Workshop 17

Resp i -:-a ry Pa th ul ugy

to
Topic

FviiCF-C'SCOPY
' Lobar Dneumonia
Fibrinc;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 aiveciitis
bi 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 I

fu{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 aliver
eonsistency.
 Mieroseop,v - trII
/
I6
^
\i +L^ ^^- ,i+-,Y
rirs Lavrt
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-'pFurative
neeri,- 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
{\-,. --- 'r"-' ic tliroml'i-emboir
seiri

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 witir
rt,.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-lobuiar
Panasinar cr pa*lobuiar
D^*^-^^+^l
I dld)tlrrc!
T*^^,,i ^-
,.:
ili ._r!..-:.1:
ijt
_+[\

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
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
: :::1:-::=::j +cJic u, *J****
-:::- ases
-E--
- chlldr+e a:rd eideslv
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= --*---:--:--
!l iiii tr--\ijaijislijii *.{-i--:-+ 4i'v.
ii-t 4UjdLEtii *!=.:.:-!:
L-Liii -
inffammatory exudates irr various siages oievoiution
. -Hisinlnoical
-------D--- se,:iinn fhrartr'h Lins - Hil
. Ceiiii'ai piace - acute suppu!'aiive bronchioijtis
puruient €xudate iii the lumen and brcnchiolar wall
necrotic 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 by
aspirati+!1
nf omnin+in fl"irl
amrrioiie eeiis
o-.ilornrri s' Crliqir,{
LUiLi!i iii(].i gA ,'p!!-
ir.-tiiCiQ-\i LErr,\
,,^*i,,
gt f^+
v iiiii LdSEUSd - ldlt
t^*,,^,-
I4tlugt, - 1-..;-
ttdtl
e -. -'.^- rL--..^L iung.
l_iieinin,ri*ol , secii{in;fi;-iiugil i..-
ffir siatn
. alveolar du$s and aiveoli eantain
exfoiiated epithelial cells appearing as hematoxiiinophiiic rolling
siiiiciure*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
lJL...!.Ur!*.Ji
<{i
"-+=
U.JLG--L.ee {!,-t-h
lrULiui
*r rrner r rnnn
Ui:Lui!ir-r::idt i * hrnt rhnnn.-r r tn,:n i *\
erLriir-.ir:-irLiri!uiii:iiiia,i

systemic disease - sepsis

" r-arreql rnathn,
*...-gens:
:=-----=-==----:-=-=--1---=!----=-------.=--=-
- Stl ci,tt'-.'-'-'LLi- (1ui Yils }t(ilji ii i\jvupllila,
*--:(trlr-rrtH.(f,tlvE tr--#^-:-
Hr -^*-+:,,- lj(f,trlEI r([-
"^^^^-^^l
^-^^^t
dlrrdltr 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
 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!=,: eontaining
a^*i-tnnr*a.
Lr JLrlruLJ LLrr !rLulruirrrrr."
-a',+-n^Lii^. -- ' Infgct1CUS
qrid '
AgentS
Fibrincus ex':daie passes ihr,:ugir K-r:irn pares ftom an ai..,eoius tc anciher

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

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,,+;^-
rEluiuiruri JLoSE /l^,,.
-+^^^ Q o\ r-i.^. ? ,,,^^1,-
luo_yJ. o-7 !. LGhgJ J vaggnJ
iri urteottlpiieated easrs, aiveoiar exudaie (iiquefied by erizyiles) is
{lartnnrrtarl -_'--- ro"
--=- -J ^f - r ---*--*
-o^"^^ho,
eiirninaie<i by expectcraiian
removed by iymphatic ways
?\ I .' I
-tr fle rung a€faalcn rs resrsre{l.

Complications
.- iLUII<
,,*.,.h"..-.-.
GUJVLJJ
crrnnrrrnfprl
rsrlJsr *ivu nonrnfin
rrvvr vrrv irr^-
rsrrs r.^,
sr w
. Lung carnification
ecrlleetive srgan! sation +i-' ihe a! ".'eciai ezsd ate
' ht
rieui'ai ernFi€ma
cxten*ci*n *f the inflammati+n to the pler:ra
c^ n^ ^-^-^,--:^
----
fraa'.i?i eiriia

gnr:ocard;t;s
fr{eningitis
tj-,^^*a
i -yijcliilir -i--^^--
- dliJbt/CDD

'.,r,r st t) L:\ Y'* ; l.'i{ii! { i,+ ti

. lr irJtviv<iwgi
i"+^!n-i^.1 "^^+i^n +hrn,'-h
JwLLrvii irri vugii 1""-
iurr-+, C;*,;^*^.^,,
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 4IrIti4t I ^-, u lrl
^{- -^^l^-*-+
Itrttlllt tlt4tttttl\i^--
-aJ
Fibroi:iasts
f-niiqoa'n fiher,.
Reniainias infr am matci=v' cei ; s