Vascular Lung Diseases

Transcription

1 Vascular Lung Diseases

2 SESSION SPECIFIC OBJECTIVES List the major types of vascular lung disease Recognize and describe the pathology of vascular lung disease: Pulmonary embolism, thrombosis, hypertension, and diffuse pulmonary hemorrhage (Goodpasture s, SLE, Wegener s, idiopathic)

3 Vascular Lung Diseases Pulmonary thromboemboli Pulmonary emboli of other types Pulmonary thrombosis Pulmonary hypertension Diffuse pulmonary hemorrhage syndromes

4 Pulmonary Embolus, right main pulmonary artery

5 Pulmonary Embolus with lines of Zahn (H&E)

6 Pulmonary arteriogram, with right lower lobe filling defect

7 Pulmonary infarct, right lung

8 PULMONARY EMBOLI OF OTHER TYPES Fat emboli (injury to long bones) Tumor emboli (metastatic cancer) Air emboli (venous system) Talc emboli (IV drug abuse) Amniotic fluid emboli (pregnancy complication)

9 Fat emboli, lung (osmium post fixation)

10 Tumor Embolus, pulmonary artery

11 Microcrystalline cellulose (Darvocet tablet), polarized light

12 PULMONARY IN SITU THROMBOSIS Most often occurs in malignancy (hypercoagulation) or pulmonary hypertension Thrombi are pale and form casts of arterial tree

13 Pulmonary artery thrombosis

14 PULMONARY HYPERTENSION Primary pulmonary hypertension Pulmonary arterial hypertension (PAH) Pulmonary veno-occlusive disease Secondary pulmonary hypertension Chronic pulmonary emboli Congenital heart disease (ASD, VSD)

15 Pulmonary aterial hypertension elastic stain

16 Pulmonary aterial hypertension plexiform lesion

17 Recanalized pulmonary embolus, chronic thromboembolic disease

18 Pulmonary veno-occlusive disease, elastic stain

19 Right ventricular hypertrophy, primary pulmonary hypertension

20 DIFFUSE PULMONARY HEMORRHAGE Goodpasture s syndrome Systemic lupus erythematosus Wegener s granulomatosis Idiopathic

21 Immunologic Lung Disease (Gell & Coombs) Immune reaction Mediator Histology Example Type I Reaginic AB Eosinophils Asthma Type II Cytotoxic AB Alveolar hemorrhage Goodpasture s Syn Type III Immune complexes Vasculitis SLE Type IV Sensitized lymphs Granulomas Sarcoidosis HP

22 Goodpasture s Syndrome

23 Goodpasture s Syndrome with intra-alveolar hemorrhage

24 Goodpasture s Syndrome, lung IgG immunofluorescence

25 Goodpasture s Syndrome, kidney IgG immunofluorescence

26 Pulmonary capillaritis (microangiitis), H&E

27 CLASSIC WEGENER S GRANULOMATOSIS Necrotizing granulomatous arteritis of lungs Necrotizing inflammation of upper respiratory tract Glomerulonephritis

28 Necrobiotic nodule, Wegener s granulomatosis

29 Necrotizing granulomatous arteritis, Wegener s (H&E)

30 Geographic necrosis, Wegener s granulomatosis (H&E)

31 Back wall of my den

32 Obstructive Lung Disease

33 SESSION SPECIFIC OBJECTIVES List the major types of obstructive lung disease Recognize and describe the pathology of obstructive lung disease Emphysema, small airways disease, large airways disease, bronchiectasis, and asthma

34 OBSTRUCTIVE LUNG DISEASE Emphysema Small airways disease Large airways disease Bronchiectasis Asthma

35 CLASSIFICATION OF EMPHYSEMA Centrilobular (85%) Panlobular (5%) Paracicatricial (5%) Localized (5%)

36 Centrilobular emphysema (gross)

37 Centrilobular emphysema free floating alveolar septa

38 CT of thorax -Centrilobular emphysema

39 Panlobular emphysema (gross)

40 Liver with globules of alpha-1 antitrypsin (PAS Stain)

41 Ultrastructure of liver in alpha-1 antitrypsin deficiency

42 Paracicatricial emphysema, tuberculosis

43 Localized emphysema (gross)

44

45 Autofluorescent smoker s macrophages

46 Ultrastructure of smoker s macrophages with numerous secondary lysosomes

47 CONSEQUENCES OF EMPHYSEMA Pulmonary obstruction ( TLC, FEV 1 ) Diminished elastic recoil Diminished D L CO

48

49 Centrilobular emphysema post-mortem pulmonary artery injection

50 SMALL AIRWAYS DISEASE Mucous plugging Goblet cell metaplasia Chronic inflammation Peribronchiolar fibrosis

51 Small airways disease with mucous plugging (PAS)

52 Small airways disease with goblet cell metaplasia

53 Respiratory bronchiolitis with numerous smokers macrophages

54 Bronchiolitis obliterans secondary to Adenovirus infection

55 Bronchial wall: mucous gland hyperplasia

56 Chronic bronchitis with dilated mucous duct

57 BRONCHIECTASIS Obstruction (foreign body) Genetic (CF, primary ciliary dyskinesia) Infection (children) Traction (sarcoidosis)

58 Bronchiectasis (gross)

59 Bronchiectasis secondary to peanut aspiration (gross)

60 Saccular bronchiectasis cystic fibrosis

61

62 Bronchiectasis, (H&E)

63 ASTHMA Goblet cell metaplasia Mucous plugging Smooth muscle hyperplasia Thickened basement membrane ± eosinophils

64 Chest x-ray in asthma (PA & Lateral) with hyperinflation

65 Status asthmaticus with mucous plugging (H&E)

66 Bronchial mucous plug (asthma) with Charcot-Leyden crystals

67 Wasting away in Margaritaville