Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

107 Cards in this Set

  • Front
  • Back
-most commonly caused by Haemophilus influenzae type B
-infants/young children
-swelling obstructs air flow
-inspiratory stridor = wheezing sound on inspiration
-onset of cyanosis--> tracheostomy?
What makes up the majority of LARYNGEAL cancers?
Squamous cell carcinoma

Tumors strongly related to CIGARETTE SMOKING.
Name the 4 groups of squamous cell carcinoma (larynx) and describe each.
1) Glottic carcinoma: 1 or both true vocal cords.
2) Transglottic carcinoma: true and false vocal cords.
3) Supraglottic carcinoma: ventricle, false vocal cords, or epiglottis.
4) Infraglottic carcinoma: involves the true vocal cords, with infraglottic extension.
List INFECTIONS of the bronchi/bronchioles (4)
Respiratory Syncytial Virus
Bordetella pertussis
The collapse of expanded lung tissue.

An important postoperative complication of abdominal surgery due to mucous obstruction of a bronchus and diminished respiratory movement.

The collapsed lung becomes fibrotic and permanent bronchial dilatation results.
Bronchiectasis (define)
The irreversible dilatation of bronchi as a consequence of destruction of the muscular and elastic elements of their walls.
What are the causes (common, and other) of bronchiectasis?
Common cause (non-obstructive): a complication of respiratory infections or defects in the defense mechanisms that protects the airways from infection-- more widespread and involves MANY LOBES of the lungs.

Other causes (obstructive): inhaled foreign bodies, tumors, mucous plugs, compressive lymphadenopathy-- LOCALIZED to lung segment distal to obstruction.
Describe localized, non-obstructive bronchiectasis
Results from childhood bronchopulmonary infections such as measles, pertussis, or other bacterial infections.

Frequent causes: infections with adenovirus and respiratory syncytial virus.

Vaccines/antibiotics reduce the frequency.
Describe generalized bronchiectasis (non-obstructive)
Secondary to INHERITED impairments in host defense mechanisms or ACQUIRED conditions that permit introduction of infectious organisms into the airways.

Usually bilateral and most common in lower lobes.
List the inherited conditions associated with generalized bronchiectasis (4)
1. cystic fibrosis
2. dyskinetic ciliary syndromes
3. hypogammaglobulinemias
4. deficiencies of specific IgG subclasses.
List the acquired disorders associated with generalized bronchiectasis (4)
1. neurologic diseases that impair consciousness, swallowing, respiration, cough reflex.
2. incompetence of lower esophageal sphincter.
3. nasogastric intubation (insertion of tube)
4. chronic bronchitis
Define pneumonia.
A generic term that refers to inflammation and solidification of the pulmonary parenchyma.
Lobar pneumonia.
Consolidation (solidification) of an entire lobe (S. pneumoniae and Klebsella pneumoniae).
Signifies scattered, solid foci in the same or several lobes.
Pneumococcal Pneumonia
Pneumonia caused by Strep. pneumoniae- still a problem even with antibiotics.

Mostly a consequence of altered defense barriers in the respiratory tract.
Describe the stages of the pathology of pneumococcal pneumonia.
Earliest stage: "red hepatization": firm consistency of the affected lung brings to mind the liver. Congestion of capillaries and outpouring of PMN leukocytes.

Next phase: lysis of PMN leukocytes and appearance of macrophages. Gray hepatization: lung is still firm.

Alveolar exudate is removed and the lung gradually returns to normal.
Complications that can follow pneumococcal pneumonia (7)
Pleuritis (often painful)
Pleural effusion
Bacteremia (>25% of patients)
Pulmonary fibrosis (rare)
Lung abscess (rare)
Klebsiella Pneumonia
Causes lobar pneumonia.
Associated with alcoholism and seen frequently in middle-aged men.

The bacteria has a thick, gelatinous capsule, which is responsible for the MUCOID APPEARANCE of the cut surface of the lung.
What is a serious complication of Klebsiella Pneumonia?
Bronchopleural Fistula- a communication between the bronchial airway and the pleural space.
Staphylococcal Pneumonia
Uncommon COMMUNITY-acquired disease.

Pulmonary infection with S. aureus is common as a superinfection following influenza.

Repeated episodes are encountered in patients with CF.

Characterized by development of pulmonary abscesses.
Legionella Pneumonia
Organism: Legionella pneumophilia -- abundant both within and without the phagocytic cells.

Thrives in aquatic environments; outbreaks have been traced to contaminated water in AC cooling towers, evaporative condensers, construction sites.


Treatment: erythromycin.
Results from inhalation of Chlamydia psittaci in dust contaminated by shit from birds (parrots), usually pets.

Severe systemic symptoms (fever, malaise) but FEW RESPIRATORY SYMPTOMS other than cough.
Mycoplasma pneumoniae

Insidious onset, minimal respiratory symptoms.

Course of disease prolonged, rarely fatal.
Organisms that cause tuberculosis.
Mycobacterium tuberculosis.
Primary Tuberculosis
Acquired from initial exposure to M. TB, most commonly from inhaling infected aerosols produced by the coughing of a person with cavitary TB.

Ghon complex.

>90% of infections asymptomatic.

Less commonly: spreads to other parts of lungs - PROGRESSIVE PRIMARY TUBERCULOSIS (kids/immunosuppressed adults)
Describe the Ghon complex
First lesion of PRIMARY tuberculosis.

1. Peripheral parenchymal granuloma, often in the lower lobes.

2. a prominent, infected mediastinal lymph node.
Secondary Tuberculosis.
Can be reactivation of primary TB or new infection in a host previously sensitized to primary TB.

Cellular immune respone --> formation of granulomas and extensive tissue necrosis -> a lesion develops that has foci of caseous necrosis --> some foci erode into a bronchus, after which drainage of infectious material creates TB cavity = TUBERCULOUS CAVITY.
Complications of secondary tuberculosis (4)
1. miliary TB: results from hematogenous dissemination of the organisms; multiple, small, tuberculous granulomas in many organs.
2. hemoptysis: can drown patients in their own blood.
3. bronchopleural fistula -- tuberculous empyema and pneumothorax result.
4. intestinal tuberculosis: after swallowing tuberculous material.
Name the fungal infections of the lung (5)
1. Histoplasmosis
2. Coccidioidomycosis
3. Cryptococcosis
4. north american blastomycosis
5. aspergillosis
-disease of midwest and SE of US, esp. the MI and Ohio river valleys.

Cause: inhalation of Histoplasma capsulatum in infected dust, commonly from bird shit.

Similar to TB-- asymptomatic and lesions similar to the Ghon complex.
Cause: inhalation of spores of Coccidioides immitis

Southwest of US

Similar to histoplasmosis and TB
Cause: inhalation of the spores of Cryptococcus neoformans; organisms frequently found in pigeon shit.

Most serious cases occur in immunocompromised patients.
North American Blastomycosis

cause: Blastomyces dermatitidis

Concentrated in basins of missouri, MI, ohio rivers.

similar to all other fungal infections.
Infection of the lungs by Aspergillus species, usually A. niger or A. fumigatus
List the 3 kinds of circumstances of aspergillosis
1. invasive pulmonary aspergillosis
2. aspergilloma
3. allergic bronchopulmonary aspergillosis
invasive pulmonary aspergillosis
-most serious
-occurs exclusively as an OPPORTUNISTIC infection in patients with compromised immunity (AIDS).

Extensive blood vessel invasion --> occlusion, thrombosis, infarction of lung tissue.
="fungus ball"

Aspergillus species can grow in pre-existing cavities and proliferate to form an aspergilloma within the cavities.
Allergic Bronchopulmonary Aspergillosis

and its (4) characteristics
People with asthma have an unusual immunologic reaction to Aspergillus infection.

1. transient pulmonary infiltrates on chest radiographs.
2. eosinophilia of blood and sputum.
3. skin sensitivity and serum precipitins to A. fumigatus
4. elevated levels of serum IgE

Use systemic corticosteroids.
Pneumocystis carinii Pneumonia
Occurs in immunocompromised people- a frequent cause of death in AIDS patients.

Classic lesion has an interstitial infiltrate of plasma cells and lymphocytes, diffuse alveolar damage, and hyperplasia of type II pneumocytes.

Cysts look like "new moon" bodies.

Treatment: trimethoprim-sulfisoxazole or pentamidine.
Viral Pneumonia
Viral infections of the pulmonary parenchyma produce INTERSTITIAL (not alveolar) PNEUMONIA and diffuse alveolar damage.
-cytomegalovirus: intense interstitial infiltrate of lymphocytes; infected alveolar cells are large and have typical dark-blue nuclear inclusions.
-measles infection: presence of large, multinucleated gian cellts with nuclear inclusions.
-varicella infection: interstitial pneumonia + disseminated, focally necrotic lesions in the lung.
Lung Abscess
A localized accumulation of pus that is accompanied by destruction of the pulmonary parenchyma, including the alveoli, airways, and blood vessels.

Most common cause: aspiration, often in the setting of altered consciousness.

ALCOHOLISM is the single most common condition predisposing to lung abscess.
Also at risk: people suffering from drug overdose, epilepsy, neurologic impairment.

Abscesses have abundant PMN leukocytes and variable # of mac's.

Have the capacity for SPONTANEOUS DRAINAGE.

cough,fever, produce large amts. of FOUL-SMELLING SPUTUM.
What are the organisms involves in the poly-microbial infections causing LUNG ABSCESSES?
Fusiform bacteria and Bacteroides species are often isolated.

also: S. aureus, K. pneumoniae, S. pneumoniae, Nocardia
Diffuse Alveolar Damage (DAD)
A nonspecific pattern of reaction by the distal pulmonary parenchyma to a variety of acute insults that is characterized by interstitial inflamamtion and accumulation of proteinaceous alveolar exudate.

A final common pathway of pathologic changes caused by many differnet agents-- ALL these agents are capable of injuring the epithelial and endothelial cells of the alveoli.
What is the clinical counterpart of severe DAD (Diffuse Alveolar Damage)?
ARDS = adult respiratory distress syndrome

mortality rate is >50% and in patients older than 60, 90%
Describe the phases of DAD (Diffuse alveolar damage)
Initial EXUDATIVE PHASE: edema, exudation of plasma proteins, accumulation of inflammatory cells, and the appearance of hylaine membranes. Mild interstitial inflammation with lymphocytes, plasma cells, and mac's.

Organizing phase: begins weeks after initial injury. Proliferation of fibroblasts within the interstitial space and within the alveolar spaces.
What is the most conspicuous feature of the exudative phase of DAD?
Hyaline membranes = eosinophilic, glassy "membranes" that consist of precipitated plasma proteins and the cytoplasmic and nuclear debris from sloughed epithelial cells.
List the specific causes of Diffuse Alveolar Damage (5)
1. oxygen: related to increased production of activated oxygen species in the lung.
2. shock: ARDS follows shock from any cause --> "shock lung"
3. drug-induced DAD: drugs include most chemotherapeutic agents. best known = BLEOMYCIN.
4. Radiation Pneumonitis
5. Respiratory Distress Syndrome of the Newborn (RDS) = known as HYALINE MEMBRANE DISEASE.
What are the 2 types of radiation pneumonitis?
Alveolar injury is believed to result from generation of oxygen radicals through the radiolysis of water.

1. Acute radiation pneumonitis: occurs in 10% of patients who receive radiation therapy for lung or breast cancer. Dose-related and appears 1-6 months after therapy. Most patients recover.

2. Chronic radiaiton pneumonitis: characterized by INTERSTITIAL FIBROSIS and may follow acute DAD or develop insidiously.
Goodpasture Syndrome
A triad of diffuse alveolar hemorrhage, glomerulonephritis, and a circulating, cytotoxic autoantibody to a component of basement membranes.

Simultaneous attack on the lung AND kidney.

Patients suffer intra-alveolar hemorrhage. Typically young men.
Chronic Obstructive Pulmonary Disease (COPD)
a nonspecific term that describes patients with chronic bronchitis or emphysema who show evidence for a decrease in forced expiratory volume as measured by spirometric pulmonary function tests.

-chronic bronchitis
Chronic Bronchitis
Defined clinically as the presence of a chronic, productive cough without a discernable cause for more than 2-year period.

Primarily a disease of cigarette smokers.

Hyperplasia and hypertrophy of the mucus-secreting cells and an increased proportion of mucous to serous cells.

Dyspnea and cyanosis may also take place, and cor pulmonale may result - cyanosis + edema secondary to cor pulmonale = "BLUE BLOATER"
Enlargement of the airspaces distal to the terminal bronchioles, with destruction of their walls but without fibrosis.

Major cause: cigarette smoking

Increased # of neutrophils, which contain serine elastase and other proteases.
Describe the alpha1-antitrypsin deficiency.
Hereditary deficiency accounts for 1% of patients with COPD.

alpha1-AT is a circulating glycoprotein produced in the liver. It is a major inhibitor of a variety of proteases (elastase, trypsin, chymotrypsin, thrombin, bacterial proteases).

In the lung, it is important for the inhibition of neutrophil elastase, which digests elastin and other structural components of the alveolar septa --> impairs elastic recoil.
Centrilobular Emphysema
Most frequent type of emphysema.

Asocciated with both cigarette smoking + clinical symptoms.

Destruction of the cluster of terminal bronchioles near the end of the bronchiolar tree in the central pulmonary lobule (lobule = smallestion portion of the lung bounded by septa and includes several acini)

Most severe in the UPPER ZONES of the lung, the upper lobe, and the superior segment of the lower lobe.
Panacinar Emphysema
Leaves behind a lacy network of supporting tissue - "cotton-candy lung"

Tends to occur in LOWER ZONES of the lung.

Diffuse panacinar emphysema is the lesion associated with alpha1-AT deficiency.
Localized Emphysema
previously called "paraseptal emphysema"

Descruction of alveoli and emphysema in ONLY ONE location with the remainder of the lungs being normal.

No clinical significance, altho. rupture here produces spontaneous pneumothorax.

Progression of localized emphysema can result in a large area of destruction called a BULLA.
What is the most prominent radiologic abnormality in emphysema?
Overinflation of the lung- enlarged lungs, depressed diaphragm, "barrel chest"
What are "pink puffers"
These patients have a higher respiratory rate and increased minute volume but can maintain arterial hemoglobin saturation at near-normal levels.
Characterized by variable obstruction to the flow of air and increased responsiveness of the airways to a variety of stimuli. Characterized clinically by paroxysms of wheezing, dyspnea, and cough.

1/2 of cases: < 10 years old; boys > girls
Status Asthmaticus
When severe acute asthma is UNRESPONSIVE to therapy.

Treatment: systemic corticosteroids.
Describe the pathogenesis of asthma.
• An inhaled allergen interacts with IgE antibody on the surface of mast cells interspersed among the epithelial cells of the bronchial mucosa.
o Mast cells degranulate and release mediators of Type I (immediate) hypersensitivity: histamine, bradykinin, leukotrienes, prostaglandins, thromboxane A2, and PAF (platelet-activating factor).
o  smooth muscle contraction, mucus secretion, and increased vascular permeability and edema = all cause airway obstruction.
o Chemotactic factors attract neutrophils, eosinophils, and platelets to the bronchial wall.
o Eosinophils release leukotriene B4 and PAF, aggravating bronchoconstriction and edema.
o Leukotriene B4 and PAF recruit more eosinophils  vicious circle that prolongs/amplifies the asthma attack.
List the different kinds of asthma (7)
Allergic asthma: pollens, animal hair/fur, house dust w. mites
Infections: viral resp. tract infection
Exercise-induced asthma
Occupational asthma
Drug-induced asthma (aspirin)
Air pollution
Emotional factors: psychological stress
Describe the pathology of asthma.
The airways are filled with thick, adherent mucous plugs.

Charcot-Leyden crystals: the plugs contain strips of epithelium and many eosinophils, the extruded granules of which coalesce to form needle-like crystals.

Curschmann spirals: the mucoid exudate forms a cast of the airways, which may be expelled with coughing.

Epithelium has lost its pseudostratified appearance - only basal cells remain. Increase in # of goblets cells.

Prominence of bronchial smooth muscle = muscle hyperplasia.
Treatment of asthma.
Beta-adrenergic agonists, inhaled corticosteroids, cromolyn sodium, methylxanthines, anticholinergic agents.
Pulmonary diseases caused by inhalation of INORGANIC dusts.

Most important factor: capacity of inhaled dusts to STIMULATE FIBROSIS.

Silica and asbestos produce extensive fibrosis, while coal and iron are weakly fibrogenic.
A pneumoconiosis caused by inhalation of silicon dioxide (silica), usually in crystalline form (as quartz).

sandblaster, mining, stone cutting, metal polishing/sharpening.

Tuberculosis is more common in patients with silicosis than in the general population (lung cancer not associated at all).
Pathogenesis of silicosis
Silicar particles are ingested by alveolar macrophages.

Silicon hydroxide groups on the silica particles form hydrogen bonds with phospholipids and protiens --> damage cellular membrnaes --> kills the macrophage.

The dead macs release free silica particles and fibrogenic factors.

Released silica is re-ingested by more mac's --> amplifies the process.
Simple Nodular Silicosis
Most common form of silicosis.
20-40 years after exposure; lungs contain SILICOTIC NODULES <1 cm in diameter.

No significant respiratory dysfunction.
Progressive Massive Silicosis
Nodular masses are >1 cm in diameter, against a background of simple silicosis.

Represent the coalescence of smaller nodules.

Related to the amt. of silica in the lung.
Coal Workers' Pneumoconiosis
Coal dust = amorphous carbon with other constituents of the earth's surface, including some amts. of silica.

Characteristic pulmonary lesion: coal dust macules = black areas scattered through the lungs.

aka "black lung disease" or "simple coal workers' pneumoconiosis"

Focal dust emphysema: dilatation of resp. bronchioles that probably results from the atrophy of smooth muscles.
(coal workers' pneumoconiosis)

appearance of larger, nodular lesions in the lungs suggests a change caused by silica in the inhaled dust.
Asbestos-Related Disease
Refers to the pneumoconiosis that results from inhalation of asbestos fibers. Asbestos fibers are composed of silicates; they deposit in the distal airways and alveoli, particularly at the bifurcations of the alveolar ducts.

It is an INTERSTITIAL FIBROSIS of the lung.

-pleural plaques
-carcinoma of the lung
Asbestos body
consists of an asbestos fiber that has beaded aggregates of iron along its length.

The iron derives from hemoglobin that has been liberated from microhemorrhages.

Found in the walls of bronchioles or within the alveolar spaces, often engulfed by alveolar macrophages.
Pleural plaques
(asbestos-related disease)
Plaques on the parietal pleura --

you see them 10-20 yrs after exposure to asbestos.

gross exam: raised, white, shiny, w/ consistency of cartilage

microscopically: densely collagenous, hyalinized, and sometimes calcified.
Mesothelioma & asbestos
(asbestos-related disease)
There is a CLEAR-CUT relationship between asbestos exposure and malignant mesothelioma.
Carcinoma of the lung
(asbestos-related disease)
Bronchogenic carcinoma is 3-5x more common in non-smoking abesteros workers than in non-smoking workers not exposed to asbestos.
the pulmonary disease that follows inhalation of beryllium.

beryllium is used in structural materials employed by the aerospace industries, in the manufacture of industrial ceramics, and in atomic reactors.

Pathologic findings are those of Diffuse alveolar damage.

Chronic disease differs from other pneumoconioses in that the amt. and duration and exposure may be small, and the lesion is suspected to be a hypersensitivity phenomenon.
hypersensitivity pneumonitis
refers to a group of immunologically mediated conditions caused by exposure to ORGANIC dusts, in which the alveoli and distal airways are preferentially involved.

>30 environmental antigens are known to produce this - most in occupational settings.

Represents a combination of TYpe III (immune complex-mediated) and Type IV (cell-mediated) hypersensitivity reactions.
What are the different types of hypersensitivity pneumonitis?
Farmer's lung (prototype): farmers exposed to moldy hay - inhalation of thermophilic actinomycetes that grow in moldy hay.

Bagossosis: sugar cane workers exposed to moldy, pressed sugar cane (bagasse).

Pigeon breeder's disease: bird breeders who come in contact with feathers, serum, and shit of pigeons.
What is most characteristic of the chronic phase of hypersensitivity pneumonitis?
presence of scattered, pooly formed granulomas that contain foreign body giant cells.
a chronic disease of unknown cause in which NONCASEATING GRANULOMAS occur in almost any organ of the body. THe lung is most frequently involved, but the lymph nodes (hilar), skin, and eye are also common targets.

Scandinavian countries; Irish women in London; distinctly uncommon in China.
US: blacks 15: whites 1.

Exaggerated cellular immune response on the part of helper/inducer T lymphocytes to unknown exogenous antigens or autoantigens.

Nonspecific polyclonal activation of B cells by T-helper cells leads to HYPERGLOBULINEMIA.
List the grades of pulmonary hypertension (in order of increasing severity) (6)
1. medial hypertrophy of muscular pulmonary arteries and appearance of smooth muscle in the pulmonary arterioles.
2. intimal proliferation
3. intimal fibrosis
4. formation of plexiform lesions, together with dilatation and thinning of pulmonary arteries.
5. rupture of pulmonary arteries
6. fibrinoid necrosis
With all grades of pulmonary hypertension, what is seen in the largest pulmonary arteries?
Primary pulmonary hypertension
pulmonary hypertension of unknown cause.

Most common wiht young women in their 20's and 30's.

Medical treatment is ineffective; indication for heart-lung transplantation.
Recurrent Pulmonary Emboli
Multiple thromboemboli in the smaller pulmonary vessels gradually restrict the pulmonary circulation.

Placement of a filter in the inferior vena cava prevents further embolization.
Functional Resistance to Arterial Flow (Vasoconstriction)
Any disorders that produces hypoxemia results in pulmonary hypertension.

Includes chronic obstruction to the flow of air, infiltrative lung diseases, and living at high altitudes.
Cardiac causes of pulmonary hypertension.
Left ventricular failure

Mitral stenosis
comprises 1/3 of all invasive lung cancers

tends to arise in the periphery, usually in the upper lobes.

most occur in smokers.

initial presentation: irregular masses; readily metastasize to the same sites as squamous cell carcinomsa, but tend to grow more rapidly and frequently invade the pleura.
Bronchioloalveolar Carcinoma
A distinctive subtype of adenocarcinoma that grows along pre-existing alveolar walls.


Most of these cancers originate from CLARA CELLS, although some are composed mainly of type II pneumocytes.
Small Cell Carcinoma
a highly malignant lung cancer that is characterized by sheets of small tumor cells that differentiate in the direction of the neuroendocrine cells.

90% of patients smoke.

Arise from the pluripotential basal cells of the bronchial epithelium; near the hilum of the lung.

2/3 of tumors have already metastasized to bone, liver, brain, and other organs.

Tx: chemotherapy

Carcinoid tumors
a group of neuroendocrine, pulmonary neoplasms derived from the pluripotential basal layer of the respiratory epithelium.

Not related to smoking.

Large majority of tumor cells are endocrinologically silent.
Metastatic Tumors

Viewed radiologically as "cannon ball" metastases.

Primary sites: breast, stomach, pancreas, colon.
Lymphangitic Carcinoma
A metastatic tumor.

Condition in which the metastatic tumor spreads widely through the pulmonary lymphatic channels, forming a sheath of tumor around hte bronchovascular tree and veins.
the presence of air in the pleural cavity.

may result from traumatic perforation of the pleura or may be spontaneous.

most commonly iatrogenic (due to physician) - seen after aspiration of fluid from the pleura; pleural or lung biopsies; transbronchial biopsy; positive pressure-assisted ventilation.
Spontaneous pneumothorax
young adults

due to the rupture of subpleural emphysematous blebs.

it subsides by itself but some patients need withdrawal of the air.
Tension pneumothorax
unilateral; extensive enough to move the mediastinum to the opposite side, with compression of the opposite lung.
Define pleural effusion.
the accumulation of excess fluid in the pleural cavity.
an effusion that resembles water and would be regarded as edema if it occurred elsewhere; may be due to increased hydrostatic pressure within the capillaries
cloudy effusion containing many PMN leukocytes that results from infections of the pleura; commonly a complication of bacterial pneumonia that extends to the pleural surface
a variant of pyothorax in which thick pus accumulates within the pleural cavity, often with loculation and fibrosis
accumulation of blood in the pleural cavity as a result of trauma or rupture of a vessel
accumulation of a milky, lipid-rich fluid (chyle) in the pleural cavity caused by lymphatic obstruction—this suggests disease of the lymph nodes in the posterior mediastinum
-A malignant tumor of mesothelial cells that is most common in the pleura but also occurs in the peritoneum and tunica vaginalis of the testis.
-Most pleural and peritoneal mesotheliomas are related to asbestos exposure.
- Middle-age men who are occupationally exposed to asbestos, even for a short time.
- Patients present with a pleural effusion or with a pleural mass, chest pain, and dyspnea.
- Treatment is ineffective; hopeless prognosis
Squamous cell carcinoma (of lung, not larynx)
-30% of all invasive lung cancers in the U.S.
-Most arise in the central part of the lung, from the major or segmental bronchi.
-in well-differentiated tumors, keratin ocurs as "pearls" which appear as brightly eosinophilic aggregates of keratin surrouned by "onion skin" layers of squamous cells.
-These metastasize to the regional lymph nodes, esp. the hilar and mediastinal nodes.
-Most common site of extranodal metastasis: adrenal gland.
- superior vena cava syndrome.
-Pancoast tumor.
- A Pancoast tumor can paralyze the cervical sympathetic nerves and cause Horner Syndrome
Pancoast tumor
(squamous cell carcinoma of the lung)
growth of a lung cancer in the APEX of a lung. May extend to involve the 8th cervical and 1st and 2nd thoracic nerves --> shoulder pain radiating down the arm = Pancoast syndrome
Horner Syndrome
When a Pancoast tumor paralyzes the cervical sympathetic nerves.

Depression of eyeball, drooping of upper eyelid, constriction of pupil, absence of sweating on the affected side.
Emphysema and impairment of elastic recoil.
Smoking reduces alpha1-AT activity in the lung owing to oxidation of methionine residues in the enzyme. So, unopposed and increased elastolytic activity leads to destruction of elastic tissue in the walls of the distal airspaces.