Lung Pathology Flashcards
Which restrictive lung diseases may be caused by inhalation of inorganic dust particles?
Pneumoconioses (includes anthracosis, coal worker’s pneumoconiosis, silicosis, and asbestosis)
What causes anthracosis? What histopathologic finding is characteristic of this disease?
Inhalation of carbon dust. Macrophages eat the carbon, resulting in irregular black patches both grossly and histologically (see photo).
Inhalation of both coal dust and silica may cause which restrictive lung disease?
Coal workers pneumoconiosis
Which disease is characterized by fibrotic nodules filled with necrotic black fluid; other sequalae include bronchiectasis and pulmonary hypertension?
Coal worker’s pneumoconiosis
What type of jobs put people at risk for silicosis? Where is silica found?
Silica is found in rocks! People at risk are stone masons, miners, glass makers, stone cutter cats.
What gnarly infectious disease does silicosis put people at greater risk for?
TB
Your patient is a 58 y.o. male who has worked in landscaping forever and he presents with shortness of breath. He doesn’t have heart failure and you get some PFTs that show he is restricted. You do a lung biopsy and the histologic slide is attached. What is your diagnosis?
Chronic silicosis - characterized by fibrotic nodules that enlarge and block airways and blood vessels.
In which lobes of the lung does asbestosis preferentially affect?
The lower lobes
Inhalation of what specific particles causes coal workers pneumoconiosis?
Coal AND silica dust
If your patient was in the ship-building industry and presents with a restrictive lung disease, what should be one of your top DDxs?
Asbestosis
Name a histologic finding in a lung affected by asbestosis. Describe the shit.
Ferrugenous bodies - stain positively for iron stains.
Arise from protein coating asbestos fibers.
What restrictive lung disease, caused by inhalation of inorganic particles, results in formation of dense fibrocalcific plaques on the parietal pleura? What might you find on a histological section from this patient’s lung?
Asbestosis. You might also find ferrugenous bodies.
What cancer(s) do asbestosis predispose people to?
Bronchiogenic carcinoma and malignant mesothelioma
Inhalation of ________ can cause the condition seen here on XR.
Asbestos - its a mesothelioma
What are the two types of idiopathic pulmonary fibrosis? Which type has a better prognosis?
Usual interstitial pneumonia (UIP) - bad prognosis
Non-specific interstitial pneumonia (NSIP) - 100% 5-year survival rate
Idiopathic pulmonary fibrosis is characterized by chronic inflammation of the _______ _______.
alveolar walls
What two gross findings are characteristic of idiopathic pulmonary fibrosis?
- Cobblestoning - surface of the lungs are bumpy
- Honeycomb appearance on a cut surface
What is the distribution of fibrosis in the lungs in UIP?
Fibrosis is seen in the periphery and bases of the lungs in UIP
What is your Dx?
Idiopathic pulmonary fibrosis (honeycomb appearance)
What is your Dx?
Idiopathic pulmonary fibrosis (cobblestoning)
What histological findings are seen in hypersensitivity pneumonitis? How are granulomas of HSP different than those of sarcoidosis?
Non-caseating granulomas and interstitial thickening (fibrosis).
HSP granulomas are seen more often in the periphery and are less well-developed than in sarcoidosis.
Your patient is febrile and is experiencing shortness of breath and productive cough. They recently had a flu-like illness. The photo shows what their lungs would look like. What type of pneumonia is this?
Air space pneumonia –> lobar pneumonia
Is “walking pneumonia” an interstitial or an air space pneumonia?
Interstitial
What is that scary face looking thing? In what patient population is this seen in?
CMV inclusion causing an interstitial pneumonia. Seen in transplant patients that are on immunosuppression.
Is this a caseating or non-caseating granuloma?
Caseating. That whole thing in the middle is necrosis. Non-caseating granulomas have nuclei in the middle of that shit.
What is your Dx?
Pneumocystis pneumonia
What is your Dx?
Aspergillosis, fungus ball/mycetoma on the top right
HIV patient with CD4 count of 50. What is your Dx?
Angioinvasive aspergillosis
Pigeon shit. What is your Dx?
Cryptococcus
Name the bug.
Coccidiodomycosis
What are those lines called?
Lines of Zahn
What is the definition of pulmonary hypertension? Describe the 5 WHO classes.
Pulmonary HTN is a mean pulmonary artery pressure of 25mmHg or greater at rest.
This lesion is due to pulmonary hypertension. What is it called?
Plexiform arteriopathy - due to smooth muscle hypertrophy and hyperplasia
You are working at a clinic on top of a mountain, and your patient presents with shortness of breath. You do a lung tissue biopsy and stain that shit and look at it and it looks like this. What is your Dx?
High altitude pulmonary edema. Pink stuff in the alveolar air spaces is transudate.
In neonatal respiratory distress syndrome, a lack of _______ causes atelectasis, which in turn causes hypoxemia and pulmonary vasoconstriction, ultimately damaging the endothelial cells resulting in plasma leakage into the alveoli. This results in what is seen in the photo (arrow). What is that called?
It is all caused by lack of surfactant. Stuff in the photo is hyaline membranes - from leakage of plasma proteins into the alveoli.
