Week 5: Respiratory System Pathology Part 1

Question 1

Cystic Fibrosis

Answer 1

• also called mucoviscidosis
• it is a hereditary disease caused by a defective gene, chromosome 7
• characterized by secretions of excessively vicious mucous by all exocrine glands
• the thick mucous secreted by mucous in trachea and bronchi blocks air passages and can cause areas of collapsed lung, recurring pulmonary infections (mucous traps pathogens) and cysts and abscesses

Question 2

IRDS - Hyaline Membrane Disease

Answer 2

• under airation of alveoli due to lack of surficant
• new borns

Question 3

Croup

Answer 3

• Viral infections in young children that proceeds inflammatory obstructive swelling to the subglottic portion of trachea
• breathing sounds like a harsh grating sound or a braking cough
• as it progresses it causes inflammatory edema and spasm which may cause laryngeal obstruction

Question 4

Croup Radiographic Appearance

Answer 4

AP soft tissue neck shows tapered narrowing of subglottic airway (hourglass shape = steeple sign) due to edematous swelling

Question 5

Epiglottitis

Answer 5

• acute infection of the epiglottis (often in children) which causes thickening of epiglottis tissue and surrounding pharyngeal structures
• patient may present with signs of tripod position, drooling, stridor, dyspnea or tachypnea

Question 6

Epiglottitis Radiographic Appearance

Answer 6

• lateral soft tissue neck x-ray shows rounded thickening of the epiglottic shadow; approximate size of an adult thumb
• can cause obstruction so prompt action needed

Question 7

Pneumonia

Answer 7

• acute infection/inflammation of the lung commonly caused by bacteria or viruses, sometimes because of aspiration
• symptoms: fever, productive cough, chest pain, shortness of breath, fatigue and general malaise

Question 8

Alveolar Pneumonia

Answer 8

• inflammatory exudate (fluid made of protein) replaces air in the alveoli, inflammation spreads from one alveoli to another
• may involve pulmonary segments or either lobe
• also called air space pneumonia
• generally caused by bacteria

Question 9

Air Bronchogram Sign

Answer 9

bronchus are still getting air (showing dark on image) but a pathological process in the alveoli is causing something other than air to fill them up so they show lighter on image
 = air filled bronchial tree against airless lung parenchyma


Question 10

Bronchopneumonia

Answer 10

inflammation originates in the bronchi or bronchial mucosa and spreads to the alveoli
- bronchial inflammation can cause airway obstruction leading to atelectasis with loss of lung volume
-often bacterial

Question 11

Interstitial Pneumonia

Answer 11

• inflammation involving the walls and the lining of alveoli and alveoli peta (alveolar supporting structures or structures around alveoli)
• often viral or mycoplasmal

Question 12

Aspiration Pneumonia

Answer 12

caused by aspiration of esophageal contents (in patients with swallowing issues) or gastric contents (general anesthetic, tracheostomy, coma, trauma)

Question 13

Lung Abscess

Answer 13

• necrotic areas of pulmonary parenchyma containing pus like material, it become encapsulated within fibrous walls
• many potential causes
• often occurs in right lung from aspiration
• patients maybe have fever, cough, foul smelling sputum
• infection can spread to other areas of the body including the brain

Question 14

Tuberculosis

Answer 14

• bacterial infection that primarily affects the lungs but can also affect other systems
• it is spread by coughing (airborne transmission)
• primary infection: inflammatory cells collect around bacilli and form a fibrous tubercle/small mass to prevent spread
• create with antibiotics
• primary TB may reactivate after healed which is called secondary TB with caseated (cheese like) necrotic areas

Question 15

Miliary Tuberculosis

Answer 15

• military: rash or condition resembling millet seeds (small seeds, so grainy appearance)
• dissemination of the disease throughout the bloodstream
• many fine, discrete nodules distributed uniformly

Question 16

Tuberculoma

Answer 16

• sharply defined parenchymal nodule containing viable TB bacilli that can develop into primary or secondary TB
• may caseate (necrotic cheesecake tissue)
• may remain unchanged for long period of cause active disease
• radiographic appearance: single or multiple nodules with caseation

Question 17

Respiratory Syncytial Virus
 (RSV)

Answer 17

• affects mostly children, attacks the lower respiratory tract
• causes necrosis of epithelium of bronchi and bronchioles, bronchiolitis (inflammation of bronchioles), bronchial obstruction from necrotic and edemic materials, bronchospasm and interstitial pneumonia
• contact or droplet spread, wear PPE

Question 18

Respiratory Syncytial Virus
 (RSV) Radiographic Appearance

Answer 18

• hyperinflation with diffuse increase interstitial markings
• necrosis of respiratory epithelium appears as interstitial pneumonia if seen
• atelectasis can be seen in severe cases

Question 19

Severe Acute Respiratory Syndrome
(SARS) (SARS-CoV Disease)

Answer 19

• a viral upper and lower respiratory infection caused by coronavirus
• symptoms: fever, headache, body aches, respiratory distress, dry cough and may develop pneumonia, hypoxemia
• contact and droplet precautions

Question 20

Chronic Obstructive Pulmonary Disease

Answer 20

• includes several conditions of chronic obstruction of airways producing ineffective air exchange and makes breathing difficult
• leading cause is cigarettes but can also be cause by infection, pollution, exposure to harmful substances (asbestos)

Question 21

Chronic bronchitis (COPD)

Answer 21

chronic cough with phlegm from airway inflammation

Question 22

Emphysema (COPD)

Answer 22

destruction of alveoli and obstruction of small airways

Question 23

Asthma (chronic) (COPD)

Answer 23

bronchiolar spasm with decreased airflow and sometimes obstruction of airway

Question 24

Bronchiectasis (COPD)

Answer 24

• abnormal dilation of the bronchi = widening and hardening (less elasticity)
• could be due to repeated damage/infections, COPD or comorbidity

Question 25

Acute Bronchitis

Answer 25

- inflammation of the bronchi - walls of bronchi and bronchioles thicken, excessive mucous production which leads to obstruction of small airways - usually viral but could be bacterial or pollutant exposure - lasts about 1-2 weeks - radiographic appearance: typically normal images

Question 26

Chronic Bronchitis

Answer 26

- inflammation of the bronco that is recurring or longstanding (must have for months at a time and have for at least over 2 years for it to be chronic) - mucous glands become hyperplasticity (increase in number of cells) which can cause narrowing of airways and overinflation of mungs (emphysema)

Question 26

Emphysema

Answer 26

- obstructive and destructive changes in small airways lead to a dramatic increase in volume of air in the lungs - from smoking, chronic bronchitis, air pollution, respiratory tract irritants - produces excess mucous which plugs airways which increases airway resistance - air becomes tapped in lungs, overinflation, alveolar distentions and rupture of alveolar walls because hard to exhale (due to bronchial narrowing)

Question 26

Asthma

Answer 26

- very common disease in which the airways become narrowed due to allergens - extrinsic asthma: due to house dust, pollen, molds, animal dander, certain fabrics and various foods - intrinsic asthma: due to exercise, heat or cold exposure, and emotional upset - swelling of bronchial mucous membranes - excessive secretions of mucus - spasm of smooth muscle wall in the bronchus - leads to severe narrowing of the airway - breathing difficult, especially expiration = wheezing - may evolve into pneumonia - most effectively diagnosed clinically

Question 27

Bronchiectasis

Answer 27

- permanents abnormal dilation of the one or more are bronchi due to destruction of elastic and muscular parts of bronchial walls - like bronchitis but permanent - due to COPD, autoimmune disease, cystic fibrosis, HIV, or diabetes - hard to clear mucous, bacteria can grow in mucous and cause further problems - patients typically have chronic productive cough