9/16- Cases 3: ILD and Respiratory Failure Flashcards
What are the hallmarks of ARDS?
1) Non-cardiogenic pulmonary edema
2) Hypoxemia
3) Respiratory failure requiring mechanical ventilation
What is seen here?
ARDS lung
What is pathologic hallmark of acute phase of ARDS?
Hyaline membranes- DAD (diffuse alveolar damage)
- Pink strands plastered along alveolar walls
- Byproduct of damaged alveolar lining: epithelial cells, nucleocytoplasmic debris
- Begin ~ day 2 and peak day 4-5
What is seen here?
Closer view of hyaline membranes in acute ARDS
- Pink strands plastered along alveolar walls
What conditions are associated with ARDS/DAD?
What is seen here?
- Reticular infiltrates (fine lines)
- Lower lobe predominant
What is seen here?
Honeycombing
- Cystic spaces
- Fibrous tissue (surrounding spaces)
Possible outcome of ILD
- Indicative of burnt out lung
- Not participating with gas exchange
What is seen here?
Cystic space lined by metastastic bronchial epithelium (?)
- Indicative of burnt out lung
- Not participating with gas exchange
What is seen here? Most likely diagnosis (pt is asymptomatic)?
Bilateral hilar lymphadenopathy
- Higher than where you would see enlargement due to pulmonary arteries Most likely Sarcoidosis
Who is the typical Sarcoidosis pt?
More in:
- Younger
- Women
- African Americans
What is seen here?
Sarcoidosis
- Well-defined noncaseating granulomas
What is seen here?
Sarcoidosis
- Asteroid bodies (not specific to sarcoidosis, can have with any granulomas)
What is seen here?
Asbestosis
- Lower lobe
Fibrosis of interstitial surface and pleura
- Greyish white lines = fibrosis
- Very thickened visceral pleura due to fibrosis
What is seen here?
Asbestosis- Honeycombing
- May look very similar to UIP
What is seen here?
Asbestos body
- Iron protein coat encasing asbestos fibers
What is a ferruginous body?
Any iron coated fiber
- asbestos body is a specific type
What is seen here?
Pleural plaque (white area on left) due to asbestos exposure
- Mesothelioma is really red, hemorrhagic body (lower right)
T/F: pleural plaques are acellular
True
- Collagen “basketweave” apperance
- Typically no asbestos bodies within
Mesothelioma is a cancer of ____?
Mesothelioma is a cancer of pleural surface
- Hallmark of asbestos exposure
What is seen here?
See protrusions where pleura should be
- Mesothelioma
What is seen here?
Asbestosis
Which lobes are affected by asbestosis and silicosis?
- Asbestosis: lower lobes
- Silicosis: upper lobes
What is seen here?
?
What is seen here?
Silicosis
- Collection of macrophages undergo lamellar fibrosis to form silicotic nodules
- Need to see silica particles (birefringent with polarized light)
