Respiratory Pathology 6 - SRS Flashcards
What are the categories of pulmonary diseases of vascular origin we covered in this lecture/dsa?
Pulmonary embolism
Pulmonary hemorrhage
Pulmonary Infarction
Pulmonary HTN
Diffuse Pulmonary hemorrhage syndromes
Other vasculitidies
What are the diffuse pulmonary hemorrhage syndromes we covered here?
- Goodpasture syndrome
- Wegener Granulomatosis
- Idiopathic pulmonary hemosiderosis
Pulmonary embolism is an underdiagnosed and significant cause of death via what?
Respiratory and hemodynamic compromise with 10% of cases resulting in infarction with hemoptysis.
What color infarct do you get in the lungs?
Red infarct, because various sources of blood to the parenchyma
What are the clinical presentations associated with pulmonary embolism?
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- Dyspnea
- Fever
- Chest pain
- hemoptysis
- electromechanical dissociation
- Sudden death
What enzyme will be elevated in PE?
LDH (as with many other diseases)
Where do most PE’s come from, and where do they most often end up?
Most form in the deep leg veins
Most go to the lower lobe of the lungs
What is the procedure by which we perform a V/Q scan?
- Patient inhales a radioactive compound
- Radioactive compound injected into the vein, travels to the lung tissues
- Visualize the distribution of the two radioactive compounds to see if areas are subject to obstruction of vasculature or airway
In a pulmonary embolus what would you likely see if you performed a V/Q scan?
- Inhaled radioactive compound will likely distribute evenly to the whole lung.
- Injected radioactive compound will reveal a portion of lung that is not being perfused due to clot obstruction
What is the gold standard for dxing a PE?
Pulmonary angiography
What is shown on this spiral CT?
Pulmonary embolisms indicated by both arrows. While angiography is the gold standard, typically in clinic the diagnosis is made with spiral CT
What lines will you see in a thrombus that tell you it did not form post mortem?
Line’s of Zahn
What is shown here?
Embolic blockages at the points indicated.
What is shown here?
An acute hemorrhagic pulmonary infarct
Explain the color of this infarct.
This is an older infarct that has had hemosiderophages come in and clean out some of the RBC’s. So, not a white infarct even though it looks white now.
What caused the finding indicated by the arrow?
Fat embolus d/t trauma (e.g. long bone fx or surgery)
The finding is absence of RBC’s in the vessel lumen. The staining procedure dissolved the fat embolus, so you can’t see it either. Have to logic it out.
This image has been frozen sectioned and stained with Sudan Black B. What is shown here?
This is a fat embolus. The process of frozen sectioning preserves the fat from the embolus, and a stain such as Sudan Black B will visualize the fat cells.
In addition to fat emboli, what other embolism is possible from a long bone fx??
Bone marrow embolus
Name as many types of emboli as you can!
- Thrombotic
- Fat
- Bone marrow
- Tumor
- Air
- Nitrogen
- Talc and metal oxides
- bullets
- amniotic fluid
What kind of embolism is shown here?
What are the lines?
Amniotic Fluid embolus, occured during delivery due to tear in the placenta allowing the amnion into the circulatory system.
The lines are Vernix - shed superficial epithelium.
This picture wiggled
What is a possible consequence of this?
This will lead to production of tissue factor and will often lead to concomitant disseminated intravascular coagulation.
Medical emergency
What does the chest xray of the patient this embolus was taken from tell us about the patient’s status?
The lung fields are diffusely edemetous and inflamed and the mother is in danger of going into acute respiratory distress syndrome d/t the amniotic embolus.
At what pressure is the pulmonary system in HTN?
Pressures are greater than or equal to 25mmHg
What are the clinical symptoms of PHTN?
- Dyspnea
- fatigue
- anginal chest pain
- cyanosis if advanced
