Resp - 08 - Pulmonary Vascular Disease

Front 1

hemodynamic pulmonary edema

Back 1

increased hydrostatic pressure usually

less likely decreased oncotic presure

leftsided heart failure (cardiogenic) - see alveolar edmema, heart failure cells (macrophages w/ hemosiderin)

hypostatic pneumonia

Front 2

microvascular pulmonary edema

Back 2

due to pneumonia (focal) or acute lung injury (diffuse)

no heart failure, see damage lung -> inflammation -> increased vascular permeability

severe acute lung injury = acute respiratory distress syndrome

see extensive whiteout on radiograph

causes: infection (sepsis), trauma, aspiration of gastric, shock

Front 3

diffuse alveolar damage (DAD)

Back 3

diffuse damage to alveolocapillary membrane

central role by neutrophils

insult causes capillary to be more permiable - allows netrophils through -> chemical mediators do damage -> edema, lack of surfactant

--> formation of hyaline membrane (composed of plasma proteins - fibrinogen)

outcome - resolution or interstitial fibrosis (honeycombing = bad)

Front 4

acute interstitial pneumonia (hamman - rich syndrome)

Back 4

idiopathic DAD -> acute respiratory failure

see interstitial fibrosis most often, rarely see resolution -> stays in proliferative phase -> fibrosis

Front 5

pulmonary thromboembolism

Back 5

deep vein thrombosis

usually asymptomatic but if have >60% compromise -> sudden death due to respiratory compromise OR cor pulmonale

if chronic -> pulm hypertension

paradoxical embolism if there is a cardiac septal defect

Front 6

paradoxical embolism

Back 6

DVT embolizes but instead of going to lung it goes through a cardiac septal defect and into systemic circulation

can cause stroke

Front 7

pulmonary hypertension

Back 7

pulm pressure > 1/4 of systemic blood pressure (usually should be about 1/8 of systemic)

>25 mm Hg at rest

Front 8

pulmonary arterial hypertension

Back 8

familial form:
mutation in bone morphogenic protein receptor type 2 (BMPR2)

see intimal and medial thickening

women in 3rd-4th decades

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also see drug induced (fen phen, methamphetamines), and connective tissue disease

Front 9

pulmonary hypertension due to left heart disease

Back 9

mitral stenosis is a frequent occurance

]-> increased LA pressure
-> increased pulm venous pressure
-> increased pulm arterial pressure

Front 10

pulm hypertension due to lung disease

Back 10

COPD, restrictive disease

Front 11

chronic thromboebolic PH

Back 11

decreased functional cross sectional area of pulm vasculature -> increased vascular resistance

Front 12

pulm hypertension due to unclear mech

Back 12

hematologic disorder, systemic disorder, metabolic disorder

atherosclerosis

Front 13

pulmonary hypertension grade

Back 13

low grade is reversible

high grade is irreversible - characterized by plexogenic pulmonary arteriopathy - plexiform lesions, angiomatoid lesions - fibrinoid necrosis

Front 14

diffuse pulmonary hemorrhagic syndromes

Back 14

goodpasture syndrome - see inflam destruction of basement pattern - type II hypersensitivity - linear pattern

idiopathic pulmonary hemorrhage (hemosiderosis) - children - blood etabolized by macrophages

vasculitis

Front 15

vasculitis-associated pulmonary hemorrhage

Back 15

see neutrophlic capillaritis - alveolar septum surrounded by neutrophils

microscopic polyangitis

wegner granulomatosis

SLE - diffuse granular immunoflourescence