Pulmonary Pathology I Flashcards
Basic composition of airways
mucus glands, smooth muscle and ciliated columnar respiratory epithelium
Bronchi (general definition) + pathologies that can affect bronchi
- bronchi = large airways w/cartilage
- Acute bronchitis
- Chronic bronchitis
- Bronchiectasis
- Asthma
Pathologic (histologic) changes in Acute Bronchitis
- Neutrophils in the airway lumen and infiltrating the wall of the airway
- Usually infectious
Pathologic (histologic) changes in Chronic Bronchitis
Chronic inflammation (mostly lymphocytes) in the airway wall
Squamous metaplasia of the epithelium (transformation of the ciliated columnar type cells to flattened polygonal squamous cells)
Mucus gland hypertrophy (too many glands making too much mucus)
Pathologic (histologic) changes in Bronchiectasis
- Dilation of the airway compared to the neighboring vessel (should be roughly the same size)
- Often the result of long-standing infection/inflammation
Pathologic (histologic) changes in Asthma
- Thickened subbasal lamina
- Eosinophilic inflammation
- Mucus hypersecretion
Bronchioles (general definition) + pathology affecting bronchioles
- broncioles = small airways w/out cartilage
- chronic bronciolitis
- follicular bronchiolitis
- constrictive/obliterative bronchiolitis
- granulomatous bronchiolitis
Structures indicated by arrows (A - D)
A. Mucus glands
B. Smooth muscle
C. Cartilage
D. Epithelium
Process occuring + likely dx
- squamous metaplasia
- chronic bronchitis
Process occuring + likely dx
- mucus gland hyperplasia
- dx: chronic bronchitis
Pathologic (histologic) changes in chronic bronchiolitis
- Inflammation in the wall of small airways that do not contain cartilage.
- Most common type of inflammation is chronic inflammation (lymphocyte predominate)
Pathologic (histologic) changes in follicular bronchiolitis
lymphoid aggregates with germinal centers
Pathologic (histologic) changes in constrictive/obliterative bronchiolitis
- Fibrosis squeezing the airway lumen shut
- May cause severe airtrapping in the downstream lung
Pathologic (histologic) changes in granulomatous bronchiolitis
- Granulomas composed of clustered histiocytes and multinucleated giant cells
- May be centrally necrotizing or nonnecrotizing
- Necrotizing cases are usually infectious
- Nonnecrotizing cases may be infection, sarcoid or chronic beryllium disease
Probable dx
constrictive bronciolitis
Probable dx
- airway lume = completely obliterated by fibrosis ==>
- obliterative bronchiolitis
Airspaces (general definition) + pathology affecting airspaces
- Pneumonia: acute, aspiration, eosinophillic, organizing
- Diffuse Alveolar Damage (DAD
- Emphysema
- Other smoking-related lung diseases:
- Respiratory Bronchiolitis (RB)
- Desquamative Interstitial Pneumonia (DIP)
- Diffuse Alveolar Hemorrhage (DAH
- Pulmonary Alveolar Proteinosis (PAP)
Pathologic (histologic) changes in Acute Pneumonia
Neutrophils, macrophages and fibrin within airspaces
Usually infectious
Pathologic (histologic) changes in Aspiration Pneumonia
Airspace foreign material (food)
Multinucleated giant cells
Pathologic (histologic) changes in Organizing Pneumonia
- Plugs of loose myxoid fibroblastic tissue plugs in airspaces and small airways
- Usually patchy and may have densely consolidated areas
- May have a small amount of intermixed pink fibrin
- A relatively non-specific finding consistent with an element of sub-acute lung injury
- Also known as Bronchiolitis Obliterans Organizing Pneumonia (BOOP) or Cryptogenic Organizing Pneumonia (COP)
Pathologic (histologic) changes in Eosinophillic Pneumonia
Eosinophils, macrophages and fibrin within airspaces
Pathologic (histologic) changes in Diffuse Alveolar Damage (DAD)
- Hyaline membranes (fibrin ribbons in the airspaces lining the alveolar septa)
- Alveolar septa may be expanded by inflammation and fibroblastic tissue
- The histologic pattern that corresponds to ARDS
Probable Dx
- Diffuse Alveolar Damage ==> ARDS
Pathologic (histologic) changes in Emphysema
- Enlarged airspaces
- Broken alveolar septa (irreversible damage)
- Subpleural blebs – may become very large and cause a pneumothorax if ruptured
Smoking emphysema vs. Alpha-1-antitrypsin pathologic features
- Smoking-related emphysema is worse in the upper lobes and around bronchioles (centrilobular emphysema)
- Alpha-1-antitrypin deficiency related emphysema is worse in the lower lobes and is NOT worse around the airways (panlobular emphysema)
Pathologic (histologic) changes in Respiratory Bronchiolitis
Brown pigmented macrophages in small bronchioles and surrounding airspaces
Pathologic (histologic) changes in Desquamative Interstitial Pneumonia (DIP)
Similar brown pigmented airspace macrophages as RB, but found diffusely in the airspaces, not just around small airways
Probable Dx
Severe emphysema
Probable Dx
- Nonnecrotizing granuloma
- Dx: granulomatous bronchiolitis
- infection, sarcoid, beryllium
Pathologic (histologic) changes in diffuse alveolar hemorrhage
- Blood and iron-containing macrophages within airspaces
- Alveolar septa may be mildly thickened by inflammation and fibroblastic tissue
- May be associated with capillaritis (neutrophils attacking the capillaries of the alveolar septa)
Pathologic (histologic) changes in pulmonary alveolar proteinosis
Airspaces filled with pink fluid and macrophages
