lungs 6
Terms
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- Sarcoidosis definition
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- Idiopathic multi-system non-necrotizing granulomatous inflammation
- a granuloma is focal accumulation of epithelioid histiocytes - Sarcoidosis Clinical
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- Multi-system granulomatous disease
– Adults, B>W, F>M – complain of dyspnea
- a diagnosis of exclusion
– must exlude infection - Sarcoidosis radiology
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- Interstitial infiltrates in bronchovascular distribution
– Usually hilar adenopathy
– usually diagnosed w/ transbronchial biopsy - Sarcoidosis path
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- Tight, well-formed non-caseating granulomata
– Focal accumulations of epithelioid histiocytes
– can fuse together to make Langhan’s giant which are multinuclear - Hypersensitivity pneumonitis definition
- Specific immune response to inhaled organic dusts
- Hypersensitivity pneumonitis clinical
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- Organic dusts from occupational or environmental exposure
– can be acute and chronic
– come in w/ dyspnea, cough, fatigue - Hypersensitivity pneumonitis organic dusts
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- Organic antigens are microorganisms in hay, sugarcane, and maple bark
– can also be in hot tubs and air conditioners
– animal proteins in birds, pets, and grain weevils
– also synthetic organic chemicals - Hypersensitivity pneumonitis radiology
- bilateral interstitial linear or nodular pattern
- Hypersensitivity pneumonitis path
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- Patchy peri-bronchiolar expansion and interstitial expansion from chronic inflammation
- loosely formed granulomata
– the expansion will usually be stellate - Pneumoconiosis definition
- Inorganic dust accumulation +/- fibrosis
- Pneumoconiosis clinical
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- an occupational or environmental exposure and the radiology varies by dust
– can present as restrictive or obstructive due to loss of elasticity, but usually its restrictive
– Sx are SOB - Pneumoconiosis fibrogenic is from silica (SiO2)
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- crystalline, 1-2 mm diameter
– early is just an accumulation of histeocytes (so you need hx!), but late will show Fibrotic Nodules - Pneumoconiosis fibrogenic is from asbestos (SiO4)
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- has an Fe/protein coat (ferruginous bodies)
– will see Patchy Sub-Pleural Fibrosis from collagen - Pneumoconiosis fibrogenic from coal
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- if silica-free, you will only see accumulation of coal
– will only trigger fibrosis if it has silicates in it
– w/ coal, its black no matter what the stain
– can get this from cigarette smoke, so get the hx - causes of sub-plerual fibrosis
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– asbestosis (more likely than mesolthelioma)
- UIP
- rheumatoid lung disease - Usual interstitial pneumonia (UIP) definition
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- Progressive patchy interstitial fibrosis
- aka Idiopathic pulmonary fibrosis (IPF) - Usual interstitial pneumonia (UIP) clinical
- – in adults (mean 51) – poor response to steroids w/ a 66% mortality – dx early so you can transplant
- Usual interstitial pneumonia (UIP) radiology
- - Patchy subpleural infiltrates from fibrosis, DDx asbestos, rheum
- Usual interstitial pneumonia (UIP) path
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- will show patchy interstitial inflame and fibrosis that is alternating with normal parenchyma (temporally heterogeneous)
– Morphological overlap with rheum dzs like scleroderma
– looks like honeycomb - proliferating phase of DAD definition
- Interstitial fibroblastic proliferation >1 week after acute lung injury
- proliferating phase of DAD clinical
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- decreased pulm compliance -> mechanical ventilation
– 50% mortality – the ones that survive can remodel the lung or scar it off – we don’t know what lets some do this and some die - proliferating phase of DAD radiology
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- will show diffuse, interstitial > alveolar pattern
– also increased interstitial markings - proliferating phase of DAD path
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- will show Interstitial + intra-alveolar fibroblastic proliferation
– Temporally uniform
– there is lots of lot of fibroblastic response and DAD is defined by this proliferation (the organizing phase)