9/16- Cases 3: ILD and Respiratory Failure

Question 1

What are the hallmarks of ARDS?

Answer 1

1) Non-cardiogenic pulmonary edema
2) Hypoxemia
3) Respiratory failure requiring mechanical ventilation

Question 2

What is seen here?

Answer 2

ARDS lung

Question 3

What is pathologic hallmark of acute phase of ARDS?

Answer 3

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

Question 4

What is seen here?

Answer 4

Closer view of hyaline membranes in acute ARDS

• Pink strands plastered along alveolar walls

Question 5

What conditions are associated with ARDS/DAD?

Answer 5

Question 6

What is seen here?

Answer 6

• Reticular infiltrates (fine lines)
• Lower lobe predominant

Question 7

What is seen here?

Answer 7

Honeycombing

• Cystic spaces
• Fibrous tissue (surrounding spaces)

Possible outcome of ILD

• Indicative of burnt out lung
• Not participating with gas exchange

Question 8

What is seen here?

Answer 8

Cystic space lined by metastastic bronchial epithelium (?)

• Indicative of burnt out lung
• Not participating with gas exchange

Question 9

What is seen here? Most likely diagnosis (pt is asymptomatic)?

Answer 9

Bilateral hilar lymphadenopathy

• Higher than where you would see enlargement due to pulmonary arteries Most likely Sarcoidosis

Question 10

Who is the typical Sarcoidosis pt?

Answer 10

More in:

• Younger
• Women
• African Americans

Question 11

What is seen here?

Answer 11

Sarcoidosis

• Well-defined noncaseating granulomas

Question 12

What is seen here?

Answer 12

Sarcoidosis

• Asteroid bodies (not specific to sarcoidosis, can have with any granulomas)

Question 13

What is seen here?

Answer 13

Asbestosis

• Lower lobe

Fibrosis of interstitial surface and pleura

• Greyish white lines = fibrosis
• Very thickened visceral pleura due to fibrosis

Question 14

What is seen here?

Answer 14

Asbestosis- Honeycombing

• May look very similar to UIP

Question 15

What is seen here?

Answer 15

Asbestos body

• Iron protein coat encasing asbestos fibers

Question 16

What is a ferruginous body?

Answer 16

Any iron coated fiber

• asbestos body is a specific type

Question 17

What is seen here?

Answer 17

Pleural plaque (white area on left) due to asbestos exposure

• Mesothelioma is really red, hemorrhagic body (lower right)

Question 18

T/F: pleural plaques are acellular

Answer 18

True

• Collagen “basketweave” apperance
• Typically no asbestos bodies within

Question 19

Mesothelioma is a cancer of ____?

Answer 19

Mesothelioma is a cancer of pleural surface

• Hallmark of asbestos exposure

Question 20

What is seen here?

Answer 20

See protrusions where pleura should be

• Mesothelioma

Question 21

What is seen here?

Answer 21

Asbestosis

Question 22

Which lobes are affected by asbestosis and silicosis?

Answer 22

• Asbestosis: lower lobes
• Silicosis: upper lobes

Question 23

What is seen here?

Answer 23

?

Question 24

What is seen here?

Answer 24

Silicosis

• Collection of macrophages undergo lamellar fibrosis to form silicotic nodules
• Need to see silica particles (birefringent with polarized light)