Airspace Diseases

Question 1

Acute Pneumonia

Answer 1

• neutrophils in airspaces

Question 2

Diffuse Alveolar Hemorrhage (DAH)

Answer 2

• Blood and iron-containing macrophages in airspaces
• Alveolar septa thickened by inflammation and fibroblasts
• Might be associated with capillaritis

Question 3

aspiration pneumonia

Answer 3

• foreign material in airspaces

- may also have multinucleated giant cells

Question 4

eosinophilic pneumonia

Answer 4

• eosinophils, macrophages, and fibrin in airspaces
• better with steroids
• from smoking and drug reaction (cocaine)

Question 5

Organizing pneumonia (BOOP)

Answer 5

• Fibroblast plugs in airways and airspaces
• pathcy but may be densely consolidating
• can include small bits of fibrin
• can melt away without fibrosis if steroids added

Subacute to chronic presentation
Noninfectious pneumonia
Imaging shows ground glass and consolidation that may be migratory
Path: organizing pneumonia
Plugs of granulation tissue and fibrosis distal to bronchioles
Very steroid responsive, but requires 6-12 months.
Relapses possible with rapid steroid withdrawal.

Question 6

Diffuse alveolar damage (DAD)

Answer 6

• hyaline membranes (ribbons) filling airspaces
• alveolar septa thickened by inflammation and fibroblastic tissue
• most severe airspace disease

Question 7

Emphysema

Answer 7

• enlarged airspaces
• broken alveolar septa
• subpleural blebs
• non-pathologic
• can lead to pneumothorax due to wall fragility
• smoke related is worse in upper lobes and around airways
• alpha-1-antitrypsin deficiency worse in lower lobes but generally same throughout lobule (panlobular)
• increased lung compliance
• impaired gas exchange
• pan-acinar: Involves entire acinus, Older patients, Alpha-1-anti-trypsin deficiency
• centri-acinar: Smoking related, Involves respiratory bronchioles
• diminished breath sounds
• hyper-resonant
• pursed-lip breathing and tripod

Question 8

Respiratory bronchiolitis (RB)

Answer 8

• smoking related
• pigmented macrophages in airspaces near bronchioles
• worst in upper lobes

Question 9

Desquamative interstitual pneumonia

Answer 9

• smoking related

- pigmented macrophages in all airspaces

Question 10

pulmonary alveolar proteinosis (PAP)

Answer 10

• airspaces filled by pink fluid and macrophages