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Inflammation Lung parenchyma & pleura

Inflammation Lung parenchyma & pleura. Soheir Mahfouz. BRONCHOPNEUMONIA. DEFINITION Patchy suppurative consolidation of the lung centered around a bronchus or bronchiole & involves immediately adjacent alveoli. BRONCHOPNEMONIA --CP. Febrile Extremes of age Cough with productive sputum.

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Inflammation Lung parenchyma & pleura

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  1. InflammationLung parenchyma & pleura Soheir Mahfouz

  2. BRONCHOPNEUMONIA DEFINITION Patchysuppurative consolidation of the lung centered around a bronchus or bronchiole & involves immediately adjacent alveoli

  3. BRONCHOPNEMONIA --CP • Febrile • Extremes of age • Cough with productive sputum

  4. BRONCHOPNEUMONIA --Etiology Organisms gram +ve cocci: Staph, Strept gram –ve: H. influenza, pseudomonas, E.coli & Klebsiella FOR DIAGNOSIS 1- True sputum sample: diagnostic feature intracellular organisms in neutrophils & macrophages 2- Culture is necessary for determination of organism & antibiotic sensitivities NB In many cases the microbial agent is never diagnosed

  5. Consolidation Patchy, firm & raised

  6. BRONCHOPNEUMONIA –(special presentations) Pseudomonas aeroginosa • Infects lung hematogenously especially in burn patients & immunocompromised. In cystic fibrosis pts. It may be air born and usually fatal • Causes inflammation with necrosis of vascular walls resulting in hemorrhagic pneumonia

  7. Vascular necrosis Hemorrhagic pneumonia

  8. BRONCHOPNEUMONIA –(special presentations) Legionella pneumonia • Neutrophils +manymacrophages in a background of fibrin • Org: short gm –ve coccobacillus DIAGNOSIS: Serology, culture & IF of sputum CP: Acute onset but responds to appropriate antibiotics

  9. HISOPATHOLOGIC VARIANTS OF BRONCHOPNEUMONIA • Neutrophilic or exudative type : common type (SBP) • Histiocytic: Legionella & Mycoplasma • With hyaline membranes: Strept & E. coli • With coagulative necrosis • With abscess formation • With hemorrhage: Pseudomonas (septic vasculitis) & Klebsiella • With leukopenia: in leukemic patients or in chemotherapy patients • With granulomas

  10. Lobar & bronchopneumonia – Complications • Post pneumonic abscess, gangrene • Empyema • Direct spread : bronchopleural fistula & pyopneumothorax • Distant spread: Toxemia, septicemia, pyemia • Lung fibrosis

  11. Bronchopneumonia: -abscessing

  12. Interstitial pneumonia & ILD DEFINITION: Inflammation /infection affecting the interstitial tissue , sparing the alveolar spaces NB Atypical pneumonia is a patchy form of interstitial pneumonia & is also called pneumonitis Causes • Viral: respiratory scyncetial virus- cytomegalovirus, HS,Varicella-Zoster,Measles, Adenovirus,Influenza • Mycoplasma • Protozoal: Pneumocystis carnii • Chemical irritants: gases & lipid & aspiration pneumonia • CT diseases: SLE, rheumatoid or mixed

  13. Interstitial pneumonia & Interstitial lung disease (ILD) • Chronic fibrosing pneumonia • Fibrous interstitial pneumonia • Bronchiolitis obliterans organizing pneumonia (BOOP) • Diffuse alveolar damage (DADS)/ AIP • Giant cell interstitial pneumonia • Lymphocytic interstitial pneumonia • Usual interstitial pneumonia • Idiopathic interstitial pneumonia: UIP(IPF)-DIP-NSIP –BOOP(COP) - AIP(ARDS)- RBILD • Pulmonary fibrosis (Diffuse parenchymal lung disease DPLD / ILD) : Pneumonia (UIP – DIP- NSIP) + other causes for lung fibrosis

  14. Acute Interstitial pneumonia (Haman Riche) Chronic Interstitial pneumonia UIP DIP NSIP NB: LIP & GIP are generally secondary pneumonias IDIOPATHIC Interstitial pneumonia NEW Classification

  15. Interstitial pneumonia • UIP usual interstitial pneumonia • Idiopathic interstitial pneumonia • Non specific interstitial pneumonia • Acute necrotizing interstitial pneumonia • LIP lymphocytic interstitial pneumonia

  16. Interstitial pneumonia -Viral • Diffuse interstitial inflammation lymphohistiocytic + edema • More severe cases may have additional changes resembling acute alveolar damage with hyaline membrane formation DIAGNOSIS: LM, serology look for a 4 fold rising titre & DNA probes

  17. Interstitial pneumonia

  18. Interstitial pneumonia: Respiratory scyncetial virus

  19. Cytomegalovirus

  20. Measles

  21. Adenovirus

  22. Pneumocystis carnii

  23. OTHER PNEUMONIAS (non infectious) • Aspiration pneumonia • Lipid pneumonia

  24. ASPIRATION PNEUMONIA • Chemical • Bacterial • Mechanical obstruction: fluids & solid objects

  25. Lipid pneumonia • Endogenous : usually associated with Airway obstruction by neoplasm or FB which releases lipids & gives rise to pneumonia • Exogenous :Are a reaction to aspiration of gastric contents or mineral oils gives rise to a FB granulomatous reaction

  26. LIPID PNEUMONIA

  27. LIPID PNEUMONIA This is the microscopic appearance of an exogenous lipid pneumonia in which lipid vacuoles appear, mainly along airways, accompanied by an inflammatory response that can contain foreign body giant cells. The term exogenous refers to the origin of the lipid material outside the body. This material is aspirated into the bronchial tree.

  28. LUNG ABSCESS- Types • Aspiration • Post pneumonic • Pyemic Complications of • Bronchiectasis • Infected cysts • Direct spread from liver abscess • Bronchial obstruction

  29. LUNG ABSCESS Chronic Acute

  30. LUNG ABSCESS- post pneumonic

  31. LUNG ABSCESS-pyemic BV Bacteria & pus

  32. LUNG ABSCESS- FATE • SMALL: FIBROSIS • LARGE: CHRONIC ABSCESS • Rupture into a bronchus: hemoptysis,purulent sputum, bronchopleural fistula exposure to saprophytes • Lung gangrene & severe toxemia • Spread by blood: toxemia, septicemia & pyemia • Secondary amyloidosis

  33. Important terms PLEURISY • DEFINITION: Acute fibrinous / serofibrinous inflammation • Definition: collection of fluid in pleural cavity PLEURAL EFFUSIONS

  34. ACUTE NON SUPPURATIVESerofibrinous/Fibrinous Site: Cavities lined by mesothelium • Pleura • Pericardium • Peritoneum • Meninges

  35. Important terms • Terms for abnormal accumulations of fluid: A transudate is protein-poor salt water squeezed through blood vessels by hydrostatic pressure, i.e., it has specific gravity of extracellular fluid, 1.010 or thereabouts. An exudate is an abnormal, protein-rich fluid which has leaked out of inflamed vessels. • A body fluid (either an exudate or an area of liquefaction necrosis) containing neutrophilic leukocytes and necrotic debris is pus. The preferred adjective to describe things with lots of pus is purulent. To produce pus is to suppurate. Pus which literally fills an important body cavity is called an empyema. (This is most common in the pleural cavities.)

  36. Transudate

  37. Hemothorax

  38. EMPYEMA

  39. Chylothorax The right pleural cavity is filled with a cloudy yellowish-tan fluid, characteristic for a chylothorax. In this case, lymphoma involving the lymphatics of the chest and abdomen led to the collection of chylous fluid. The right lung is markedly atelectatic.

  40. Fibrinous inflammation

  41. Fibrinous layer Fibrinous layer Submesothelial acute inflammation Submesothelial acute inflammation Congested BV

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