RESPIRATORY

PATHOLOGY
FK-UHN
2013

LUNG DISEASE

INFECTION
NON INFECTION

LUNG DISEASE

INFECTION
- BRONCHITIS
- BRONCHIOLITIS
- PNEUMONIA
* BRONCHO PNEUMONIA
* LOBAR PNEUMONIA
* SPECIAL PNEUMONIA

BRONCHITIS

ACUTE : SPREAD ACUTE

LARYNGOTRACHEO
BRONCHITIS (CROUP)
SEVERE (CHILD)
ETIO : RSV, H. INFL, STREP.
PNEUMONIA
CLINIC : COUGH, PURULENT,
SPUTUM

BRONCHITIS

CHRONIC: - ACUTA CHRONICA

- COUGH > 3 MONTH /
2 YRS
ETIO : SMOKER, POLUTION, INF.
STR. PNEMONIA, H. INFLUENZAE,
RSV, ADENOVIRUS
CLINIC : MAN HYPERCAPNIA,
HYPOXCEMIA, CYANOSIS ( BLUE
BLOATERS ) EMPHYSEMA

PNEUMONIA

ALVEOLAR INFLAMMATION
HIGH PROTEIN EXUDATE
PMN,LYMPHOCYTE &
MACROPHAGE INFILTRATION
LOBAR &
BRONCHOPNEUMONIA

PNEUMONIA

CLINIC : - PRIMAIR
- SECUNDARY
ETIO :
- BACTERIAL
* STREP. PNEUMONIA
* STAPH. AUREUS
* M. TUBERCULOSA, ETC
- VIRAL * INFLUENZAE, MEASLESS
- YEAST* CRYPTOCOCCUS,
CANDIDA, ASPERGILLUS

PNEUMONIA

ETIO : OTHERS PNEUMOCYSTIS

CARINII, MYCOPLASMA, ASPIRATION, LIPID & EOSINIPHYLIC
HOST REACTION :
- FIBROUS
- SUPURATIVE
ANATOMIC :
- BRONCHOPNEUMONIA
- PNEUMONIA LOBARIS

BRONCHOPNEUMONIA

CONSOLIDATION PLAQUE
BRONCHIOLUS & BRONCHUS
AROUND ALVEOLI
INFANT & OLD & WEAKNESS
PATIENT ( CA, CARDIAC FAILURE,
CHRONIC KIDNEY FAILURE, TRAUMATIC CEREBROVASCULAR), ACUTE
BRONCHITIS, CHRONIC OBSTR. RESP.
TRACT,OR CYSTIC FIBROSIS & POST
OP.

BRONCHOPNEUMONIA
-

LESION :
- FOCAL (CENTRE OF
RESPIRATORY TRACT) / PLAQUE
- BILATERAL ( BASAL )
- AUSCULTATION CREPITATION
ETIO :
-

Staphylococcus
Streptococcus
H. influenzae
Coliform, Yeast

HP :
-

ACUTE INFLAMMATION + EXUDATE

LOBAR PNEUMONIA

ALL OF LOBUS
INFANT & OLD PATIENT <<
AGE : 20 50 YRS
MAN > WOMEN
90 % STREP. PNEUMONIA
(PNEUMOCOCCUS)
CLINIC COUGH RUSHTY SPUTUM
FEBRIS (40OC), INSPIRATION
PAIN, BRONCH ASPIRATION
KLEBSIELLA OLD, DM, ALKOHOLIC

PNEUMONIA (STADIUM)

CONGESTION :
- I 24 HRS
- EXUDATE (PROTEIN)
ALVEOLI SPACE
- OEDEMA PULMONAL
- RED COLOUR

RED HEPATISATION
- > 24 HRS DAYS
- ACCUMULATION (LYMPHOCYTE,
MACROPHAGE) ALVEOLAR
- EXTRAVASATION RED CELLS
- FIBRINOUS EXUDATE
(PLEURAL)
- GAS (-) , CONSOLIDATION
(HEPAR)

GRAY HEPATISATION
- FEW DAYS (STAD II)
- FIBRINE (ACCUMULATION)
- WHITE & RED CELLS (LYSIS)
- DARK GRAY

RESOLUTION :
- 8 10 DAYS UNTREATED
- EXUDATE & INFILTRATION
DEBRIS (ABSORB)
- ALVEOLUS WALL (N)
- ALL OF CASE RECOVERY

PNEUMONIA NON INFECTION

ASPIRATION
- LIQUID / FOOD
CONSOLIDATION
INFLAMMATION (SECONDAIRY)
- RISK FACTOR : POST OP, COMA,
STUPOR, LARYNX CA, ETC
- LESION : POSITION !!

LIPID PNEUMONIA
- ENDOGEN OBSTRUCTION
(MACROPHAGE GIANT
CELL)
- EXOGEN
PARAFFIN LIQUID
INTERSTITIAL FIBROSIS

EOSINIPHYLIC PNEUMONIA
- EOSINOPHYL >
INTERSTITIAL & ALVEOLI
(ASTHMA, ASPERGILLUS,
MICROPHYLARIA),
LOEFFLER SYNDROME
(IDIOPATIC)

TUBERCULOSIS

ETIO : M. TUBERCULOSE
LOC : - LUNG >>
- ETC
CLINIC : - VARIATION
- DYSPNOE
- LOSS BODY WEIGH
- FEBRIS - DISTRESS
- SWEATING - COUGH

TYPE : - PRIMAIR
- SECUNDAIR
- MILIER
DX CLINICAL SIGN
LAB : - SPUTUM
- MANTOUX
- BLOOD
RADIOLOGY
IMMUNISATION BCG

PRIMAIR :
- FIRST CONTACT
- PRIMAIR LESION (GHON
LESION) + REG.
LYMPHNODE (GHON
COMPLEX)
- FIBROCALCIFICATION,
BACIL (+)

SECUNDAIR :
- REACTIVATION (PRIMAIR)
- LOC APEX ( +/- BILATERAL )
- FIBROCALCIFICATION

MILIER
- PRIMAIR / SECUNDAIR
- IMMUNITY <
- ORGAN
* MENINGES * KIDNEY
* BRAIN
* LIVER
* OSTEO
* LYMPHA
- GRANULOMA M.
TUBERCULOSA (+)

BREAK

OBSTRUCTION LUNG DISEASE

LOCAL
DIFUSE ( CHRONIC )
- CHRONIC BRONCHITIS
- EMPHYSEMA
- ASTHMA
- BRONCHIECTASIS

LOCAL OBSTRUCTION LUNG

DISEASE

MECHANIC FACTOR
OBSTRUCTION
(C. AL,
TUMOR) COLLAPS /
EXPANSIVE
COMPLICATION ( LIPID, INF.
PNEUMONIA)
FINCTION TEST NORMAL

DIFUSE OBSTRUCTION LUNG

DISEASE

CHRONIC BRONCHITIS
EMPHYSEMA
ASTHMA
BRONCHIECTASE

CHRONIC BRONCHITIS

ETIO : - SMOKERS >>,

- POLUTION
STREP. PNEUMONIA
H. INFLUENZAE &
VIRAL SEVERE
HYPERCAPNIA, HYPOXIA &
CYANOSIS (BLUE BLOATERS)

EMPHYSEMA

ALVEOLUS DILATATION +
ELASTICITY (<<)
FORM :
- CENTRILOBULAR
EMPHYSEMA
- PANLOBULAR EMPHYSEMA
- PARASEPTAL EMPHYSEMA
- IRREGULAR EMPHYSEMA

OTHER FORM
- BULOSA EMPHYSEMA
- INTERSTITIAL EMPHYSEMA
- SENILE EMPHYSEMA
CLINIC :
- DYSPNOE
- COUGH
- SPUTUM

ASTHMA

BRONCHUS IRRITABLE (+)

BRONCHUS SPASM MUCOUS (>>)
OBSTRUCTION DYSPNOE
TYPE : - ATOPIC
- NON ATOPIC
- ASPIRINE INDUCED
- OCCUPATIONAL
- ALLERGIC (ASPERGILLUS)

ATOPIC ASTHMA

ENVIRONMENT MATERIAL
HYPERSENSIVITY
REACTION BRONCHUS
CONSTRICTION
TACHYPNOE, DYSPNOE
STATUS ASTHMATICUS
DEAD

NON ATOPIC ASTHMA

T. RESP. INFECTION
CHRONIC BRONCHITIS
ALLERGEN TEST (-)
LOCAL IRRITATION
BRONCHUS CONSTRICTION

ASPIRINE INDUCED ASTHMA

MECHANISM (?)
+/- PROSTAGLANDINE
DECREASE / LEUKORINE
INCREASE RESP. TR.
IRRITABLE
RHINITIS, NASAL POLYPS,
URTICARIA (+)

OCCUPATIONAL ASTHMA

REACTIVE HYPERSENSIVITY
(ALLERGEN)
DYSPNOE
COUGH (CHRONIC)
ALLERGEN :
- WOOD
- CHEMICAL
- ETC

ASPERGILLUS BRONCHITIS ALLERGY

SPORA ASPERGILLUS
FUMIGATUS HYPERSENSITIVITAS REAC DYSPNOE
MUCOUS GLOBULE
ASPERGILLUS HYPAE (+)

BROCHIECTASIS

ETIO :
- BRONCHUS OBSTRUCTION
- INFECTION (SEVERE)
- CONGENITAL (<<<)
BRONCHUS & BRONCHIOLUS
DILATATION
COUGH (CHRONIC), DYSPNOE,
SPUTUM (>>>) + BLOOD

CLINIC :
- LOBUS INFERIOR + INFECTION
- CLUBBING FINGER
COMPLICATION
PNEUMONIA, EMPIEMA,
SEPTICAEMIA, MENINGITIS,
ABSCESS METASTASIS
(CEREBRAL), AMYLOID (+)

PNEUMOCONIOSIS

DUST: INORGANIC / ORGANIC

TISSUE REACTION :
- MILD
- FIBROUS
- ALLERGIC
- NEOPLASTIC

COAL WORKERS
PNEUMOCONIOSIS
SILICOSIS
ASBESTOSIS
HYPERSENSITIVITY

CARCINOMA OF THE LUNG

Squamous cell.
Adenocarcinoma.
Large Cell Undifferentiated
Carcinoma.
Small Cell Undifferentiated
(Oat Cell) Carcinoma.

PLEURA

EFFUSION
NEOPLASMS OF THE PLEURA

PLEURAL EFFUSION

A collection of fluid in the

pleural cavity.
Transudate Low specific
gravity, low protein concentrat,
and lack of inflammatory cells.
Exudates : specific gravity over
1.015, a protein level of over 1.5
g/dL, and many inflammatory
cells.

Empyema : Bacterial infection

commonly produces a frankly
purulent exudate.
Hemorrhagic exudates occur in
malignant effusions, TB, uremia,
and pulmonary infarction.
Cytologic examination of effusion
sediment malignant neoplasia .

CHYLOTHORAX

Chylothorax : Secific kind of pleural

effusion characterized by
accumulation of chyle in the pleural
cavity.
Chyle : Milky fluid of high fat content
that is normally present in the thoracic
duct.
Evidence of an abnormal
communication between the thoracic
duct and the pleura.

Neoplasms of the Pleura

Primary Mesothelial Neoplasm.

Secondary Pleural Neoplasms.

Primary Mesothelial Neoplasm

Benign Fibrous Mesothelioma.

Malignant mesothelioma.
Rare neoplasm strongly related
etiologically to asbestos exposure;
many cases have occurred in World
War II shipyard workers.
There is a long lag period (as long as
40 years) between asbestos
exposure and tumor development.

Secondary Pleural Neoplasms

Direct involvement of the pleura

by lung carcinoma is the most
common secondary pleural
neoplasm.
Metastases from distant sites
the breast, colon, kidney, and
thyroid.