Pulmo Part 2 Flashcards
Hallmark of CILD (restrictive, infiltrative)
Reduced compliance (more pressure required to expand lungs bec they are stiff) necessitating effort in breathing (dyspnea)
Unknown etiology
Patchy progressive bilateral interstitial fibrosis resulting in hypoxemia and cyanosis
Histology: usual intersitial pneumonia
Idiopathic pulmonary fibrosis
Cryptogenic fibrosing alveolitis
Endogenous inhibitor of pulmonary fibrosis
Caveolin-1
Downregulated by TGFB1
Cobblestones of pleural surface bec of retraction scars along interlobular septa
Patchy interstitial fibrosis
Fibroblastic foci
Temporal homogeneity (early and late lesion)
Honeycomb fibrosis
Idiopathic pulmonary fibrosis
Dense fibrosis causing collapse of alveolar wall and cystic spaces lined by hyperplastic type II pneumocytes or bronchiolar epithelium
Honeycomb fibrosis
Dry velcro like crackles on inspiration
Cyanosis, cor pulmonale
Peripheral edema
Lung biopsy for diagnosis
Mean survival 3 years
Tx: lung transplant
Idiopathic pulmonary fibrosis
Mild to mod chronic interstitial inflamm in uniform or patchy distribution
Nonspecific interstitial pneumonia cellular
Best prognosis
Diffuse patchy intersitial fibrosis without temporal homogeneity of UIP
Nonspecific intersitial pneumonia fibrosing
BOOP Bronchiolitis obliterans organizing pneumonia
subpleural or perobronchial patchy areas of air space consolidation
Polypoid plugs of loose CT
Lung architecture normal
Tx: steroid 6 mos
Cryptogenic organizing pneumonia
Cryptogenic organizing pneumonia histologic hallmark
Balls of fibroblast in alveolar space
Masson body
Restrictive lung diseases with reduced lung compliance and reduced FVC
Ratio of FEV/FVC = normal
Diffuse interstitial fibrosis
Unifying pathogenic factor of DIF
mac activation and TGFB release (fibrogenic)
Patchy intersitial fibrosis, fibroblastic foci, cystic space formation honeycomb lung and Usual Interstitial Pneumonia
Idiopathic pulmonary fibrosis
Non neoplastic lung reaction to mineral dust
Pneumoconiosis
Particles 5-10 um are
Particles 0.5 less are
unable to reach distal airway
move into and out of alveoli without deposition
Most dangerous bec they get lodged at the bifurcation of distal airway
1–5 um
Key cellular element in initiation and perpetuation of lung injury and fibrosis
alveolar macrophage
Smoking worsens effects of inhaled mineral dusts especially
asbestos
Most common mineral dust pneumoconioses
coal
dust
silica
Coal worker’s pneumoconiosis:
Macule and nodule
Coal mining
Complicated coal worker’s pneumoconiosis
PMF
Sandblast quarrying mining stone cutting foundry work, ceramics
Silicosis
Pleural effusion, pleural plaque, diffuse fibrosis, mesothelioma, carcinoma of lung and larynx
Mining, milling, fabrication of ores and materials, installation and removal of insulation
Asbestos
Pigment accum without perceptible cellular reaction
Anthracosis
Most inoccuous coal induced pulmo lesion in coal miner and smoker
Carbon engulfed mac accumulating in CT along lymphatics
Pulmonary anthracosis
Dust laden mac
small amounts of collagen fibers arrayed in delicate network
Frequent in upper lobes
Centrilobular emphysema
Coal macule
Coal nodule
Simple CWP
Coalescence of coal nodule
Multiple intense blackened scar larger than 2cm
Dense collagen and pigment
Complicated CWP
Progressive massive fibrosis
Pulmonary dysfunction
Pulmonary hypertension
Cor pulmonale
Progressive massive fibrosis
Most prevalent chronic occupational disease worldwide
Silicosis
Most implicated in silicosis
Less fibrosis if mixed with other minerals
quartz
Tiny barely palpable discrete pale-to-blackened nodules in upper zones of lungs
Concentrically arranged hyalinized collagen fibers surrounding amorphous center
Whorled appearance, weakly birefringent silica at the center sometimes with egg shell calcification in LN
Silicotic nodule
Silicosis is associated with inc susceptibility to
tuberculosis and
lung cancer
inhibited ability of mac to kill phagocystosed bacteria
Asbestos fiber is curly and flexible
Most common and impacted at upper respiratory passage
Serpentine
Chrysotile
Asbestos fiber is straight, stiff and brittle
More pathogenic bec can lodge deep to interstitium
Amphibole
asbestos can produce
asbestosis
lung ca
mesothelioma
Important to synergy between smoking and lung ca in asbestos
adsorption of carcinogen in tobacco smoke onto asbestos
Golden brown fusiform rod with transluscent center
Asbestos fiber coated with iron material
Asbestos bodies
Most common manif of asbestos exposure
Well circumscribed plaque of dense collagen containing calcium on parietal pleura
Pleural plaque
Asbestosis begins
in lower lobes and subpleura
Asbestos exposure is linked with
1 parenchymal intersitial fibrosis 2 plaques/diffuse pleural fibrosis 3 pleural effusion 4 lung cancer 5 malignant pleural mesothelioma 6 laryngeal cancer
Causes pneumonitis and interstitial fibrosis
Bleomycin
Causes pneumonitis and fibrosis
Amiodarone
1 month post radiotherapy
Fever, dyspnea, pleural effusion, pulmo infiltrates
Resolve with corticosteroid therapy progressing to chronic radiation pneumonitis
Radiation pneumonitis
Multisystem disease of unknown etiology characterized by noncaseating granuloma in organs
Diagnosis of exclusion in young less than 40, nonsmoker
Mc manifestation
Sarcoidosis
Bilateral hilar lymphadenopathy or lung involvement
Sarcoidosis pathogenesis
Disordered immune regulation in genetically predisposed persons
Diagnostic histopath feature in sarcoidosis
Noncaseating epitheloid granuloma irrespective of organ involved
Laminated concretion of calcium and protein
Schaumann body
Stellate inclusion enclosed within giant cell
Asteroid bodies
Uveoparotid involvement in sarcoidosis
Mikulicz syndrome
CD4 cells secreting THI Independent cytokines
IFN y
IL2
LN enlargement, sicca syndrome, erythema nodosum, visceral invovlement
Lung 90% with granuloma formation and intersitial fibrosis
Sarcoidosis
Immunologically mediated and delayed type hypersensitivity inflammatory lung disease primarily affecting alveoli
Type III and IV (caseating granuloma) hypersensitivity
Hypersensitivity pneumonitis
Mold’s hay exposure
Micropolyspora faeni
Farmer’s lung
Moldy sugar cane
Bagasse
Thermophilic actinomycetes
Bagossis
Moldy maple bark
Cryptostroma corticale
Maple bark disease
Cool mist humidifier
Actinomycetes
Aureobasidium pullulans
Humidifier lung
Mold barley
Apergillus clavatus
Malt worker’s lung
Moldy cheese
Penicillium casei
Cheesewasher’s lung
Dust contaminated grain Sitophilus granarius (wheat weevil)
Miller’s lung
Pigeon dropping
Pigeon serum protein in dropping
Pigeon breeder’s lung
Chemical industry
Trimellitic anhydride isocyanate
Chemical worker’s lung
Fever, dyspnea, hypoxia and diffuse pulmo infiltrate
BAL 25% eosinophil
Prompt response to corticosteroid
Acute eosinophilic pneumonia with respiratory failure
Transient pulmonary lesions
eosinophilia
Thickened alveolar septa with eo and giant cell
Simple pulmonary eosinophilia
Loeffler
Clinically silent emboli percentage
Recurrence rate of PE
60-80%
30%
Hemoptysis
Anemia
Diffuse pulmonary infiltrate
Diffuse alveolar hemorrhage syndrome
Proliferative rapidly progressive glomerulonephritis
Hemorrhagic interstitial pneumonitis
Antibody against alpha3 of collagen IV
Goodpasture syndrome
diffuse alveolar hemorrhage
hemosiderin
linear immuneglobulin deposition in renal biopsy
Diffuse alveolar hemorrhage syndrome
Pulmo manifestation like Goodpasture but no renal disease or antibasement membrane antibody
Idiopathic pulmonary hemosiderosis
Upper respiratory or pulmonary manifestation
Necrotizing vasculitis
Parenchymal necrotizing granulomatous inflammation
sinusitis, epistaxis, nasal perforation
cough, hemoptysis, chest pain
PR3 ANCA +
Wegener’s granulomatosis
Pneumococcal infections occur with inc frequency in
1 chronic disease (DM, COPD, CHF)
2 congenital or acquired IgG defect (AIDS)
3 sickle cell or splenectomy bec harbors phagocyte and produces antibody
Pneumococcal pneumonia is acquired by
with lobes more involved
aspiration of pharyngeal flora 20%
lower lobes and right middle lobe
4 stages of pneumonia
Congestion
Red hepatization
Gray hepatization
Resolution
Heavy, boggy red, vascular congested lobe
Proteinacious fluid, scattered neutrophil and bacteria in alveoli
Congestion
Liver like consistency and alveolar spaces are packed with neutrophil, red cell, and fibrin
Red hepatization
Dry, gray firm
Lysed red cell with fibrinosuppurative exudate persists within alveoli
Gray hepatization
Uncomplicated case
Digestion of exudate to produce granular semifluid debris resorbed ingested by mac coughed up by fibroblast
Resolution
Complications of pneumonia esp sero type 3
1 abscess
2 empyema
3 organization of intraalveolar exudate converting lung to solid fibrous tissue
4 meningitis, arthritis, infective endocarditis
Gram + lancet shaped diplococci
Most common cause of CAP and a lobar inflammation
S pneumoniae
Most common bacterial cause of acute exacerbation of COPD
H influenzae
Causes epiglottitis and suppurative meningitis in children
H influenzae type B
Encapsulated
Inc cause of bacteria in elderly
2nd most common cause of acute exac of COPD in adult
Causes otitis media along with H influenzae and S pneumoniae
M catarrhalis
Important cause of secondary bacterial pneumoniae in children and healthy adults after viral respi illness (measles, influenza)
Assoc with abscess and empyema
Also a cause of nosocomial p
Staphylococcus aureus
Staph pneumoniae with r sided staph endocarditis is a serious complication of
iv drug abuse
Most freq cause of gram neg bacterial pneumonia
Klebsiella pneumoniae
Pneumonia affecting alcoholics, debilitated and malnourished
Klebsiella
Thick gelatinous sputum is characteristic of Kleb bec
viscid capsular polysaccharide preventing coughing up
Nosocomial and cystic fibrosis related pneumonia
Neutropenic, burns, mech vent
Propensity to invade bv with extrapulmo spread
Fulminant, death with coag necrosis of pulmo parenchyma invading walls of necrotic blood vessel
Pseudomonas aeruginosa
Pseudomonas vasculitis
Pontiac fever(URTI)
Water cooling towers, tubing system
Inhaled aerosolized organism or aspiration of contaminated water
Common in cardiac, renal, hema and organ transplant patient
Legionella pneumophila
L pneumonia may be dx by
L antigen in urine or
+ fluorescent antibody on sputum
Standard: culture
Mosy common atypical pneumonia occuring in closed community
Mycoplasma pneumoniae
Red blue congested subcrepitant area
Inflammatory reaction largely confined within walls of alveoli
Widened edematous septa
Alveolar space free of cellular exudate
Atypical pneumoniae
Moderate amount of sputum Absence of consolidation Moderate elevation of white cell Lack of alveolar exudate Respi distress out of proportion to clinical and radio signs
Atypical pneumoniae
Influenza subtypes are determined by
Hemagglutinin
Neuraminidase
Epidemics
Mutations of HA and NA antigen allowing them to escape most host antibodies
Antigenic drift
Pandemics
HA and NA replaced through RNA recombination with that of animal viruses making all animals susceptible to new influenza virus
antigenic shift
Pulmo abscess resulting from aspiration of infective material are more common on
the right side with more vertical airway
posterior segment of upper lobe
apical segment of lower lobe
Lung abscess may rupture into
Pneumothorax
Empyema
Most common cause of death from single infectious agent
TB
Single most important risk factor for development of TB
HIV
Polymorphism of this gene predisposes diseasr progression without development of effective immune TB response
NRAMPI
Immunity to TB is mediated by
THI cells stimulating mac to kill bacteria
comes at cost of hypersensitivity
Most common opportunistic viral pathogen in AIDS
CMV
