1M-PULMO Flashcards
The lungs are subdivided into __ lobes
5
○ Three on the right (Upper, Middle, and
Lower)
○ Two on the left (Upper and Lower)
____ are of special importance to thoracic surgeons in cases of resection, there is no need to resect the whole lobe.
*Bronchopulmonary segments
The cut surface of the normal lung is characterized
by connective tissue septa that subdivide the
parenchyma into ___
Polygonal pulmonary lobules
The 2 main components of the lung interstitium
Alveolar walls and extra-alveolar connective tissue
- Covers the lungs
- For gas exchange
Type I pneumocytes
- Produce surfactant
- Main proliferating component after alveolar injury
Type II pneumocytes
Produce mucin & contribute to the defense of lungs against pathogens
Goblet and ciliated cells
Decrease in number as one
approaches the terminal
bronchioles
Goblet and ciliated cells
Increase in number as one
approaches the terminal
bronchioles
Clara cells
Has secretory function
and represent the main
progenitor cells after
bronchiolar injury.
Clara cells
Numerous in the fetus and neonate
*Airway-associated neuroendocrine cells
The lymph drainage is mainly cephalad,
primarily through ___
Mediastinal lymph node
groups
also to abdominal lymph nodes
The vasculature of the lung derives from ____
The pulmonary vessels and bronchial vessels
Permanent dilation of bronchi with destruction of some elements of the bronchial wall and inflammatory changes that extend into lung
parenchyma.
BRONCHIECTASIS
It represents the end stage of variety of unrelated
disorders
BRONCHIECTASIS
Partial or total obliteration of the bronchial lumen.
It can occur in any area of the lung and
follows the branching pattern of the
obstructed bronchus.
Localized bronchiectasis
Localized bronchiectasis: reversible or irreversible?
○ REVERSIBLE if the source of obstruction is relieved at an early stage
○ Otherwise, the secondary
inflammatory and fibrotic changes will
render the condition IRREVERSIBLE
Consequence of inflammation and post
inflammatory destruction of airway walls
that is usually the result of repeated
episodes of infection.
Diffuse bronchiectasis
Microscopic finding in bronchiectasis
Mixed infiltrate of both acute and chronic
inflammatory cells.
Lymphocytes often predominate
Treatment for bronchiectasis
● Conservative medical treatment- focused on
prevention or suppression of infection and early
treatment for acute exacerbations is sufficient
● Surgical resection- is limited primarily to patients with
localized disease in whom hemorrhage and/or
repeated pulmonary infections cannot be controlled
with more conservative measures.
Follow the aspiration of foreign material or are a complication of necrotizing pneumonia.
ABSCESS
Most common locations of lung abscesses
Right upper lobe
Right lower lobe
Left lower lobe
In patients who are bedridden: apical portion
Agents that are most commonly responsible for lung abscesses
Anaerobic organisms
Have thick fibrotic walls and are surrounded by areas of organizing pneumonia.
Chronic abscesses
Lung abscesses in children are most commonly due to?
Streptococcus species
Staphylococcus aureus
Klebsiella pneumoniae
Treatment of Lung abscess
● Intravenous antibiotics - particularly in children.
● Aspiration and drainage or partial resection of the lobe - for small unilocular abscesses
● Lobectomy - For larger lesions
Postoperative complications for LA
Bronchopleural fistula and empyema
Simulate radiological and gross features of neoplastic processes.
GRANULOMATOUS INFLAMMATION
Stains used for granulomatous inflammation?
● Ziehl-Neelsen for Mycobacteria
● Gomori Methenamine Silver stain for Fungi
T or F: Gross features of tuberculosis in tissue obtained for diagnosis are similar with surgical specimens.
FALSE
In surgical specimens obtained from patients who have failed medical management, most of the resected tissue typically consists of:
- inflamed,
- fibrotic, and
- otherwise nonfunctioning lung parenchyma
Localized conglomerates of necrotizing granulomatous infection due to Mycobacterium tuberculosis
*TUBERCULOMAS
Round, discrete, firm, solitary lung nodules seen in adults and are a form of tuberculous reinfection
TUBERCULOMAS
Microscopic finding in tuberculomas
Central caseous necrosis
Granulomatous infections of caused by ‘atypical’ or ‘unclassified’ mycobacteria; commonly seen in
immunocompromised hosts and/or in patients with
preexisting lung disease.
ATYPICAL MYCOBACTERIOSIS
Causative agent(s) of Atypical Mycobacteriosis
○ M. avium complex (MAC)
○ M. kansasii
○ M. xenopi
○ M. abscessus
Diagnosis of Atypical Mycobacteriosis
● Cannot be distinguished from TB on the
basis of their gross or microscopic appearance.
● May be suspected from the appearance
of the organisms in acid-fast preparations
- Bacilli in atypical mycobacteriosis are a lot thicker and longer than in M. tuberculosis.
● Positive identification of the organism by culture
and/or polymerase chain reaction (PCR) techniques
is necessary.
Hallmark of SARCOIDOSIS
Compact non-caseating granuloma
*composed of epithelioid cells, Langhans giant cells, and lymphocytes.
SARCOIDOSIS can present in the thoracic cavity in various ways:
○ Moderate to marked perihilar lymph node
involvement without pulmonary disease
○ Diffuse pulmonary disease without
radiographic evidence of node involvement
○ Combination of lymph node enlargement
and diffuse pulmonary disease
○ Pulmonary interstitial fibrosis, and localized
bronchostenosis with distal bronchiectasis
and atelectasis.
In sarcoidosis, granulomas are also frequently present
around and within ___?
Blood vessel walls
*predominantly pulmonary veins, and may contribute to pulmonary hypertension.
A pulmonary disease characterized by extensive vascular granulomas that infiltrate and occlude pulmonary arteries and veins and are
accompanied by widespread necrosis of lung tissue
Necrotizing sarcoid granulomatosis
Most common benign lung neoplasm of the lung
HAMARTOMA
Adult male presents with an asymptomatic solitary lung nodule in the peripheral lung parenchyma just beneath the pleura. It is small (<2 cm) and has a characteristic popcorn pattern of calcification radiographically.
HAMARTOMA
Sharply delineated and lobulated lung nodule. Its
cut surface is characterized by glistening nodules of
cartilage separated by ill-defined clefts.
HAMARTOMA
Microscopically made up of normal cartilage arranged in islands, fats, smooth muscle, a characteristic myxoid stroma, and clefts lined by ciliated or nonciliated respiratory epithelium.
HAMARTOMA
