CONGENITAL

ANOMALIES &
ATELECTASIS
 CONGENITAL ANOMALIES

• Pulmonary hypoplasia

● Defective development of both lungs

● Decreased weight , volume and acini for body weight and gestational age
● Due to abnormalities that do not let the lung expand in utero
● E.g congenital diaphragmatic hernia
• Foregut cysts

● a portion of the trachio-bronchial tree gets separated during

develpment
● Mostly located in the mediastinum
● Can be bronchogenic , eosophageal or enteric
● Incidental finding or compress adjacent structures
● Bronchogenic cyst most common lined by ciliated
pseudostratified columnar epithelium.
● The wall contains bronchial glands, cartilage, and smooth muscle
Pulmonary sequestration
● Discrete area of lung tissue that
● Lacks connection to the airway system
● Has abnormal blood supply
● May be on extralobar or intralobar types
ATELECTASIS AND ITS TYPES

• Incomplete expansion of lung

(neonatal atelectasis)

OR

• Collapse of a previously expanded lung

( acquired atelectasis)
• Types of acquired atelactasis

● Resorption atelectasis
● Mediastinum shifts towards the atelectatic lung

● Compression atelectasis
● Mediastunum shifts away from atelectatic lung

● Contraction atelectasis

It is reversible except those caused by contraction

IMAGE FROM ROBINS ATELECTASIS
 RESORPTION ATELECTASIS

• Mediastinum shifts towards atelectatic side

COMPRESSION ATELECTASIS
 CONTRACTION ATELECTASIS

• Occurs due to local or generalized scarring and fibrosis of the lung or

pleura that prevents complete expansion
• Idiopathic pulmonary fibrosis
• Radiation induced fibrosis
• IRREVERSIBLE !
 A 7-year-old boy accidently inhales a small peanut which lodges in one
of his bronchi. A CXR reveals mediastinum to be shifted towards the
side of obstruction. Which of the following pulmonary abnormalities is
most likely present?
a. Resorption atelectasis
b. Compression atelectasis
c. Contraction atelectasis
d. Patchy atelectasis
Resorption atelectasis
LET’S REVIEW
• Pulmonary edema
● Cardiogenic
● Non-cardiogenic
• Acute lung injury
● Definition , causes , pathophysiology , morphological changes
• Obstructive lung disease
● Emphysema
● Chronic bronchitis
● Asthma
● Bronchiectasis
Chronic interstitial lung disease
• Fibrosing
● IPF , non-sp IP , COP, Pneomoconiosis , CTD , radiotion , drug induced
• Granulomatous
● Sarcoidosis , hypersensitivity pneumonitis
• Smoking related
• Pulm alveolar proteinosis
• Pulmonary vascular disease :
● Pulmonary embolism
● Pulm HTN
● Pulm hemorrhagic syndrome
• Infections
● CAP , HAP , AP
● Lung abscess
• Tumors
1. Most common foregut cyst ________

2. Most common cause of pulmonary edema due to altered

hemodynamic effects ________

3. What are the clinical and morphological manifestation of severe

acute lung injury called

4. What is the composition of hyaline membrane

5. Define acute lung injury and what is the key initiating event?
 ANSWERS

1. Bronchogenic cyst
2. Left sided congestive heart failure
3. Clinically ARDS , morphologically DAD
4. Exudate + cellular debris + fibrin
5. ALI : abrupt onset of significant hypoxemia & bilateral
pulmonary infiltrates in the absence of cardiac failure. Damage to
endothelial or alveolar epithelial cells + inflammation
1. What is emphysema ?
2. Classify emphysema?
3. In alpha 1 anti-trypsin deficiency , what type of emphysema is
seen?
4. Define chronic bronchitis and most important tissue changes?
5. What is bronchiectasis , give causes ?
 ANSWERS

1. Irreversible enlargement of air spaces distal to the terminal

bronchiole , destruction of their wall without fibrosis
2. Pan-acinar (most common) , centri-acinar , distal acinar ,
irregular
3. Pan-acinar
4. Persistant productive cough for atleast 3 months in atleast 2
consecutive years in the absence of any other identifiable cause …
Mucus gland hyperplasia , mucus hypersecretion and inflammation
5. Destruction of smooth muscle and elastic tissue by chronic
NECROTIZING infections leading to permanent dilation of
airways. Cause , infections , obstruction , congenital conditions
inhibiting adequate clearance
1. Define asthma
2. Is it always reversible
3. What is the histological manifestation of IPF ?
4. What is pneumoconiosis
5. What inhaled particle size is most damaging ?
6. Name few mineral dusts that can induce pneumoconiosis.
7. Egg-shell calcification of lymph nodes is seen with_____
8. Silicosis is associated with increased susceptibility to which
infection ?
9. Complication of asbestosis ?
10. What are ferruginous bodies ?
11. Sarcoidosis is a systemic disorder , also involving lungs. What is
the characteristic morphological feature?
• What is the other name for hypersensitivity pneumonitis?
• It occurs due to inhalation of mineral? or organic dust ? .. Name a
few
• What are the consequences of pulmonary embolism?
• Plexiform lesions in arterioles are seen in ____?
• Name the gene involved in primary pulmonary hypertension
• Stages if lobar pneumonia
• What is lung abscess
a. Atypical epithelial cells invading the stroma , forming glands and
producing mucin.
b. Hyperplasia of respiratory mucus glands
c. Abnormal permanent dilation of bronchi
d. Invasive lesion with trabeculae and rosettes of small cells with
nuclear molding , brisk mitosis , necrosis
e. Increased submucosal glands , smooth muscle hyperplasia in the
wall , eosinophils
a. Adenocarcinoma
b. Chronic bronchitis
c. Bronchiectasis
d. Small cell carcinoma
e. Airway remodeling in asthma
THANKYOU