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34 Cards in this Set

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__________ is a medical condition in which the lungs are not fully inflated. It may affect part or all of one lung. It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation.
Atelectasis
Describe atelectasis and recognize the different types
Atelectasis is collapse of lung tissue; usually reversible (as opposed to COPD which is usually not reversible); prone to infection

TYPES
1) resorption atelaectasis (due to airway obstruction)
2) compressive atelectasis (pleural cavity filled by air, fluid, blood, or tumor)
3) contraction atelectasis (local or generalized fibrotic changes that prevent complete expansion of the lung)
provide examples of resorptive atelectasis
-mucus plugs/exudates (ie. asthma, chronic bronchitis, bronchiectasis)
- aspiration of foreign body
- tumors
in which of these types of atelectasis will mediastinum shift toward the atelectic lung as opposed to the normal lung?

a. resorptive (obstructive) aelectasis
b. compressive atelectasis
c. contraction atelectasis
A. the other two will cause a shift toward normal lung
tension pneumothorax, pleural effusions, pleural metastasis are examples of ________ atelectasis.
compressive
give an example of contraction atelectasis
pulmonary fibrosis
Diffuse alveolar damage (DAD) can lead to pulmonary edema by what mechanism?

a. hemodynamic
b. microvascular injury
B. In DAD (which is the pathology of the clinical condition, ARDS), due to infection, sepsis, or trauma, damage is done to alveolar capillaries so that tight junctions within alveolar capillaries aren’t intact and will leak fluid and cells into interstitium and air space within alveoli.
causes of diffuse alveolar damage (DAD) -- which, of course is the same thing as acute respiratory distress syndrome (ARDS)
PSAT

Pneumonia (esp viral pulmonary infection)
Sepsis/DIC
Aspiration
Trauma
Describe pulmonary edema and its causes
pulmonary edema = filling of airspaces with fluid so that lungs become heavy and wet with foamy fluid in airways

TWO CAUSES:
1. hemodynamic ("cardiogenic" - due to back up of blood from left heart failure, for example, and causes increased hydrostatic pressure and alveolar capillary congestion)
2. microvascular injury (pulm edema due to direct injury to alveolar capillaries so that there is increased permeability and fluid leakage, like in ARDS/DAD)
Describe alveolitis and tell me what kind of inflammatory cells are usually found
ALVEOLITIS = acute injury to lung parenchyma (usually NEUTROPHIL infiltrate into interstitium and airspaces with edema and fibrin formation)
__________ is a medical condition in which the lungs are not fully inflated. It may affect part or all of one lung. It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation.
Atelectasis
Describe atelectasis and recognize the different types
Atelectasis is collapse of lung tissue; usually reversible (as opposed to COPD which is usually not reversible); prone to infection

TYPES
1) resorption atelaectasis (due to airway obstruction)
2) compressive atelectasis (pleural cavity filled by air, fluid, blood, or tumor)
3) contraction atelectasis (local or generalized fibrotic changes that prevent complete expansion of the lung)
provide examples of resorptive atelectasis
-mucus plugs/exudates (ie. asthma, chronic bronchitis, bronchiectasis)
- aspiration of foreign body
- tumors
in which of these types of atelectasis will mediastinum shift toward the atelectic lung as opposed to the normal lung?

a. resorptive (obstructive) aelectasis
b. compressive atelectasis
c. contraction atelectasis
A. the other two will cause a shift toward normal lung
tension pneumothorax, pleural effusions, pleural metastasis are examples of ________ atelectasis.
compressive
give an example of contraction atelectasis
pulmonary fibrosis
Diffuse alveolar damage (DAD) can lead to pulmonary edema by what mechanism?

a. hemodynamic
b. microvascular injury
B. In DAD (which is the same thing as ARDS), due to infection, sepsis, or trauma, damage is done to alveolar capillaries so that tight junctions within alveolar capillaries aren’t intact and will leak fluid and cells into interstitium and air space within alveoli.
causes of diffuse alveolar damage (DAD) -- which, of course is the same thing as acute respiratory distress syndrome (ARDS)
PSAT

Pneumonia (esp viral pulmonary infection)
Sepsis/DIC
Aspiration
Trauma
Describe pulmonary edema and its causes
pulmonary edema = filling of airspaces with fluid so that lungs become heavy and wet with foamy fluid in airways

TWO CAUSES:
1. hemodynamic ("cardiogenic" - due to back up of blood from left heart failure, for example, and causes increased hydrostatic pressure and alveolar capillary congestion)
2. microvascular injury (pulm edema due to direct injury to alveolar capillaries so that there is increased permeability and fluid leakage, like in ARDS/DAD)
Describe alveolitis and tell me what kind of inflammatory cells are usually found
ALVEOLITIS = acute injury to lung parenchyma (usually NEUTROPHIL infiltrate into interstitium and airspaces with edema and fibrin formation)
Describe the histopathology of different phases of alveolitis
TWO PHASES: exudative and organizing phase

1) EXUDATIVE (EARLY) PHASE = characterized by inflammation/injury to alveolar endothelium and type 1 pneumocytes with inflammtion in interstitium and exudate in alveolar spaces

ORGANIZING (LATE) PHASE = scarring/fibrosis of granulation tissue in the interstitium (this is "healed" state)
Describe the histopathology of the different phases of diffuse alveolar damage (remember DAD = ARDS)
exudative phase = characterized by hyaline membrane that line airspace, edema, reactive type II pneumocytes, and interstitial inflammation

organizing phase = proliferation of reactive type II pneumocytes, fibroblasts lay down granulation tissue, lead to thickened alveolar septum and interstitial fibrosis
what is BOOP?
bronchiolitis obliterans organizing pneumonia = pattern of AIRWAY-CENTERED acute lung injury
- there's granulation tissue in the LUMEN of: bronchioles (BO) and adjacent alveoli (OP)
Identify the causes of bronchiolitis obliterans-organizing pneumonia pattern
#1 Idiopathic (COP - cryptogenic organizing pneumonia)

- infections (viral, mycoplasma)
- obstruction
- medications/radiation therapy
- bone marrow transplant
Describe the pathologic features of bronchiolitis obliterans-organizing pneumonia
intraluminal granulation tissue in membranous bronchioles, respiratory bronchioles, alveolar ducts, alveoli...leading to scarring around airways and fibrosis of intersitium
Recognize histopathologic findings of rejection in the lung after transplantation
grading scale (A1-A4) according amt of lymphocytic infiltration into the area
what do you use to assess rejection in a lung transplantation?
transbronchial biopsy
DAD + Viral inclusions
= _____ pneumonia

DAD + Atypical fibroblasts/type II cells, Vacuolization of endothelium
= ______ pneumonitis
viral

radiation
Specific diagnostic clues
viral inclusions = ______pneumonia

food particles = ______ pneumonia

lymphoplasmacytic infiltrates + poorly formed granulomas = _______ pneumonitis

lymphoplasmacytic infiltrates + plasma cells dominant + rheumatoid nodules + follicular bronchiolitis or vasculitis = _______ lung

lymphoplasmacytic infiltrates + intraalveolar macrophage and eosinophil infiltrates = _________ pneumonia
viral; aspiration; hypersensitivity; rheumatoid; eosinophilic
what is obliterative bronchiolitis
chronic rejection (fibrous obliteration of airway lumens)
How does pulmonary edema differ from diffuse alveolar damage?
DAD is a condition that can lead to pulmonary edema. pulm edema itself is when there is injury to alveolar capillaries such that there is increased permeability and fluid leakage
How does organizing pneumonia differ from diffuse alveolar damage? How are they similar?
organizing pneumonia and DAD are both conditions that specifically damage alveoli.

OP is granulation tissue that gets into the INTERSTITIUM and LUMEN of alveoli, whereas DAD is caused by infection or something else (sepsis, aspiration, or trauma) that leads to inflammation and granulation tissue formation in the INTERSTITIUM and ALVEOLAR SEPTAL WALL
A 24 year old woman is burned in a house fire, suffers extensive fluid loss, and is hypotensive on arrival to the emergency department. She develops nosocomial infection and ARDS after prolonged intubation and ventilatory support. What do you expect her chest x-ray to show? What would a lung biopsy show? What are the potential multifactorial causes in this case?
CXR = diffuse alveolar infiltrates ("white-out" or "snow storm")

lung biopsy would show widespread alveolitis in exudative phase (since it's acute) with lots of fibrinous exudate mixed with cell debris from necrotic pneumocytes (hyaline membranes), edema, reactive type II pneumocytes, interstitial inflammation
Acute cellular rejection after lung transplant is characterized by what type of inflammatory cell reaction? What patterns may be seen on transbronchial biopsy?
lymphocytes

transbronchial biopsy = would show lots of lymphocytic infiltrates in the perivasculature