Coin lesion -- considered malignant until proved otherwise

Hamartoma - benign cartilaginous lesion

Cannon balls

metastatic lesions

Metastases- irregularly sized and shaped lesions -- compare to previous CXR

Squamous cell carcinoma - large, irregular nuclei with keratin

more common men than women, most arise in bronchi, obstruction is presenting feature

Adenocarcinoma -- tall, columnar cells mucin (+)

women, non-smokers <40 yoa, associated with scars, slow growing but metastasize early

Large cell carcinoma -- aggressive

Small cell carcinoma- basophilic cells with areas of necrosis, lymph-like cells (oat cells) derived from neuro-endocrine cells

Associated with paraneoplastic syndromes

Small cell carcinoma

Endobronchial carcinoma

This one is too high to be resected

A small endobronchial carcinoid (right). Histologically, there are well-defined nests of homogeneous cells with uniform nuclei (left).

Mesothelioma -- related to which type of asbestos?

Amphibole (straight)

Pleural effusion

must tap to determine if transudate or exudate

Pneumothorax

Laryngeal cancer

Squamous carcinoma -- hyperkeratosis, associated with alcohol and smoking

Presentation:

persistent hoarseness

Mesothelioma -- uniform cells invading pleura

Pneumocystis carinii

hypoxemia, no infiltrate

common in immunosuppressed pts

Pneumocystis carinii biopsy -- fluffy alveolar infiltrates

Lobar pneumonia -- classically what bt?

Strep pneumo

Lobar pneumonia

Stage 3 Gray hepatization -- PMNs ingesting and destroying RBCs

Acute bacterial pneumonia -- early red hepatization with neutrophils

Bacterial pneumonia -- PMNs in alveoli

Bronchopneumonia -- common organisms?

Strep pneumo, H flu, Legionella, Pseudomonas

Legionaire’s disease

Bronchopneumonia -- some normal alveoli, congestion near bronchi

Interstitial pneumonia -- lungs look fluffy

Interstitual pneumonia -- somealveoli filled, few inflammatory cells

Interstitial pneumonia -- thickened septa

Fluorescent stain for Tb

Acid fast stain for Tuberculosis

Caseating granuloma -- immune competent pt

Ghon’s complex -- primary focus plus regional lymph node

Tuberculosis -- reactivation in upper lobes

Miliary Tb -- disseminated