Respiratory Pathology Part C

Infectious/inflammatory disorders of lower respiratory system || Vascular diseases || Miscellaneous lung disorders

What disorder involves inflammation of the lungs due to a bacterial/viral/mycoplasma/fungal infection that results in accumulation of fluid within certain sections of the lungs?

pneumonia

Where: pneumonia

certain sections of the lungs

Why: pneumonia

bacterial, viral, mycoplasma, or fungal infection

RA: pneumonia (3 types)

alveolar pneumonia (aka lobar or pneumococcal pneumonia)

bronchopneumonia

interstitial pneumonia

Describe the RA for alveolar pneumonia (this pic and pic in description)

homogenous consolidation in segments or the entire lung — air bronchograms are present (when an entire lobe fills with fluid but has not collapsed)

Describe the RA of bronchopneumonia

inflammation produces small patches of consolidation throughout the lungs — no air bronchograms present

Describe the RA of interstitial pneumonia

mesh-like shadows resulting from linear or reticular opacities — untreated can lead to “honeycomb lung” or cystic spaces as demonstrated by CT

What form of pneumonia is most common?

pneumococcal pneumonia

PT is 43 yr old male presenting with productive cough and fever/chills

What pathology is present?

pneumonia — alveolar/pneumococcal pattern

What disorder causes aspiration of esophageal or stomach contents due to obstructions, neuro/muscular diseases, trauma, and anesthesia?

aspiration pneumonia

Where: aspiration pneumonia

upper and lower lobes affected the most if PT is bedridden

Why: aspiration pneumonia

esophageal obstructions, neuro/muscular diseases, trauma, and anesthesia

RA: aspiration pneumonia

multiple alveolar densities throughout lung

What disorder involves a necrotic area of lung tissue containing purulent material?

lung abscess

Where: lung abscess

frequently occurring in the right lung — can spread to the brain and produce brain abscesses

Why: lung abscess

aspiration is the most common cause — necrosis as a secondary complication

RA: lung abscess

encapsulated opaque mass with air fluid level

PT presents with fever, cough and foul-smelling sputum

What pathology is present?

lung abscess

What disease is spread by droplets in the air by infected coughing patients?

tuberculosis

Where: tuberculosis

primarily a lung disease but it can spread to the gastrointestinal, genitourinary and skeletal systems

Why: tuberculosis

caused by mycobactrium tuberculosis

RA: primary tuberculosis (4 criteria)

lobar consolidation

enlarged hilar/nodes

the ghon lesion

pleural effusion

Describe the RA of tuberculosis with lobar consolidation

dense well-defined consolidations usually apical

(image shows consolidation in upper and lower lobes)

What disease may lead to necrosis of lung parenchyma?

tuberculous pneumonia

What disease involves large numbers of bacteria spread throughout the blood stream?

miliary tuberculosis

RA: miliary tuberculosis

fine discreet nodules throughout both lungs

(symmetric and spread through the blood in this PT)

What is a tuberculoma?

a single dense nodule or multiple pulmonary nodules that may lead to dissemination of tuberculosis

What disease in known as a serious form of pneumonia that affects both lungs?

severe acute respiratory syndrome (SARS)

Where: SARS

throughout both lungs

Why: SARS

upper and lower respiratory infections from person to person droplet contact

RA: SARS

• early stages: lungs appear normal

• middle stages: focal infiltrates (abnormal tissue buildup in lung parenchyma)

• later stages: areas of consolidation

PT presentation: SARS

nonproductive cough, fever chills, respiratory distress and progresses to hypoxia

RA: covid-19

multiple bilateral patchy consolidations or opacities

What disease involves the formation or lodging of a blood clot in the pulmonary artery?

pulmonary emboli

Where: pulmonary emboli

clot lodged in the pulmonary artery

Why: pulmonary emboli

commonly a clot from lower limb gets lodged in pulmonary artery — can also be from fat, fragments of a cancerous tumor, or an air bubble

What disease is the most common pathological process involving the lungs in a hospitalized PT?

pulmonary emboli — because PTs are coming in for trauma/cancer treatments/had surgery

RA: pulmonary emboli

CT (most common and more accurate) shows filling defect, NUCMED ventilation study shows perfusion defect

serial CXR rarely to never done but show enlargement of affected vessels

[larger white area = pulmonary trunk leading to the right and left pulmonary arteries]

What is a pulmonary infarct?

necrosis in a part of a lung caused by an obstruction in a branch of a pulmonary artery

What disorder involves partial or complete collapse of a lobe of lung due to diminished air in the lung?

atelectasis

Where: atelectasis

entire lobe of a lung

Why: atelectasis

secondary condition to:

• bronchial obstruction caused by a foreign body

• trauma

• neoplasm

• excessive mucus secretions

RA: atelectasis

a localized increase in density appearing as thin streaks or plates — “plate like atelectasis” to lobar collapse — displacement of lobar fissures

PT presents with difficulty breathing and a productive cough

What pathology is present?

atelectasis

What disease involves the complete break down of the lung leading to a massive leak of cells and fluid into the interstitial and alveolar spaces, resulting in acute and severe respiratory distress?

adult respiratory distress syndrome

Why: adult respiratory distress syndrome

non-thoracic trauma, shock, aspiration of toxic substances, severe pulmonary infection

RA: adult respiratory distress syndrome

patchy, ill defined areas of fluid throughout both lungs, unlike pulmonary edema with CHF (congestive heart failure), heart remains normal size

What disorder involves the aspiration of solid foreign bodies into the bronchial tree?

intrabronchial foreign bodies

Where: intrabronchial foreign bodies

foreign body in bronchial tree — atelectasis in lower lungs usually lower right

RA: intrabronchial foreign bodies

some are radiopaque some are not

• partial obstruction: causes hyperaeration and a shift of the heart and mediastinum

• complete obstruction: causes lobe of lung to collapse - if severe enough volume loss causes a shift of the heart and mediastinum towards affected side with elevation of ipsilateral hemidiaphragm

What pathology is present?

intrabronchial foreign body

What disorder involves air getting into tissues under the skin?

subcutaneous emphysema

Where: subcutaneous emphysema

usually in the skin covering the chest wall or neck, but can occur in other parts of the body

Why: subcutaneous emphysema

(hint: think extreme or aggressive)

many causes, most common is collapsed lung due to rib fracture

PT presents with bulging skin around the neck area

What pathology is present?

subcutaneous emphysema

What disease involves infection and inflammation of the sinuses?

sinusitis

Where: sinusitis

maxillary antra most common

Why: sinusitis

viral or bacterial in origin

RA: sinusitis

increased density and/or fluid levels in an upright sinus radiograph

PT presents with toothache and has recently fallen ill with a viral infection

What pathology is present?

sinusitis (image demonstrates chronic sinusitis as mucosal lining has gotten polyp-like, thus no visualization of air-fluid levels)

What pathology is pictured here?

nasal polyps from chronic sinusitis