Pulmonary Disorders Flashcards
Obliterative bronchiolitis
- Caused by adenovirus
* Bronchiolitis —> healing by fibrosis
RSV
- Nosocomial infection of children
- Usually self-limited
- May cause disorganized epithelium and severe distention (? displaced surfactant)
Whooping cough
- Bordetella pertussis
* May cause bronchiectasis
Candida albicans
•May produce mucosal ulceration
Bronchocentric granulomatosis
- In asthmatic pts: allergic aspergillosis
* Non-asthmatic pts: TB or histoplasma; often coincides w/ autoimmune disease
Right middle lobe syndrome
Collapse of R middle bronchus from hilar lymphadenopathy
Strep pneumoniae
- Young to middle-aged adults
- Lobar PNA
- S/p aspiration of pneumococci or viral URI
- “Rusty” sputum, alveolar filling on CXR
Klebsiella pneumoniae
- Lobar PNA
* Mucoid lung surfaces, bulging lobes, tissue necrosis/abscesses —> bronchopleural fistula
Staph aureus
- Common in CF pts, nosocomial infection
* Many small abscesses; may create pneumatoceles (cystic spaces)
Group B strep
Newborns; Sx look like respiratory distress syndrome; w/ severe toxemia, rapid death
Legionella
- Hard to Cx
- Contaminated water
- Widespread bronchopneumonia w/ necrosis of inflammatory cells
Pseudomonas aeruginosa
- Immunocompromised, burns, CF
* Occurs w/ vasculitis
Mycobacterium
- Ghon lesion: granuloma at periphery of lung
- Miliary TB: multiple small granulomas in many organs
- M. avium-intracellulare: immunocompromised, extensive macrophage infiltrate w/ innumerable acid-fast orgs
Actinomycosis
- Multiple small lung abscesses
- Gram + filamentous bacteria
- Sulfur granules
Nocardia
- Beaded, thin filaments w/ R angle branching
* Pts w/ lymphomas, neutropenia, chronic granulomatous disease, alveolar proteinosis
Histoplasmosis
- Midwest & South
- Inhalation of bird droppings
- Resembles TB
- Granulomas prone to calcification
Aspergillosis
- AIDS pts or pts on cytotoxic therapy
- Invasive: blood vessel invasion —> thrombosis, lung infarcts
- Aspergilloma: fungus ball grows in pre-existing cavity
- Allergic bronchopulmonary aspergillosis: eosonophilia, increased serum IgE, proximal bronchiectasis
Pneumocystitis jiroveci
- Fungus
- Interstitial infiltrates, type 2 pneumocyte hyperplasia
- Alveoli filled w/ foamy exudate
CMV
- Interstitial infiltration
* Cytomegaly w/ nuclear inclusion
Diffuse alveolar damage
- Causes ARDS
- Triggered by variety of insults
- Hyaline membranes and collagen deposition in alveolar walls
- Leakage of plasma proteins
- “Honeycomb lung”
Goodpasture syndrome
Diffuse alveolar hemorrhage, glomerulonephritis, Ab to basement membrane
Eosinophilic PNA
- Loeffler syndrome: Mild or asymptomatic PNA with eosinophilia
- Acute/chronic: allergy association
- Infectious: parasites
Lipid PNA
- Endogenous: secondary to bronchial obstruction
* Exogenous: aspirated oils
Alpha 1-antitrypsin deficiency
- A1AT is an inhibitor of proteinases including elastases
- Lack of inhibition leads to alveolar wall destruction
- Possible liver disease
Silicosis
- Simple nodular: progression of 10-40 yrs; “whorled” collagen nodules containing needle-shaped silicates; possible “eggshell calcification” of nodes
- Progressive massive: nodules 2-10 cm wide w/ central cavitation
- Acute: progression of a few yrs; no nodules; alveoli contain eosinophilic material
Coal workers’ pneumoconiosis
- Anthracosis or anthracosilicosis
- Scattered 1-4 mm black foci
- Carbon-laden macrophages
Asbestos
- Diffuse interstitial fibrosis
- Asbestos bodies: long, thin fiber surrounded by iron-protein coat
- Plaque on parietal pleura
- Mesothelioma
Berylliosis
- Aerospace, industrial ceramics, or nuclear industries
* Noncaseating granulomas
Talcosis
- Variable pathology
- FB granulomas w/ plate-like particles
- Associated w/ IV drug use
Acute hypersensitivity pneumonitis
- Acute or chronic interstitial inflammation
* Chronic may have poorly formed granulomas, organizing PNA
Sarcoidosis
- Can also involve nodes, skin, eye
- More common in African-Americans
- CD4 helper cells form multiple noncaseating granulomas
- Along pleura, interlobular septa, around bronchovascular bundles, bronchial submucosa (diagnose via bronchoscopic biopsy)
- Can progress to onion-skin fibrosis around giant cells
Idiopathic pulmonary fibrosis
- Patchy interstitial fibrosis adjacent to normal lung
- Loose fibroblastic tissue adjacent to dense collagen
- Epithelium grows into dilated airspaces
- Gradual DOE and dry cough over 1-3 yrs
Desquamative interstitial PNA
- Smokers
- Alveolar architecture is preserved w/ minimal fibrosis
- Intra-alveolar macrophages contain golden-brown pigment
Respiratory bronchiolitis
- Smokers
* Pigmented macrophages centered on bronchioles
Langerhans cell histiocytosis
- Smokers 20-40
- Nodular infiltrates w/ stellate border
- Langerhans cells: eosinophilic cytoplasm, grooved nuclei
- Eosinophils
Lymphangioleiomyomatosis
- Women of childbearing age
- Abnormal proliferation of smooth muscle in lung (? hormonal control)
- Tuberous sclerosis gene complex mutation
Pulmonary HTN
- L to R shunt
- Recurrent PEs
- Hypoxemia
- LV failure
Pulmonary hamartoma
- Usu. at periphery
- Popcorn calcification
- Several types of tissue interspersed w/ respiratory epithelium-lined clefts
Small cell carcinoma
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