Rubin's respiratory Flashcards
- Lung abscess a
localized accumulation of pus accompanized by destruction of pulmonary parenchyma, including alveoli, airways, and bv’s;
can complicate aspiration, lung cancer;
abscess cavities often partially filled with pus and air, accounting for X-ray finding of an “air/fluid level,” and can get foul-smelling sputum if abscess connected to bronchus
- Bronchiectasis often localized to
segment of the lung distal to mech obstruction of a bronchus by a variety of lesions, like tumors, inhaled foreign bodies, mucous plugs, and compressive LAD; look for mucopurulent sputum!!
- Complications of bacterial pneumonia include
- pleuritis (extension of inflamm to pleural space)
- pleural effusion
- pyothorax (infection of pleural effusion)
- pulmonary abscess
- pulmonary fibrosis;
look out for empyema!!
- Though uncommon in terms of comm-acquired disease, think of S aureus and pulm infection in context of
influenza, vital respiratory tract infections, nosocomial staph pneumonia (if prone to aspiration and intubated)
- CMV produces a
characteristic intersitital pneumonia; think immuno comp and children getting it transplacentally;
look for enlargement of infected cells, containing typical intranuclear and cytoplasmic inclusions!!
- INterstitial pneumonia characterized by
hyaline membranes and interstitial inflamm (look for diffuse alveolar damage)
- Cryptococcosis results from
inhalation of spores of C neoformans, encountered in pigeon droppings; think immunocomp;
STAINS POSITIVE with mucicarmine stain for capsular polysaccharides
- P jiroveci can appear as
small bubbles in a background of proteinaceous exudates; in this case, centrifuged bronchoalveolar lavage specimen impregnanted with silver shows a cluster of cysts; cysts appear as round or indented (crescent moon) bodies, approx 5 micrometers in diameter
- Traumatic pneumothorax can occur after
- aspiration of fluid from pleura
- pleural or lung biopsies
- transbronchial biopsies
- positive pressure-assisted ventilation
- Alveolar proteinosis is a condition in which
alveoli are filled with a granular, proteinaceous, eosinophilic material, which is PAS-positive, diastase resistant, and rich in lipids; maybe associated with compromised immunity, leukemia, and lymphoma, respiratory infections, and exposure to environ inorganic dust
- alpha1-antitrypsin deficiency leads to emphysema that is
diffuse and classified as panacinar; normally, alpha1-antitrypsin inhibits neutrophil elastase, enzyme digesting elastin and other components of the alveolar septa
- Status asthmaticus shows on histology
a bronchus containing a luminal mucous plug, submucosal gland hyperplasia, smooth muscle hyperplasia, BM thickening, and increased numbers of eosinophils
- Silicosis marked by
insidious development of fibrotic pulmonary nodules containing quartz crystals; disease can be asymp for prolonged periods of time or cause only mild to moderate dyspnea
- Anthracosilicosis is
highly fibrogenic thanks to the silica;
coal-workers’ pneumoconiosis known as black lung disease because of carbon particle deposition; in complicated cases, think palpable coal-dust nodules throughout lung as black foci (macrophages around with fibrotic stroma)
- In this patient, pulmonary thromboembolism
associated with pulmonary infarction, pleuritic chest pain, hemoptysis, and pleural effusion
- Lymphocytic interstitial pneumonia is a
rare pneumonitis where lymphoid infiltrates are distributed diffusely in the interstitial spaces of the lung; you have chronic inflamm cells and see LIP occur in context of Sjogren and HIV
- Langerhans cell histiocytosis is
eosinophilic granuloma (think of the pulmonary form associated with CIG SMOKERS!!); see Langerhans cells with lymphocytes, eosinophils, macrophages
- Lymphangioleiomyomatosis characterized by
women of childbearing age; widespread abnormal prolif of smooth muscle in lung, mediastinal and retroperitoneal lymph nodes, major lymphatic ducts;
look for bilateral, diffuse enlargement of lungs with cystic changes resembling emphysema;
could respond to antiestrogen and progesterone therapy!!!
- Eosinophilic pneumonia has
inflamm exudate composed of eosinophils and macrophages in the alveolar spaces; look for hyaline membranes;
people respond to corticosteroids!!
- Usual interstitial pneumonia demonstrates histologically
patchy, subpleural fibrosis and microscopic “honeycomb” cystic change; look for DIFFUSE FIBROSIS!!
- Cryptogenic organizing pneumonia:
- originally bronchiolitis obliterans-organizing pneumonia
- look for respiratory tract infections, inhalation of toxic materials, and collagen vascular diseases
- look for loose fibrous tissue in the alveoli and bronchioles
- Broncioalveolar carcinoma is a
primary pulmonary adenocarcinoma originating from stem cells in terminal bronchioles;
cells might be columnar and mucus producing, or cuboidal and similar to type II pneumocytes;
grow along ALVEOLAR SEPTA!!
- Carcinoid tumors occur most often in
the wall of the major bronchus and could protrude into its lumen; look for neuroendocrine differentiation
Hydrothorax is
elevation of hydrostatic pressure in those with CHF causing transudation of edema fluid into pleural cavity
