Images Flashcards
What bug is causing this pneumonia?
strep pneumo = gram positive diplococci
What bug is causing this pneumonia?
staph aureus
What bug is causing this pneumonia that can occur in pts with COPD?
H influenza
WHat bug is causing this pneumonia that is often seen in alcoholics
klebsiella pneumoniae
What is causing this pnuemonia that is seen in hospitalized patients?
pseudomonas
What does this chest xray show?
bronchopneumonia
What does this chest xray show?
Lobar pneumonia
What type of pneumonia is this?
interstitial pneumoniae
What is the difference between these two images?
left = non-necrotizing granuloma
right = necrotizing granuloma
What does this xray show?
miliary TB
What is the difference between these two pictures?
left = bronchial pneumonia
right = lobar pneumonia
What disease of the lungs is this?
bacterial pneumonia because you can see lots of neutrophils filling the air space
What is this?
lung abscess
What type of pneumonia is this?
atypical pneumonia since lack of neutrophils and inflammation just in interstitium not airways
What does this show?
Cytomegalovirus = owl eyes
What is this?
CMV
What is this?
CMV
What is this?
herpes infection
pomegranite apperance
multi-nucleated cell with intranuclear inclusions
What is this?
adenovirus
arrow = smudge cell
What is this?
ghon complex = primary TB
What is this?
cavitary lesion of seoncdary TB
What are these structures in the lung?
multiple granulomas
at this point are not necrotizing
What does this arrow point to?
necrotic center of a granuloma
What does this lesion in lung show?
periphery of necrotizing granuloma
shows histiocytes, ginat cells,and lots of lymphocytes
What kind of stain is this? What bug is the red structure?
acid fast bacilli = TB or atypical mycobacteria
What type of stain? What bug?
acid fast bacili
TB or atypical mycobacteria
What caused this lesion to form in lungs
granulomas from histoplasmosis
well circumscribed, concentric, fibrotic rim + central necrosis
What bug does this arrow point to?
this is histoplasma
narrow based budding = looks like bowling pins
What bug is this on silver stain?
large spherules = coccidoides
What bug is this on PAS stain? how can you tell?
coccidoides
lots of spherules many of which have visible endospores inside
spherules are much much biger than lymphocytes
What makes this granuloma specific for blastomycosis?
central necrosis which contains lots of neutrophils
What bug does this arrow point to
blastomycosis = broad based budding
What fungus does this show?
What fungus does this lesion represent?
this is aspergillus = aspergilloma in previous body cavity
you can see difference between central aspergilloma and the fibrotic cavity surrounding it
What does this lesion represent
This is invasive aspergillus
typical “target lesion” = central necrosis surrounded by hemorrhage and inflammation
What is morphology of aspergillus?
- acute angle < 90 branching
septate hyphae
What type of fungus does this show?
aspergillus = acute angle branched hyphae
What fungus does this show?
aspergillus = acute angle branched hyphae
What does this arrow point to?
cryptococcus
have fibroinflammatory mass with histiocytes
can see organism at arrow
What organism is this stained on GMS?
cryptococcus = narrow based budding
different sizes of organisms
What is this organism? what does the arrow point to?
white that arrow is pointing to = halo
this is cryptococcus
What organism is this pointing to on mucicarmine stain?
this is cryptococcus
narrow based budding
mucicarmine = stains the capsule
What organism creates this type of lesion
pneumocystis jiroveci
classic intra-alveolar exudate with frothy appearance
KNOW THIS
What bug is shown here on GMS stain?
hint only in immune compromised
pneumocystis jiroveci
What fungus is this on silver stain?
PCP in frothy exudate
What type of pathology does this show in this bronchial wall?
Diagnosis?
This is mucous gland hypertrophy
means this patient has chronic bronchitis
What pathology/diagnosis in the pt on the left?
emphysema
What disease in the lung on the right?
This is emphysema
you can see destruction of lung parenchma
What is this disease of the bronchiole?
Asthma!
thickened basement membrane = pink line
mucus plug
What is each of these types of emphysema
Left = centriacinar emphysema; see central areas surrounded by spared alveolar spaces
Right = panacinar emphysema; involves entire pulmonary architecture
What is this disease of the airways?
chronic bronchitis = enlarged mucus glands; very high Reid index
What is this disease of the airways?
bronchiectasis
What is this disease of the airway?
bronchiectasis!
The picture on the left is normal. What is the picture on the right?
ARDS
exudative phase
What pathophys findings in ARDS do these pictures represent?
left = proliferative phase
right = fibrotic phase
What does this chest xray in a neonate show?
Neonatal respiratory distress syndrome
due to lack of surfactant
What does this show?
hyaline membranes in exudative phase of DAD
What does this show?
hyaline membranes in diffuse alveolar damage
What does this image show?
hyaline membranes in diffuse alveolar damage
What stage of DAD is this?
What findings?
This is early organizing/proliferative phase
still have residual hyaline membranes
see fibroblastic proliferation in interstitium, type 2 pneumocyte hyperplasia
What type of pneumonia is this?
eosinohpilic pneumonia
looks like acute bacterial but eosinophils instead of neutrophils
chronic b/c have intra-alveolar fibrin and macrophages
What type of pneumonia is this?
Acute eosinophilic pneumonia
hyaline membranes with eosinophils
What kind of pneumonia is this?
acute eosinophilic pneumonia
= hyaline membranes with eosinophils
What pattern is this?
What does this show?
organizing pneumonia pattern
What does this show?
Organizing pneumonia pattern
What does this show?
organizing pneumonia pattern
with fibroblastic tissue partially within lumen of bronhole
What does this show?
traction bronchiectasis= look like dilated airways
What does this show?
arrows point to reticular abnormality = excessive linear densities
sign of ILD
What do these arrows point to?
honeycombing + cysts
sign of ILD
What do you see in this radiology that is typical of diagnosis?
typical IPF
- bases of lungs more involved than apex
- periphery more involved than center
looksl ike subpleural changes
What is this pattern?
this is usual interstitial pneumonia –> suggest idiopathic pulmonary fibrosis diagnosis
see fibrosis just underneath pleura, honeycomb changes
What does this show?
this is fibroblast focus = whirly of colalgen/fibroblasts/thick tissue
tells you that diagnosis is interstitial pulmonary fibrosis
What stage of sarcoidosis is this?
stage 1 = enlarged hilar lymph nodes but not yet lines/densities in lung fields
What is this?
well formed tightly packed non-caseating granulomas = sarcoidosis
What is this?
This is a ferruginous body = sign of asbestos exposure
What is this?
Asbestos pleural plaque = sign of exposure not disease
What is this finding that can be associated wtih many different interstitial lung diseases?
honeycomb lung
What is this finding assocaited wtih interstitial lung disease?
What type of ILD pathology is this?
usual interstitial fibrosis = patchy fibrosis w/ subpleural predominance
What type of ILD pathology is this?
usual interstitial pnuemonia = patchy fibrosis
right = start to see honeycomb changes
What does this arrow point to?
fibroblast focus = shows usual interstitial pneumonia
What type of NSIP?
cellular nonspecific interstitial pneumonia
What type of NSIP?
fibrosing NSIP
What type of interstitial lung disease?
lymphocytic infiltrative pneumonia
What type of interstitial lung disease?
lymphocytic interstitial pneumonia
What does this show?
sarcoidosis = noncaseating granulomas in lung w/ many giant cells
What finding of a type of interstitial lung disease does this show?
bronchiolocentric pattern of inflammation in hypersensitivity pneumonitis
What type of interstitial lung disease associated wtih smoking?
DIP = diffuse inflammation not just around ariway
What diagnostic marker are the arrows pointing to in this interstitial lung disease?
these are langerhans cells = polygonal cells w/ groove in nucleus
this is langerhans cell histiocytosis
What does this arrow point to?
This is birbeck granule = tennis raquet shaped intracellular structure
characteristic of langerhans cell
What is this?
pleural plaques due to asbestos exposure?
What disease is this?
asbestosis = you can see the asbestos bodies
What disease is this?
asbestosis = shows asbestos bodies
What is this?
advanced silicosis
What is this? What causes it?
silicotic nodule = due to silicosis
What is this?
simple coal workers pneumoconiosis
What is this?
simple coal workers pneumoconiosis
What is this?
complicated coal workers pneumoconiosis
What does this pathologic finding suggest? What is it called?
This is a plexiform lesion. This suggest pulmonary arterial hypertension
What significant finding does the arrow point to on this xray? what does it signify?
This is hampton’s hump
represents pulmonary infarction
What is this? Effect?
pulmonary saddle embolus
results in sudden death
What is characteristic of this clot in pulm vasculature?
has lines of zahn
tells you this is a thrombus rather than a postmortem clot
What does the characteristic pattern here represent?
these are lines of zahn = show that its a true thrombus not a post-mortem clot
What is this? Where is the location of the initial lesion?
This is a pulmonary infarct due to a small thromboembolism
typically the occluded vessel is at the point of the triangle
What is this finding in a pulmonary vessel?
pulmonary thromboembolus
What does this finding in a pulmonary vessel suggest?
This is an organized embolus you can see some recanalization occuring with webs across
sign of chronic small pulmonary embolus
What is this finding in lungs characteristic of?
this is plexiform lesion
characteristic of pulm arterial htn
What is this finding in lung on elastic stain?
plexiform lesion = suggests pulm arterial htn
What does this finding suggest in a patient with pulm htn?
suggests chronic thromboembolic disease = thrombus that is organized w/in arterial wall
What disease does this suggest?
Wegeners = have not-well formed granulomas; very blue areas of necrosis = lots of neutrophils
What vascular disease does this suggest?
What vascular disease does this suggest?
Churg-strauss
have granulomas w/ pallisaded histiocytes/giant cells
around central zone of necrosis w/ eosinophils
What is this finding? What is major cause?
this is diffuse alveolar hemorrhage w/ capillaritis
major cause is microscopic polyangiitis
What is this finding?
hemosiderin; sign of chronic hemorrhage
What is happening in this lung?
this is squamous metaplasia
sign of progression toward squamous cell carcinoma
What is happening in this lung?
This is dysplasia and carcinoma in situ
sign of progression to squamous cell carcinoma
What is this highly suggestive finding in lung cancer?
keratin pearl = sign of squamous cell carcinoma
What is this finding in setting of lung cancer?
atypical adenomatous hyperplasia
suggests adenocarcinoma
What is this finding in cancer?
minimally invasive adenocarcinoma in situ
What type of cancer?
adenocarcinoma! b/c you can see gland formation
What type of cancer?
large cell carcinoma
large cells; no keratin; no mucin; no glands
What type of cancer?
small cell lung cancer
What type of cancer?
this is a carcinoid tumor = small round uniform cells
What type of tumor?
carcinoid tumor
