Lung Pathology

Feb 21. 2016

LungCh. 12 p (459 – 512)


WEIGHT LOBES SEGMENTS BRONCHI ARTERIES, pulmonary bronchial VEINS PLEURA, visceral parietal NERVES

Histology

Bronchioles


The Alveolar – Capillary Membrane TEM of the Alveolar – Capillary Membrane Pneumocyte Type I (P) – BM – Endothelium (E)

Normal Lung

Congenital anomalies Atalectises Acute respiratory distress syndrome Obstructive lung diseases Restrictive lung diseases Vascular diseases Infections Carcinoma
Respiratory Pathology Outline



Esophageal atresia and Tracheoesophageal fistula. A, Blind upper and lower esophageal segments. B, Blind upper segment with fistula between lower segment and trachea. C, Fistula between patent esophagus and trachea. Type B is the most common.
Most common 82%

CYSTIC FIBROSIS

AR disease Defect is of chloride ion transport

Congenital anomalies Atalectises Acute respiratory distress syndrome Obstructive lung diseases Restrictive lung diseases Vascular diseases Infections Carcinoma
Respiratory Pathology Outline

Atelectasis

Greek = incomplete stretching, or expansion Lung collapse Reduced lung volume Inadequate O2 Hypoxia

Atelectasis

Atelectasis



Congenital anomalies Atalectises Acute respiratory distress syndrome Obstructive lung diseases Restrictive lung diseases Vascular diseases Infections Carcinoma
Respiratory Pathology Outline

Diffuse alveolar damage: hyaline membranes

Acute Respiratory Distress Syndrome (ARDS)

ARDS (Adult & Infantile)

Congenital anomalies Atalectises Acute respiratory distress syndrome Obstructive lung diseases Restrictive lung diseases Vascular diseases Infections Carcinoma
Respiratory Pathology Outline

Bullous emphysema with large apical and subpleural bullae.

Mic. Of Emphysema

Pathology of emphysema

Pathogenesis of emphysema. Excessive protease activity and ROS are additive in their effects to tissue damage. α1-antitrypsin (α1-AT) deficiency can be either congenital or “functional” as a result of oxidative inactivation. Pathogenesis of emphysema

Smoking

α-1 antitrypsin deficiency Pathogenesis of emphysema

Bullous

Emphysema (Centriacinar)

Panacinar

Emphysema: dilated air spaces


Definition: persistent, productive cough for ≥ 3 months in ≥ 2 consecutive yearsPathogenesis: hypersecretion of mucousCause: smoking (mostly) and pollution Chronic Bronchitis


Chronic bronchitis. marked thickening of the mucous gland layer (twice-normal) and sq metaplasia of lung epithelium.

Reid index= 0.4 normally

Increase Ried index

COPD

Dyspnea & hyperventilation are prominent, so that until very late in the disease, gas exchange is adequate and blood gas values are relatively normal. Because of prominent dyspnea and adequate oxygenation of Hb, these patients are called “pink puffers.”

“Pink puffer" versus “Blue bloater" At the other extreme in emphysema is a patient who also has pronounced ch bronchitis & a history of recurrent infections with purulent sputum. Dyspnea usually is less, with diminished respiratory drive, so the patient retains CO2, becomes hypoxic, and often is cyanotic. Such patients tend to be obese—hence the designation “blue bloaters.” “Blue bloater"

Chronic inflammatory disease of airways leading to bronchial constriction Symptoms: wheezing, breathlessness Hallmarks: intermittent, reversible airway obstruction, chronic inflammation, increased mucus. Atopic (allergic) vs. non-atopic Triggers: allergens, infection, smoke, cold, exercise
Asthma

How is asthma triggered?

Then what happens?



Bronchial biopsy from an asthmatic patient ; showing 1. sub BM fibrosis, 2. eosinophilic, & 3. SM hyperplasia (4. Mucous & goblet cells hyperplasa)
1
2
3


Curshmann’s spiral A microscopic finding in the sputum of asthmatics which are spiral shaped mucus plugs. These may occur in several different lung diseases


Charcot–Leyden crystals Are microscopic crystals found in sputum in allergic disease (asthma or parasitic pneumonia or ascariasis) They consist of an enzyme synthesized by eosinophils, and are produced from the breakdown of these cells

Permanent dilation of bronchi and bronchioles due to chronic inflammation Secondary to: obstruction (tumor) congenital conditions (cystic fibrosis) bad pneumonia
Bronchiectasis


Bronchiectasis In a patient with cystic fibrosis who underwent lung resection for transplantation. C/S of lung shows markedly dilated bronchi, filled with purulent mucus, extending to subpleural regions.

Bronchiactasis

Mic. Of Bronchiactasis