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PNEUMONIA & SUPPURATIVE LUNG DISEASES

Dr. Thin Thin Win @ Safiya Yunus Department of Pathology, PPSP

Dr TTW (2009)

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PNEUMONIA
Definition 
Inflammation of the lung parenchyma

(alveoli) resulting consolidation or hardening of lung parenchyma

Dr TTW (2009)

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Etiology 
Caused by varieties of infectious agent

such as bacteria, viruses, fungi, mycoplasma etc:«  Mostly bacterial pneumonia (Pneumococci, Klebsiella pneumoniae,
Staphylococci, Streptococci, H.influenzae, Pseudomonas aeruginosa) ± Community acquired acute pneumonia
Dr TTW (2009) 3

Etiology 
Result whenever pulmonary defense

mechanism are impaired or resistance of host is lowered  Pulmonary defense mechanism ± 1. cough reflex 2. mucociliary apparatus 3. phagocytic alveolar macrophages
Dr TTW (2009) 4

Clearing mechanism can be interfered with many factors:

1. Loss or suppression of cough reflex aspiration of gastric contents in coma, anesthesia, neuromuscular disorders, drugs, chest pain ± aspiration pneumonia

2. Injury to mucociliary apparatus ±
cigarette smoking, inhalation of hot or corrosive gases, viral infection, genetic disorders
Dr TTW (2009) 5

Interfered phagocytic/ bactericidal action of alveolar macrophages ± alcohol. Accumulation of secretions ± cystic fibrosis & bronchial obstruction Dr TTW (2009) 6 . O2 intoxication 4. anoxia. smoking. Pulmonary congestion & edema 5.Clearing mechanism can be interfered with many factors: 3.

Aetiology & antomical pattern of pneumonia Community acquired acute pneumonia Aetiology Bacteria Community acquired atypical pneumonia Virus Mycoplasma Clamydia Anatomical Lobar pneumonia Interstitial pneumonia involvement Bronchopneumonia Dr TTW (2009) 7 .

Lobar pneumonia  Consolidation of a large portion of a lobe or an entire lobe  (whereas patchy consolidation in bronchopneumonia) Dr TTW (2009) 8 .

Lobar pneumonia Dr TTW (2009) Bronchopneumonia 9 .

Dr TTW (2009) 10 .A closer view of the lobar pneumonia demonstrates the distinct difference between the upper lobe and the consolidated lower lobe.

Uniformly consolidated lower lobe in lobar pneumonia ( gray hepatization) ± lower lobe become airless. liver like texture. gray white Dr TTW (2009) 11 .

4 stages of inflammatory response in lobar pneumonia  Congestion  Red hepatization  Gray hepatization  Resolution Dr TTW (2009) 12 .

Stage of congestion  Lung ± heavy. red  Vascular engorgement  Intra-alveolar fluid with few neutrophils & often numerous bacteria Dr TTW (2009) 13 . boggy.

Stage of red hepatization  Massive confluent exudation with red cells. neutrophils and fibrin filling the alveolar spaces  Gross ± lobe appear distinctly red. firm & airless with liver-like consistency Dr TTW (2009) 14 .

Dr TTW (2009) 15 Stage of red hepatization .

Stages of gray hepatization  Progressive disintegration of red cells  Macrophages replace PMN with fibrin deposition  Persistence of fibrinosuppurative exudates  Gross ± grayish brown. dry surface Dr TTW (2009) 16 .

Dr TTW (2009) 17 Stages of gray hepatization .

semi fluid debris  Resorbed & ingested by macrophages. coughed up or organized by fibroblasts growing into it Dr TTW (2009) 18 .Stage of resolution  Consolidated exudates within alveolar spaces undergoes progressive enzymatic digestion to produce a granular.

Dr TTW (2009) 19 Stage of resolution (by organization) .

Bronchopneumonia  Patchy consolidation of lung  May be one lobe or multilobar  Frequently bilateral & basal Dr TTW (2009) 20 .

3 to 4 cm in diameter  Slightly elevated. bronchioles and adjacent alveolar spaces Dr TTW (2009) 21 . dry. gray-red to yellow  Poorly delimited at margin Histology  Suppurative. granular.Bronchopneumonia Gross  Lesions . neutrophil-rich exudates that fills bronchi.

the pattern of patchy distribution of a bronchopneumonia is seen. Dr TTW (2009) 22 .At higher magnification.

Dr TTW (2009) Bronchopneumonia 23 .

Community acquired atypical pneumonia (Viral and Mycoplasma Pneumonia) Interstitial pneumonia Morphology  Patchy or whole lobe  Bilateral or unilateral  Red-blue. congested & subcrepitant  Pleuritis or pleural effusion is infrequent Dr TTW (2009) 24 .

H. edematous with mononuclear infiltrates of L. virtually within the walls of alveoli  Alveolar septa ± widened. P & N in acute cases  Alveoli ± free of exudates  Pink hyaline membrane in alveolar walls Dr TTW (2009) 25 .Community acquired atypical pneumonia (Viral and Mycoplasma Pneumonia) Histology  Inflammatory reaction in interstitial tissue.

Fungal infection (Histoplasmosis. Blastomycosis. Aspergillosis) Dr TTW (2009) 26 .Chronic Pneumonia  Localized lesion in Immunocompetent patient  Granulomatous inflammation Mycobacterium tuberculosis. Coccidioidomycosis.

due to tissue destruction & necrosis 2.Complication of pneumonia 1. Empyema . Abscess formation .spread of infection to pleura cavity causing intra-pleural fibrinosuppurative reaction Dr TTW (2009) 27 . Pleural effusion. Pleuritis.

Organization of exudates . kidneys. Septicemia Dr TTW (2009) 28 . brain.Complication of pneumonia 3. endocarditis. pericardium.to heart valves. suppurative arthritis 5. spleen. Bacterial dissemination .convert portion of lung into solid tissue with fibrous scar 4. meningitis. joints resulting metastatic abscesses.

Clinical features  Abrupt onset of high fever with chills  Productive cough  Mucopurulent sputum  Pleuritic pain & friction rub  Radiologic appearance .focal opacities in BP Dr TTW (2009) 29 .well circumscribed radio-opacity in LP .

SUPPURATIVE LUNG DISEASES  Bronchiectasis  Lung abscess  Empyema Dr TTW (2009) 30 .

resulting from or associated with chronic necrotizing infection Dr TTW (2009) 31 .BRONCHIECTASIS Definition  Disease characterized by permanent dilatation of bronchi & bronchioles caused by destruction of the muscle & elastic tissue.

tumor. FB) impaired normal clearing mechanism pooling of secretion distal to obstruction inflammation of airways  Severe infection necrotizing fibrosis and eventually dilatation of airways Dr TTW (2009) 32 .Etiology  Obstruction & infection ± major cause .obstruction (mucus.

intralobular sequestration of the lung .Kartagener syndrome Dr TTW (2009) 33 .immunodeficiency state .cystic fibrosis .primary ciliary dyskinesia .Etiology  Congenital or hereditary .

Morphology  Lower lobes. bilaterally  Vertical air passages  Most severe in more distal bronchi & bronchioles Dr TTW (2009) 34 .

S cysts filled with mucopurulent secretions Dr TTW (2009) 35 .ross  Airways ± dilated. up to 4 times  Long. tube-like enlargement of airways cylindrical bronchiectasis  Fusiform or saccular distension saccular bronchiectasis  Dilated airways can be followed directly out to pleural surfaces  On C.

Adjacent lung is almost completely destroyed Dr TTW (2009) 36 .Bronchiectasis Bronchial tubes are extremely dilated with thicken. fibrotic wall.

.Dr TTW (2009) 37 Focal area of dilated bronchi with bronchiectasis.

Histology  Full-blown. active case intense acute & chronic inflammatory exudation within the walls of bronchi & bronchioles  Desquamation of lining epithelium  Extensive areas of necrotizing ulceration Dr TTW (2009) 38 .

Clinical course  Cor pulmonale  Lung abscess  Metastatic brain abscesses  Amyloidosis Dr TTW (2009) 39 .

LUNG ABSCESS Definition  A local suppurative process within the lung. characterized by necrosis of lung tissue Dr TTW (2009) 40 .

Staphylococcus aureus. sinobronchial infection. GN organisms Dr TTW (2009) 41 . bronchitis  Aerobic & anaerobic streptococci .Etiology & Pathogenesis  Oropharyngeal surgical procedures. dental sepsis.

fungal infection. gingivodental sepsis. debilitation . coma. anesthesia. sinusitis.Mechanisms  Aspiration of infective material in acute alcoholism.cough reflexes depressed  Antecedent primary bacterial infection post-pneumonic abscess. bronchiectasis  Septic embolism  Neoplasia  Miscellaneous Dr TTW (2009) 42 .

basal. diffusely scattered Dr TTW (2009) 43 .Morphology  Size -few mm to large cavities of 5-6 cm  Single or multiple  Abscess due to aspiration more common on right ( more vertical right main bronchus ) and more single  Abscess from pneumonia or bronchiectasis usually multiple.

fetid. green-black.Morphology  Cavity filled with suppurative debris  If communication with air passage partially drain air-containing cavity  Continued infection large. multilocular cavities (gangrene of the lung)  Suppurative destruction of lung parenchyma within central area of cavitation Dr TTW (2009) 44 .

one in the upper lobe and one in the lower lobe of this left lung.Seen here are two lung abscesses. Dr TTW (2009) 45 .

Dr TTW (2009) rough-surfaced walls are seen within areas of tan consolidation.abscessing bronchopneumonia in which several abscesses with irregular. 46 .

‡ No evidence of acute inflammation in the wall Dr TTW (2009) ‡ Fairly normal surrounding lung.pulmonary abscess cavity. ‡ Old 47 . ‡ Multiloculated with delicate strands of fibrous tissue crossing the space.

meningitis  Secondary amyloidosis Dr TTW (2009) 48 .Course  Most resolve with antimicrobial therapy  Extension of infection into pleural cavity empyema  Hemorrhage  Septic emboli brain abscess.

yellow- green. creamy pus composed of neutrophils admixed with other leukocytes Dr TTW (2009) 49 .EMPYEMA  Collection of pus in pleural cavity  Suppurative pleuritis  Presence of purulent pleural exudates  Characterized by loculated.

Etiology  Contiguous spread of organisms from intrapulmonary infection  Lymphatic dissemination  Haematogenous dissemination  Direct extension of infection below diaphragm (subdiaphragmatic or liver abscess) especially on right side Dr TTW (2009) 50 .

Clinical course  May resolve by antibiotics  Obliterate pleural space or envelope the lungs expansion embarrass pulmonary Dr TTW (2009) 51 .

Dr TTW (2009) 52 .