Pulmonary Pathology DSA I Flashcards
Resorptive, Compression, and Contraction atelectasis
Resorption - apex lowers.
Compression - base raises.
Contraction - entire long shrinks.
Acute stage of Acute Respiratory Distress Syndrome (ARDS) morphology
Acutely, lungs are heavy, firm, red and boggy w/ intra-alveolar edema, inflammation and fibrin deposition w/ **diffuse alveolar damage.
What is diffuse alveolar damage?
Alveolar walls become lined w/ waxy hyaline membranes that are morphologically similar to hyaline membrane DZ in neonates.
What is ARDS?
Clinical syndrome of progressive respiratory insufficiency from diffuse alveolar damage in the settings of:
- sepsis
- severe trauma
- diffuse pulm infection
What are the 2 key initiating events of lung disease?
Damage to endothelial and alveolar epithelial cells w/ inflammation.
Smoking/pollution + genetic predisposition can lead to alveolar wall destruction via which 3 mechanisms?
- Oxidative stress, increased apoptosis, senescence.
- Inflammatory cells, release of mediators.
- Protease-antiprotease imblance (a1 can come in here).
Generally, which parts of the lungs are effect most in emphysema?
Upper 2/3.
Microscopically, what do the alveoli look like in emphysema?
What causes the alveoli look like this from smoking?
Abnormally large and separated by thin septa w/ focal centriacinar fibrosis.
Ongoing accumulation of inflammatory cells, which releases elastases and oxidants which damage the alveolar walls.
“Emphysema is…”
A chronic obstructive airway DZ characterized by permanent enlargement of air spaces distal to terminal bronchioles.
4 subtypes of emphysema
Centriacinar - most common, smoking related.
Panacinar - seen in a1 antitrypsin def.
Distal acinar
Iregular
What is the major gross change to the lung in a patient w/ chronic bronchitis?
Hyperplasia of mucous glands
Reid index
Used to asses the amount of mucous gland hyperplasia by taking the ratio of thickness of the mucous gland layer to the thickness of the wall between the epithelium and cartilage. Usually 0.4, but increased in pts. w/ COPD.
Bronchiolitis obliterans
Obliteration of the lumen of bronchioles from fibrosis seen in severe lung disease.
Chronic bronchitis defined:
Persistent productive cough for 3 consecutive mo. in at least 2 consecutive years.
2 dominant pathologic features of chronic bronchitis
Mucous hypersecretion and chronic inflammation
Curshmann spirals
A finding in sputum or bronchoalveolar lavage specimens that likely result from extrusion of mucous plugs from subepithelial mucous glands or bronchioles in pts. *dying of acute severe asthma.
Charcot-Leyden crystals
Another finding in a patent dying from acute severe asthma. They are composed of an eosinophil protein called galectin-10.
What’s airway remodeling?
Occurs in asthma and includes:
- thickening of airways
- sub-BM fibrosis
- increased vascularity
- glandular hyperplasia and increased goblet cells
- enlargement of bronchial wall muscle
Atopic asthma is caused by what immune reaction?
What 3 cytokines are most known to have a role?
What inflammatory cell is most commonly found in asthmatics?
Th2 and IgE-mediated rxn.
IL-4, IL-5, IL-13.
Eosinophils
What part of lung is usually affected by bronchiectasis? What part of the respiratory tree is most serious?
What do the airways look like?
Lower lobes BL, and most severe in distal bronchi and bronchioles.
Dilated, sometimes up to 4x normal.
Distal interstitial fibrosis of the lung gives rise to…
Restrictive lung DZ, characterized by reduced compliance and FVC. The ratio of FEV1/FVC is normal.
What “characterizes” idiopathic PF?
Patchy interstital fibrosis fibroblastic foci and honeycombing.
Coal macules and nodules
Macules are Mo found in pts. exposed to anthracosis and together form a nodule, along with some collagen fibers.
Complicated coal workers’ pneumonia
Occurs in background of simple diseases and requires yrs to develop. It is characterized by blackened scares 1 cm or bigger (usually multiple) that consist of dense collagen and pigment. The center is usually necrotic from ischemia.
What disease is associated w/ “hard, collaginous scars” in the hilar LNs and upper lung zones?
What is eggshell calcification?
Silicosis
The calcification of these nodes seen on CXR.
What do asbestos bodies look like?
Golden brown, fusiform or beaded rods w/ a translucent center and consist of asbestos fibers coated in iron proteinaceous material, like ferringuous bodies.
Most common manifestation of asbestos exposure:
Pleural plaques n the anterior and posterolateral parts of parietal pleura and over the domes of the diaphragm.
Pneumoconioses
Most common type:
A group of chronic fibrosing DZs of lung resulting from exposure to organic and inorganic particulate, suually mineral dust.
Silicosis
