Beruflich Dokumente
Kultur Dokumente
Nelia Tan-Liu
• Bronchopneumonia
o Consolidated areas of acute
suppurative inflammation.
o Consolidation may be patchy
through one lobe but is more
often multilobar and frequently
bilateral and basal because of the
tendency of secretions
Figure 2.
Gross picture of lung
Figure 4. Slide showing grey hepatization
showing patchy
consolidation of the lung
4. STAGE OF RESOLUTION
• Final stage
• The consolidated exudate within the
alveolar spaces undergoes
Viral Pneumonia
Questions:
Name the common viral agents causing
interstitial pneumonia.
Differentiate viral from bacterial pneumonia
based on predominant histologic pattern.
Describe cytopathic effects in pneumonia
caused by:
o Respiratory Syncytial Virus
o Cytomegalovirus
o Measles
Enumerate three bacterial agents that can
Figure 5. Slide showing fibrotic areas with chronic inflammation present as interstitial pneumonia.
Transudate vs Exudate
• Transudate
o fluid with low protein count; sp gr of
< 1.012
o an ultrafiltrate of blood plasma that
results from osmotic or hydrostatic
imbalance across the vessel wall
without an increase in vascular
permeability
• Exudate
o inflammatory extravascular fluid that
has a high protein concentration,
cellular debris, and an sp gr of >
1.020 Figure 7. Interstitial Pneumonitis
• The alveolar septa are widened and In Fungal Pneumonia, pulmonary damage results
edematous and usually have a from:
mononuclear inflammatory infiltrate of vascular occlusion by the fungus, resulting
lymphocytes, histiocytes, and occasionally in ischemic necrosis, or
plasma cells. direct invasion by and host reaction to the
• In acute cases, neutrophils may also be organism
present.
• The alveoli may be free from exudate, but
in many patients there are intra-alveolar
proteinaceous material, a cellular exudate,
and characteristically pink hyaline
membranes lining the alveolar walls, similar
to those seen in hyaline membrane disease
of infants.
Questions:
Enumerate 3 conditions leading to an
immunocompromised state.
Enumerate other fungal agents that may
cause pneumonia.
Tuberculosis
Case Discussion:
This is the case of a 56 year old Filipino male who
had 2 months history of recurrent febrile episodes in
the afternoon, productive cough and weight loss.
One week prior to consult, patient began to have
blood-tinged sputum and dyspneic episodes. Early tuberculous cavity formed by caseous (cheese-like) necrosis
Initial chest x-ray showed hilar lymphadenopathies,
Figure 13. Pulmonary TB with Cavitations
bilateral apical cavitations, and minimal pleural
effusion on the right.
Important Histologic Feature of TB Granuloma
Questions: • A focus of chronic inflammation consisting of
Give the definitive diagnostic modality for microscopic aggregate of macrophages that
tuberculosis. are transformed into epithelium-like cells
Discuss the different gross facets of surrounded by a collar of mononuclear
tuberculosis. WBCs
Enumerate the important histologic features Figure 14. TB
of a TB granuloma Granuloma
Reid Index
• The ratio of the thickness of the mucous
Figure 18. Trachea and Main Bronchi. The trachea in the mid-upper gland layer to the thickness of the wall
field is hyperemic, and the bifurcation and main stem bronchi contain between the epithelium and the cartilage.
mucopurulent exudate. The underlying epithelium is also inflamed. • The normal ratio is 0.4.
This picture may occur in chronic bronchitis and a superimposed
• It is increased in chronic bronchitis.
infection. However, one may also see this picture as part of an acute
inflammatory process in a patient dying of acute pneumonia.
Remember that chronic bronchitis is a clinical term.
Adult Respiratory Distress Syndrome
Case Discussion:
A case of a 52 year old diabetic, with a history of
cerebral infarct and with left-sided residuals, who
was diagnosed to have community acquired
pneumonia on admission. Patient was admitted for 6
days and was apparently improved on discharge. At
home, patient developed high grade fever, body
malaise and recurrence of productive cough.