioles and surrounding airspaces

27

Pathologic (histologic) changes in Desquamative Interstitial Pneumonia (DIP)

Similar brown pigmented airspace macrophages as RB, but found diffusely in the airspaces, not just around small airways

28

Probable Dx

Severe emphysema

29

Probable Dx

  • Nonnecrotizing granuloma
  • Dx: granulomatous bronchiolitis
    • infection, sarcoid, beryllium

30

Pathologic (histologic) changes in diffuse alveolar hemorrhage

  • Blood and iron-containing macrophages within airspaces
  • Alveolar septa may be mildly thickened by inflammation and fibroblastic tissue
  • May be associated with capillaritis (neutrophils attacking the capillaries of the alveolar septa)

31

Pathologic (histologic) changes in pulmonary alveolar proteinosis

Airspaces filled with pink fluid and macrophages