Medical autopsy - pulmonary

Question 1

components of obstructive pulmonary disease (overlap)

Answer 1

emphysema: airspace enlargement, alv wall destruction (SOB)

chronic bronchitis: mucous gland hyperplasia/hypersecretion (productive cough)

asthma: smooth muscle hyperplasia, mucus, infammation (wheeze/cough/SOB)
bronchiolitis: small airway disease (cough/SOB)
bronchiectasis: airway dilation and scarring (recurrent infection)

Question 2

asthma histo

Answer 2

mucus plugs

Curschmann spirals

eosinophils

Charcot-Leyden crystals

airway remodelling (muscle hyperplasia, fibrosis, enlarged glands)

Question 3

who are prone to aspiration? (3)

Answer 3

debilitated patients, unconcious (eg stroke), repeated vomiting (eg alcoholics)

Question 4

what are pathologic findings of aspiration

Answer 4

chemical and bacterial pneumonia

often necrotising with abscess in survivors

need either 1) witness or 2) infection/necrosis/inflammation otherwise could be postmortem transfer of stomach contents

Question 5

2 patterns of pneumonia

Answer 5

1) bronchopneumonia - patchy consolidation/suppuration (neuts and exudate)
2) lobar pneumonia - 4 stages:
- congestion (boggy, red)
- red hepatisation (red, firm - neuts and RBCs)
- grey hepatisation (grey, dry - fibrin)
- resolution (granular debris and macrophages)

Question 6

pathology of DAD

Answer 6

acute lung injury by infection or physical injury/toxin

macro: red and boggy
micro: collapsed alveoli, hyaline membranes, oedema

Question 7

pathology of respiratory bronchiolitis

Answer 7

inflammatory scarring caused by smoking/pollution

micro: alveolar macrophages in terminal airways, esp upper lobe

Question 8

causes/types of pulmonary oedema

Answer 8

cardiogenic (or haemodynamic eg oncotic)

non-cardiogenic:

• oncotic (eg nephrotic syndrome)
• neurogenic
• toxic (gas, liquid/drowning, blood borne, radiation)

Question 9

histo of pulmonary oedema

Answer 9

alveolar macrophages

haemosiderin-laden macrophages (‘heart failure cells’)

Question 10

risks for PE

Answer 10

disease (cardiac, cancer)

immobility (esp hip#)

hypercoagulability (primary, or obesity/surgery/OCP)

Question 11

pathology of PE

Answer 11

large embolus: sudden death by resp failure or acute cor pulmonale

small emboli: haemorrhage or infarction in wedge shape (apex towards hilum)

Question 12

thrombus vs post mortem clot?

Answer 12

thrombus: lines of Zahn, focally attached
clot: dependent blood with ‘chicken fat’ on top