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
Empyema is
variant of pyothorax (turbid effusion with many neutrophils); here, thick pus accumulates within the pleural cavity, often with loculation and fibrosis
Chylothorax is defined as
the accumulation in the pleural cavity of a milky, lipid-rich fluid as a result of lymphatic obstruction; usually a rare complication of malignant tumors in the mediastinum, like lymphoma
