Tutorial Module 4

Classification of Pneumonias in
Domestic Animals
Alfonso Lpez
Atlantic Veterinary College

University of Prince Edward Island

Canada

2014

September 21, 2014

CLASSIFICATION OF PNEUMONIAS
Controversial topics in veterinary medicine

Nomenclature used in veterinary medicine to group pneumonia

EPIDEMIOLOGIC CRITERIA: Enzootic, Contagious, Progressive

MORPHOLOGIC CRITERIA: Gangrenous, Lymphocytic, Proliferative, Exudative

ETIOLOGY CRITERIA : Bacterial, Viral, Mycotic, Parasitic, Aspiration

MISCELLANEOUS CRITERIA: Atypical, Cuffing, Neonatal, Calf, Shipping Fever

CLINICAL CRITERIA: Bovine Respiratory Complex, acute undifferentiated
DISEASE CRITERIA: Distemper, tuberculosis, IBR,

E
M
O
N
I
A

G
R
O

Based on TEXTURE, DISTRIBUTION and TYPE OF EXUDATE,

pneumonias in Domestic Animals can be grossly classified into

five morphologically distinct types

S
S
F

Suppurative Bronchopneumonia
Fibrinous Bronchopneumonia

Interstitial Pneumonia

Embolic Pneumonia

T
U
R
E
S

Granulomatous pneumonia
This gross classification allows you to predict the most likely port of entry,
gives you good rule-outs and help you to decide which laboratory tests
should be requested. It increases your chances to arrive at the most likely
etiological diagnosis.

Distribution y Texture de Pneumonias

Suppurative Bronchopneumonia
normal

Distribution: Cranioventral
Texture: Firm
Color: Red (acute) to grey (chronic)
Cut surface: purulent exudate in bronchi
Port of entry: Aerogenous
Common etiologies:
Bacteria (low grade pathogenicity)
Mycoplasma
Aspiration of bland material

Bovine lung

Most common sequels: Cranioventral abscesses and bronchiectasis

Suppurative Bronchopneumonia in a Calf

Cranioventral consolidation (C) while the caudal lung remains unaffected (N). The texture of
consolidated lung would be firmer than normal. Typically, on cut surface purulent exudate
could be expressed from bronchi (insert.

Suppurative Bronchopneumonia in a Pig

Cranioventral consolidation (C) while the caudal lung remains unaffected (N). The texture
of consolidated lung would be firmer than normal. Typically, on cut surface purulent exudate
could be expressed from bronchi (arrow).

Suppurative Bronchopneumonia in a Dog

N
N
C
C

Consolidation (C) of craneal lobes

while the caudal lobes remain

unaffected (N).

The texture of consolidated lung is

firmer and on cut surface purulent

exudate is present in bronchi.

Acute

The color of consolidated lung varies

according to chronicity from:
Bright red in acute suppurative
bronchopneumonia (severe hyperemia +
small exudate)
Dark red in subacute suppurative
bronchopneumonia (less hyperemia and
more purulent exudate)

Subcute

Pale grey resembling fish-flesh in

chronic suppurative broncho-pneumonia
(exudate, fibrosis, and less blood
because reduced volume density of
pulmonary capillaries).

Chronic
The main microscopic lesion in suppurative
bronchopneumonia would be neutrophils and
macrophages in bronchoalveolar spaces (see next slide).

Suppurative Bronchopneumonia / Histopathology

Bronchiole and alveoli filled with neutrophils

and few macrophages. This microscopic
findings are typical of suppurative
bronchopneumonia

Most Common Sequels of Suppurative Bronchopneumonia

Bronchiectasis
Pleural Adhesions
Lung Abscesses

Pleural Adhesions
Ffibrous adhesions (arrows) between

visceral pleura (lung) and the parietal

pleura (ribs).

Fibrous adhesions are often incidental

finding in lungs at slaughter. It only means
that the animal had a previous
bronchopneumonia

Pulmonary Abscesses

Pulmonary abscesses are common

sequel of suppurative
bronchopneumonia. Note purulent
exudate surrounded by a firbous
caupsule

Bronchiectasis
Bronchiectasis is the rupture
and dilation of bronchial wall
due to enzymatic effect of
neutrophils and macrophages.

It is a irreversible lesion no
matter how much antibiotics are
given to the animal

Bronchiectasis may look like an abscess

because of the abundant muco-purulent

exudate.

However, the exudate are

surrounded by the remnants of the brachial

wall

Pathogenesis of Bronchiectasis
Normal bronchus with cartilage and bronchial glands (arrows)

Proteolytic enzymes
released by neutrophils
degrade mucosa, glands
submucosa and cartilage.

Degraded cartilage
Distended bronchus
Distended bronchus with exudate

Fibrinous Bronchopneumonia

Fibrinous Bronchopneumonia
Bronchopneumonia
Fibrinous

Distribution: cranioventral
Texture: Hard
Color: Red yellow grey
Fibrin on pleural surface
Port of entry: aerogenous
Most common etiologies:
Highly pathogenic bacteria (exotoxins):
Mannhemia haemolytica, Actinobacillus
pleuropneumoniae;
Harsh aspirated materials

normal

Fibrinous
Bronchopneumonia
Fibrinous
Bronchopneumonia

Note cranioventral consolidation.

Affected lung covered with fibrin.

Fibrinous inflammation implies severe

lung injury (bacterial toxins).

Acute Fibrinous Bronchopneumonia

*
Grounded glass
appearance

Only a small part of the dorso-caudal lung appears normal (asterisk). Note typical
appearance of fibrin. Remember, in severe lung injury, plasma fibrinogen leaks out
of the vessels and clots forming the fibrin in tissue

Acute Fibrinous Bronchopneumonia

Fluid in thoracic
cavity

Fibrinous pneumonia is generally caused b

highly pathogenic bacteria that produce
exotoxins such as
Mannheimia haemolytica
Actinbacillus pleuropneumoniae

On cut surface, fibrinous

bronchopneumonia has a mosaic
appearance due to distention of the
interlobular septa (small arrows).

Fibrinous
Bronchopneumonia
Fibrinous
Bronchopneumonia

*
*

Histopathology H&E. Note loss of airspaces

due predominantly to exudation of fibrin
(asterisks) and to a lesser extent of leukocytes.

*
Fibrinous pneumonia, particularly Pneumonic
Mannhemiosis (Shipping Fever) and Porcine
Pleuropneumonia also cause coagulative
necrosis (asterisk) and notable dissention of the
interlobular spate

More examples of Fibrinous

Bronchopneumonia

Pleural Adhesions

1
pp

Pleural Adhesions are also important sequel

to fibrinous bronchopneumonia.

vp

1- Visceral pleura (vp) and parietal pleura

(pp) were already attached (acute case).

2 and 3- Fibrous adhesions between

visceral and parietal pleura (arrows).

With time and assuming that the animal survives, fibrinous bronchopneumonia
will eventually results in thick fibrous adhesions between visceral and parietal
pleura (arrows).

Remember, fibrin is an exudate derived from plasma fibrinogen

and fibrous means proliferation of connective tissue. Organized
fibrin is eventually replaced by fibrous connective tissue.

Lung Sequestrum
Lung sequestrum (sequestra pleural) is large pieces of necrotic separated by connective tissue from the
adjacent viable lung. Sequestrum is a nasty sequel of fibrinous bronchopneumonia.

Figure 1. Large wall-off pulmonary sequestrum in .

Contagious Bovine Pleuropnemonia (Mycoplasma
pleuropneumoniae) . This disease s occur in Asia
and Africa, but it is non-existent in the Americas.
If you were to cut this sequestrum it would be
composed of pure necrotic tissue.
Plum Island

Figure 2. Focal areas of acute necrosis

(small circle). If the animal had survived,
these areas of necrosis could become

isolated from the remaining lung forming a

sequestrum.

Interstitial Pneumonia

Interstitial Pneumonia
From all the five gross morphologic types of pneumonia, Interstitial pneumonia is
the most difficult to diagnose grossly. Even microscopically sometime is challenging

Interstitial Pneumonia
Failure of lung
to collapse

Rib
Imprints

Interstitial Pneumonia

Rib
Imprints
Elastic
Texture

Heavy Lungs

Diffuse

Interstitial Pneumonia

On cut
surface

Meaty
appearance

Often
edematous

Ports of Entry for Interstitial Pneumonia

Aerogeous

Port of entry could be either

Aerogenous such as with respiratory
viruses (BRSV, IBR), Distemper) or
Hematogenous such as in herbicide
paraquat toxicity or sepsis (ARDS).

The lesion is centered in the alveolar

wall

Normal
Hematogenous

Interstitial

Histopathology / Interstitial Pneumonia

IP

Normal

Thickening of
the alveolar
walls

Common Causes of
Interstitial Pneumonia

Virus

Sepsis
Gases
Allergy
Protozoa
Other

Distribution y Texture de Pneumonias

Embolic Pneumonia
Distribution: Multifocal

Texture: Nodular
Port of entry: Hematogenous
Color: red when acute, pale when chronic

Note multifocal hemorrhagic lesions randomly

distributed in all pulmonary lobes (arrows). Also
note that the center of the hemorrhagic foci is
often white, suggesting neutrophilic inflammation.

Embolic Pneumonia, Dog

Embolic Pneumonia
Most common etiologies:
Vegetative endocarditis (right side of the heart)
Jugular thrombosis
Rupture of hepatic abscesses into the vena cava (cattle
Embolic foreign body (hair, septic emboli, etc).

Embolic Pneumonia Calf

Note numerous foci of inflammation scattered throughout the lungs (arrows)

Embolic Pneumonia Foal

Embolic lesions are very small and often difficult to see as in the lungs of this foal. Look
closely in the inset and you will notice small dark foci with white center (arrows).

Embolic Pneumonia Dog

Histopathology

Note foci of neutrophilic inflammation lung

Endocarditis (arrow) is a common

cause of embolic pneumonia

Embolic Pneumonia Pig

Fig. 9-41. Lopez a, In: PBVD

McGavin MD, Zachary JF
Mosby, 2007

Note numerous foci of inflammation in the lungs. The focal lesion have a
white color because they are chronic and the initial hemorrhage has been
resolved. These focal lesions are evolving towards small abscesses

Sequel to Embolic Pneumonia: Pulmonary abscesses

Note numerous small abscesses resulting form septic embolisms due to vegetative endocarditis
affecting the tricuspid valve (right side) of the heart. Septic emboli are easily trapped in
pulmonary vasculature causing embolic pneumonia and its sequel pulmonary abscesses.
Bronchopneumonia may also have abscesses as sequels, except that in this latter type of
pneumonia the distribution is cranioventral and not random as in embolic pneumonia.

Granulomatous Pneumonia

Granulomatous Pneumonia
Distribution: Multifocal
Texture: Nodular (no pus)
Cut surface: granulomas
Port of entry:
Aerogenous

Hematogenous

Etiology:
Myocbacterium spp
Systemic mycoses
Parasitic ova
Trapped food particles (starch)

Dead parasites, etc.

Source unknown

Granulomatous Pneumonia

In most granulomatous pneumonias, the

etiologic agent can be detected with special
stains (to be shown later). Among the most
common causes of granulomatous
pneumonia in animals are:

Granulomas

Tuberculosis

Systemic mycosis (Cryptococcus

neoformans, Blastomyces dermatitides,
Coccidiodes immits)
Aberrant parasitic larvae, foreign body
(food particles), algae.
Feline Infectious Peritonitis in cats, etc.

Typical Granuloma
Note typical granuloma with
macrophages in the center and an
external band of fibrous connective
tissue (double arrows) infiltrated by
lymphocytes and plasma cells (not
seen at this magnification).

Epithelioid macrophages

Necrotic
Centre

Connective tissue with lymphocytes

Tuberculosis / Granulomatous Pneumonia

Focal to coalescing granulomas scattered
throughout the lung parenchyma. Nodular texture

Texture would
be nodular

Granulomatous pneumonia is typically caused by organisms or particles that cannot be

readily destroyed by macrophages or in other words resistant to phagocytosis such as
Myocabcterium, fungus, parastic ova, dead larvae, etc.

Tuberculosis / Granulomatous Pneumonia / Cow

Note abundant acid-fast organisms (Ziehl-Nielsen

stain)

Tuberculosis / Granulomatous Pneumonia / Horse

acid-fast organisms (Ziehl-Nielsen stain)

Tuberculosis can affect any tissue including

bones, bone marrow, gonads, kidneys,
meninges, etc.

Multifocal to coalescing granulomas

in lung parenchyma. ..

Note that grnulomatous lesions resemble

neoplasia...

Blastomycosis / Granulomatous Pneumonia / Dog

Port of entry in granulomatous pneumonia could be aerogenous or hematogenous.

yeasts

Lung filled with small often coalescing granulomas..

Texture is typically nodular.

Pulmonary granuloma with giant

cell containing fungal yeasts (PAS
stain)

Feline Infections Peritonitis (FIP)

Feline Infections Peritonitis (FIP) is a viral diseases that
causes granulomatous pneumonia. Granulomas can be
seen in most visceral organs as well as in brain and eyes

Granulomatous vasculitis (arrow)

caused by vascular deposition of
antigen-body complex is the
underlying mechanism.

Lungs

FMVZ-UNAM

Kidney

Granulomatous Pneumonia and Pulmonary Neoplasia

In some cases granulomatous pneumonia and lung tumors can be
remarkably similar on gross examination.
Hence the names granuloma, adenoma, carcinoma.

Histopathology is always required.

Blastomycosis / Dog

Metastatic Carcinoma /Dog

 Some images were acquired from veterinary colleges of

Canada, United States and Mexico and the names of
pathologists who contributed with some slides are known.
Their valuable contribution is sincerely acknowledged.
I would like to thank Dr. Mara Forzn, Atlantic Veterinary
College, for critically reviewing these modules.

Module 4

If you have any comments, criticisms or suggestions about

these tutorial modules please let me know.
Also, if you find any errors or typos please let me know too
lopez@upeica