ILD Oct11 M1 Flashcards
acinus def
everything distal to terminal bronchiole
lobule def
lung parenchyma surrounded by intralobular septae (acini of 1 terminal bronchiole)
how many acini per lobule
6-8
what is found in an acini
1st, 2nd and 3rd order respiratory bronchioles, alveolar duct, alveolar sac
primary lobule def and how many per acinus
lung unit distal to resp bronchiole (ducts, sacs, alveoli). 30-50 per acinus
secondary lobule (lobule) arterial, venous and lymphatic supply
centrilobular artery running parallel to centrilobular bronchiole
pulmonary veins + lymphatics run in interlobular septum
parenchyma def and contents
region involved in gas exchange
- alveolar airspace
- alveolar wall (type 1 and type 2 cells, capillaries, alv-cap BM, interstitial tissue)
- CT surrounding small vessels and lymphatics
non-parenchymal structures (give some)
large airways, large blood vessels, pleura, chest wall
Interstitial tissue surround small arteries and small bronchi: what it connects to
connects directly with alveolar interstitium of alveolar septum
function of the interstitial tissue of the lung
supporting framework for airways, vessels and alveolar airspaces
two interconnected compartments of lung interstitial tissue and do they connect
parenchymal and non parenchymal compartment of lung IS tissue. They connect
parenchymal lung IS tissue: where
in alveolar wall and surrounding small vessels and lymphatics
non-parenchymal lung IS tissue: where
pleura, interlobular septa, surrounding large vessels and airways
how big is the lung parenchymal IS
barely (not) visible on histology slide of alveolar duct
3 spaces that can be involved in ILD
parenchymal IS, non-parenchymal IS, alveolar airspace
ex of disease affecting parenchymal interstitium
pneumocytosis pneumonia
ex of diseases (2) affecting non parench IS
sarcoidosis
edema
condition where dyspnea is worse when lying down
orthopnea
Moderate oedema or interstitial pulmonary oedema (non-parenchymal disease) (filling with gelatinous apperance) symptoms examples
dyspnea, orthopnea, RR 14, O2 sat 90%, mild resp distress, still able to speak in full sentences
interstitial pulmonary edema (moderate) CXR findings
Extra lines in the lung fields running straight to pleura: Kerley B lines.
Heart bigger
Larger pericardiac silouhette
interstitial pulmonary edema (moderate) CT findings
Kerley B lines (1 cm in length, go right out to the pleura)
what kerley B lines are or represent
interlobular septa
gross histology of interlobular septa in interstitial pulmonary edema (moderate)
1mm thickness, gelatinous appearance, loose. Fluid within. Loose appearance joins with IS tissue around bronchus and pulm artery
alveolar pulmonary edema (severe) symptoms examples
severe dyspnea, sitting up doesn't relieve. always breathless, coughin up (with small amounts of frothy pink sputum) RR 30 O2 sat 82 cyanosis speak max 3-4 words at a time
alveolar pulmonary edema CXR findings
more white radioopacities in both lungs
radiolucent linear lines (airways)
name of radiolucent linear lines (airways) seen on severe (alveolar pulmonary) edema on CXR
Air bronchograms
black lines, transparent to X-ray
why see air bronchograms in CXR of alveolar pulmonary edema
No disease in airways so are radiolucent (let X ray through and appear black) bc disease in airspace
name of pattern seen on CXR of alveolar pulmonary edema and explanation
Acinar pattern. bc airspaces filled with something (fluid in case of edema)
Acinar pattern: what is the differential or what can be filling the airways
fluid, pus (pneumonia), blood (alveolar hemorrhage), pissou
alveolar pulmonary edema appearance on gross histology
lung parenchyma grey instead of red. greyish tissue goes 1 cm around edge of bronchial wall
Alveolar airspaces filled or obliterated
3 categories of edema
early pulmonary edema
interstitial pulmonary edema (non parenchymal)
alveolar pulmonary edema (parenchymal)
early pulm edema: pulm capil wedge pressure + CXR findings
13-18 mmHg. Engorged blood vessels, resulting in redistribution
interstitial pulmonary edema: pulm capil wedge pressure + CXR findings
18-25 mmHg. Kerley B lines. Thickened fissures
alveolar pulmonary edema: pulm capil wedge pressure + CXR findings
more than 25mmHg. Air bronchograms + Consolidation
redistribution meaning on X-ray
normally, see vessels in airways better on lower parts of lungs. If pressure increase bc of left heart failure, redistribution of blood towards top of X-ray
mechanism of edema in left heart failure
increase in pressure in pulm circulation and so in pulm capillaries too. Fluid leaks to alveolar airspace
why initially non parenchymal IS affected in edema and only severe edema affects parenchymal
initial leak in alveolar airspace is sucked in non parenchymal IS (making interlobular septa and perivascular IS thick) to keep gas exchange
At certain point, this capacity is surpassed
Name of phenomenon when airspaces are filled with fluid
Consolidation
of whole lobule or acinus
Treatment to edema
Diuretic to mobilize fluid (diuretic = makes you pee)
Pneumonia def
lung infection with bacteria, virus or fungus
pneumonia symptoms examples
slowly progressive dyspnea, low grade fever (38.2)
pneumonia CXR findings
fluffyness. Cloudy white appearance.
interstitial pneumonia histology of the alveoli
Thicker alveolar septum. Lymphocytes.
Might see something inside alveolar airspace if is also involved
what interstitium do we mean to be affected when say interstitial pneumonia
parenchymal interstitium
Normal CT: what we can see
vessels, airways, intralobular septum
Abnormal CT: what can be seen
Parenchymal, IS or airspace disease with variety of patterns (whitening of parenchyma area, complete whitening is consolidation), etc.
Sarcoidosis example of symptoms
painful red eye, blurred vision
sarcoidosis X ray findings
enlarged hilar lymph nodes on both sides (bilateral hilar adenopathy) interstitial pattern (kerley B lines but not exactly)
lymphadenopathy definition
disease of the lymph nodes, in which they are abnormal in size, number, or consistency.
Low magnif histo stain finding in sarcoidosis
Normal parenchyma. non parenchymal IS surrounding vessels is involved (appears pink)
higher magnif histo stain finding in sarcoidosis
non necrotizing granuloma. middle cells have elongated nuclei + lightly eosinophilic center
Important cell type found in non parench IS in sarcoidosis
Epitheloid histiocyte (activated macrophage)
sarcoidosis: bands of pinker tissue that is hypocellular, in the granulomas: what is it + shows what
collagen. shows fibrosis
how sarcoidosis heals (2)
treatment or by itself, giving fibrosis
from inside to outside of granuloma, how epitheloid histiocyte number varies. in sarcoidosis
more on outside than inside
sarcoidosis affects what system specifically
multi-system disease
what percentage of patients with sarcoidosis have their lungs affected
95%
3 names of the variants of sarcoidosis
Loefgren’s syndrome
Uveo-parotid fever (Heerfordt’s syndrome)
Lupus Pernio
Loefgren’s syndrome symptoms
fever, polyarthritis, erythema nodosum, abnormal CXR
polyarthritis def
arthritis affecting 5 or more joints simultaneously
erythema nodosum def
inflammation of fat cells under skin
Uveo-parotid fever (Heerfordt’s syndrome) symtpoms
fever, enlarged parotid and uveitis
Lupus pernio symptoms
Violaceous papules on nose, lips and cheeks
3 tests to diagnose sarcoidosis
CXR, bronchoscopy, pulmonary function tests (PFTs)
what bronchoscopy allows in sarcoidosis
confirm diagnosis with trans-bronchial or lymph node biopsy
what PFTs show in sarcoidosis
mixed restrictive obstructive pattern
how many stages to sarcoidosis
4
1st stage of sarcoidosis
hilar lymph nodes enlarged
2nd stage of sarcoidosis
hilar adenopathy + parenchymal involvement
3rd stage of sarcoidosis
lymph nodes back to normal and disease persists
4th stage of sarcoidosis
lung destruction starts, fibrosis, bronchiectasis, airways pulled open by fibrotic lung
treatment of sarcoidosis
Often not needed
steroids help improve
less often: chemo, anti-malarial agents, anti TNF agents. lung transplant
