workshop 17

8/14/2019 Workshop 17

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Workshop 17

Resp i -:-a to ry Pa th ul ugy

Topic

FviiCF-C'SCOPY

' Lobar DneumoniaFibrinc;us aiveeliti s (Maiiar;,,\

I-er;cccitic alveciitis iFiE)' Lung caraificaticn{dern*astrative). Bionehap;;e*mocia. Ficnchopneumcnia of aspiraticir- Fr-llcrcnarir emplrt'sema idemonstrati."'e,i

F,{ACROSCOPY

' L+bar Ptne::mcnia= Eicnchcpneuincntra- Llu:rg abscess- n- --^1-l^J^-:^

Dt unuilrtrutilsral. Fuimonai',u- einph,v'seina

LC BAR. PF{B'.LrivtCi-{IA

. It is a* acr-rte erudalive inflammation see*ndarv tc an aerogen bacterial infecli+ri

lecated rn iui:g alveoli *'iti: i*voiveitreni of al eniiie iotre

= Rarc due io antibiciic treatment. F.tialogy - bacterial etialagy

- 95c,i, - Strep pneun:oiiiae. Macrcsc+picali'y, is *ranifbsted b'.r entire l+be c+nsoiidati+n

" In t,!a-.;r,ic*! t,upe, l*har pneumr',nia de';elarE in 4 ttages'' -1'1A- lfT

a) cangesti.:n ii-? da-vsi - ssrcsal aiveciitisbi red hepatizatian i3-4 da:;si - fii-.'nncus ai'.'eaiitis

t'i'*t ay irepaiizat icn i 5 - 7 ria;r si -'reu cee it;'; c ai';.-ul it i s

dl resoiuiicrr i8-9 days- iasis 3 'weeksi

Lsbar Faeusronia stage Ifu{acrasccpy-Stage af congestica {da1's 1-2):

aftcted 1**g lcbe is moderately ccnde*sed, red i:: c+!+r a*4 panly

crepitant- oli cut section is ieas-ing a sero-oioody airy liquid

ivii erose*p,;v -seiciits aiveoi jii s

pariet+-a1'"-e*iar *pil i aries are ecFrges-i ed ;

ihere is a seioils ex*daie in the alveclai l*men: iniense eosinophilic liquici

irieir iri prrc,teins) tirai ecirtaii:s red't'iood ceiis and traeteria

Lobar pneuxn*nia stage II - id*ys' 3-4i

l,{acrosccp_y: Red Hepatizatioc stag€

affected iu*g lcbe is cansolidaied" soiid" dry, reii-brcwn, wiih alivereonsistency.

8/14/2019 Workshop 17


Mieroseop,v - trII/

^\ +L^ ^^- ,i+-,

I 6 i rirs Lavrt Y

co*tains e suppuraii\.'e rEetedai anii air eonierli ii.i'there i*c e.*r*1E::1ui::{at l,:*'..viti: ihe a! r e+ildiict s} -

{b} tvaii

acute atrsces:

-ihe r.iall has ii:eguiai borders reprezented. lt:'r

su-'pFurativeneeri,- ii ; t iiii_< parcnch'7ti:a

chronic abscess - the waii is fibroiic by conneciive argai'iizaiion{-r'ifirillicaf iirns.'

i ai bron cfu r--r-puimc*arv i-i st u !a Biieo illLlr c)ia :i. pi opn e il in oi o rax,

{ b } cerebrai seiri ic tliroml'i-emboir-,. --- 'r"-'

BRGhiCE{EgCTASTS. Brcneirieeia,sis iBEi rs a-bnormai dilaiion of the sma"il aad medii.iin bro;'ieiii

associateri.+ith suppuration and fiequent damage cf ia-wer iung lobes.* It is ea*sed b-v ehr*i:ie. ia{]asr:*ati*:': ait*i iecu=+*i i*f}eti":::s rvit!: :::ixed 1'!*:a.

inciuiiing anaer*bic" rvhieh eite.r the struc:ilre cif trlilsc,.ric:eiestic ..:;aii .,r,iti:

Fer:naaent br**ehial cbliter"aration.

The iesi*ii= are iceared ll: the iu=;e.'€i i'":ng ic-;=es, .ai *r biiaieiaii;. FsFeciaiii', are affeele*prei"ipirerai br.:lciri. wirieir are dilated and er-rriain puluient seer-eiions {inueus witirrt,.l r f r,rfih il,'< )

l'''iaci"oscopicaliv, ihe lesicns aia ffioie obvious uncier the pieura.. Ot the c.ross sec.iioES. ihere are n:'.:liiple c.ir-;stic lesicils cf-vairrir:g si;'es that

extend t,: the pieura. aad contain mueo-piti-riient ex-iidaies.

' The afl-ected bronchial wali is diiated arrd tibrotic, ii*m where iraciiates fibroi-rs

bancis -ovithin parenchimai lurg.C*rnpiica.iions

. When the iesicns are exiensive-eePD.

' By tjifiusion of the branciriai infbcticn; in iung parencirima resuit abssesses.* Aivaace,J *isease is ass++iated .*ith :efcudarr, amvi+id*sls

PULM OIYAEY EIIIPEYSE ]}TA* Abnerr:i;ai and peti;ralient iiisie;rli*r": and de=truetiri;-r i;irhe air spa*e:- .iiiiai',

located fioin iermiiiai broirciiicles. Classific.ail*n - based on the ertensicn of lesicns

Cei;tro-;rcinar and i:entro-lobuiarPanasinar cr pa*lobuiarD^*^-^^+^lI dld)tlrrc!T*^^,,i ^-

,.: ijtili ._r!..-:.1: _+[\

Histoloeic.ai secti*n thrcugh i,;ng" F{E. Air s;Dace distei:iion and alveolar -wall destruction

' Fusion of the aiveoiar space cont€rrt with ibrmation oiiarge air spaces

' Capillary netwsili-t irom aive+lar.,u.'all are +ompress** ar:* reduc+d i;: au*rber

8/14/2019 Workshop 17


BRONCE*FNEUMONTA {LOBTTLAR PNSLTF{CNrA}. {t is al} acute e;<uCative inflamiiiaiici: lccaied ia biaiic}iicles a"r:ri adiaceni aiveali. Bacterial etiolcgv. Stai:irilcecccus aiiieus, H i*fiue::zae, Ps. a+rug*osa. Fre===€!.s +cJic u, *J**** ases - chlldr+e a:rd eideslv:::1:-::=::j -:::- -E--

1,$i;'lrr.;.'r-rr':'.,'- 5it'gt:rr'L{ir:1i-r+:-.!;r'r:iii*ii:; ir: i'ir;it=;:i"1111'l;,.:.3i .i11;'

^ ^- --- -1^-r+ ^-- ,- p,r'rr=r.'-=.",,;date

invaiv:rrg tlre iuarea and brcnchi,:iar waiis- =-.i+1= --*---:--:-- *.{-i--:-+ *!=.:.:-!: !l iiii tr--\ijaijislijii ii-t 4UjdLEtii 4i'v. L-Liii -

inffammatory exudates irr various siages oievoiution. Hisinlnoical se,:iinn fhrartr'h Lins - Hil-------D---

. Ceiiii'ai piace - acute suppu!'aiive bronchioijtispuruient €xudate iii the lumen and brcnchiolar wallnecrotic and exfbri i at eti tr ronchioi ar ep itheliu m

. Feribronchiolar place-aciiie exudative ai.reoiltis

Leirsceltic, fi brinous, serous. Betu,ee{t broncl:pne*m*Bic foei there is a* aerated lung Farraehyma

$i rt'r l* +. i: ll l, l; ir' ti i); ii;; ;;€ ; i' ir i i; i o ;t e i,., il

'it cc+urs i* ne.+ bcrns ',vith premat ure re*pirati*n duringa pr*l+*g*d labcr byaspirati+!1nf omnin+in fl"irl

amrrioiie eeiiso-.ilornrri s' Crliqir,{ ,'p!!-LUiLi!i iii(].i gA ir.-tiiCiQ-\i LErr,\

,,^*i,, f^+v gt iiiii LdSEUSd - ldlt

t^*,,^,- 1-..;-I4tlugt, - ttdtl

e l_iieinin,ri*ol -. -'.^-rL--..^L i..-, secii{in;fi;-iiugil iung. ffir siatn

. alveolar du$s and aiveoli eantain

exfoiiated epithelial cells appearing as hematoxiiinophiiic rollingsiiiiciure*s cr "dead ieaves"

seil-lus e.xudate r.r.'ith few PMNs

. in the air,'eoiar wail - caoilla-rv eonse.qtioo

rU LiVIIJi\Ar( } A I'S{.-T.DS

' Lung abscess is a iccaiized aica cipuruleni necios;s af the lung parench'yma.r Ffir-rl,-r.;,r - it r.';ttt lrr' q r-rrn'rnlirnli+n nf a

t-r r lcr<-cacti <{i"-+=

ee {!,-t-h *r rrner r rnnn i * hrnt rhnnn.-r r tn,:n i *\lJL...!.Ur!*.Ji U.JLG--L. lrULiui Ui:Lui!ir-r::idt erLriir-.ir:-irLiri!uiii:iiiia,i

systemic disease - sepsis

" r-arreql nathn,r *...-gens::=-----=-==----:-=-=--1---=!----=-------.=--=-

- Stl ci,tt'-.'-'-'LLi- (1ui Yils }t(ilji ii i\jvupllila,*--: -^*-+:,,- tr--#^-:-Hr (trlr-rrtH.(f,tlvE lj(f,trlEI r([-

"^^^^-^^l ^-^^^t ^*^ ^. -lrrdltr Lrulu Lrr l<dtrlr)ilr)- Elt,.4 tL/fE-,-,aF-.-.*r,- ryrav! uJwvp_y

losalized areas cf suppurar,i.{e necfc$ic .

. varicus sizes {a few mm - 5-5 cm}

. qin<'ie nr mrrlfinle

' <iifferent lacaiion. feqent of oid

8/14/2019 Workshop 17


sn surface secii*n is granular. rvithcut elimi*ating an.{ exudate.

,"ii.li.l,::.,',:;:-'1 . li:.1'ili.,,t ; .'.:ll'.',)::i ;

parietc-a l',.eclar cep il la:-i es are i nten seh' ccngested.

:!:ere i= a **r!::*cs et=date i::t* ai...=r:iar lurite* ifibrirr :-:e*++r!=,: eontaininga^*i-tnnr*a. -a',+-n^Lii^. -- ' 'Lr JLrlruLJ LLrr !rLulruirrrrr." qrid Infgct1CUS AgentS

Fibrincus ex':daie passes ihr,:ugir K-r:irn pares ftom an ai..,eoius tc anciher

E -.. L ... -.--!- -L- --

l:n ./l-- = -lLOOflr pntuflruilra srage ru E{ray$, rr- /,

^n^^-^^^^^-.. J^-^-. L^-^tl-^ti^

rvr4ur usurrPy. a-lr ixy il(;liarrz4rrljrr sla3u

iutig iobe is eondense;j r.vith gray tint and liver cocsisten<;y;

on out sacTion is e!iminateei a sui,nurative exudate.

l\'r,i i i,t i-r.riti:i i ii.., i |l l,-t'.-rt'r i i,: iil,. t'r i i I t i tl

parietc-ail-eaiar capiiiai-y netlxrcrk is still congested;

alveclar lurcen coi?taiiis a suppurative exudaie campcsed oiF&iNs and h'ifs .

Lsbar pn€arao*ia stage f}--^-^1,,+;^- -+^^^ /l^,,. Q o\ r-i.^. ? ,,,^^1,-rEluiuiruri JLoSE luo_yJ. o-7 !. LGhgJ J vaggnJ

iri urteottlpiieated easrs, aiveoiar exudaie (iiquefied by erizyiles) is{lartnnrrtarl

^f -o^"^^ho,ro"

--=- -J -_'--- - r ---*--*

eiirninaie<i by expectcraiianremoved by iymphatic ways

\-t

I .' I? r fle rung a€faalcn rs resrsre{l.

Complications. i ,,*.,.h"..-.-.- LUII< GUJVLJJ

crrnnrrrnfprl nonrnfin irr^- r.^,rsrlJsr *ivu rrvvr vrrv rsrrs sr w

. Lung carnificationecrlleetive srgan! sation +i-' ihe a!

".'eciai

ezsd ateht

' rieui'ai ernFi€ma

cxten*ci*n *f the inflammati+n to the pler:ra^ n^ ^-^-^,--:^ fraa'.i?i eiriia----

gnr:ocard;t;s

fr{eningitistj-,^^*a - -i--^^-- -yijcliilir dliJbt/CDD

'.,r,r st t) L:\ Y'* ; l.'i{ii! { i,+ ti. l i"+^!n-i^.1 "^^+i^n +hrn,'-h 1""- C;*,;^*^.^,,r irJtviv<iwgi JwLLrvii irri vugii iurr-+, uiirrrviiwJvu

sta{rung. Compiieatitx rithe iibriaaus alveciitis stage by eonnectiv€ orgaaisaiil_rn oiihe

alveolar fi brinsus exudaie. Alveolar lumen is occupied by a granulation tissue, of ilbro-vascuiar iype

t-^^:l I ^-, ^{- -^^l^-*-+ i^--i 4IrIti4t u lrl Itrttlllt tlt4tttttl\-aJ

Fibroi:iastsf-niiqoa'n fiher,.

Reniainias infr am matci=v' cei ; s

workshop 17

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