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Slide 120, Lobar PneumoniaSlide 120, Lobar Pneumonia Slide 120, Lobar PneumoniaSlide 120, Lobar Pneumonia

Slide 172, Interstitial PneumoniaSlide 172, Interstitial Pneumonia Slide 172, Interstitial PneumoniaSlide 172, Interstitial Pneumonia

53 Year53 Year--Old SmokerOld Smoker EmphysemaEmphysema

Pink pufferPink pufferBarrel chestBarrel chest

HyperinflationHyperinflationTrapped airTrapped air

ThinThinLots of calories just to Lots of calories just to breathbreath

Rapid respirationsRapid respirationsPursed lipsPursed lipsCOPDCOPD

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Chromic BronchitisChromic Bronchitis

Also a chronic obstructive Also a chronic obstructive disease disease Chronic cough with Chronic cough with mucus production for 3 mucus production for 3 months.months.May lead to emphysema May lead to emphysema (especially in smokers).(especially in smokers).COPDCOPDLarger airway narrowingLarger airway narrowingIncreased secretionsIncreased secretions

Goblet cell hyperplasiaGoblet cell hyperplasia

Blue bloaterBlue bloaterCyanoticCyanotic

ClubbingClubbing

Hypertrophic Hypertrophic osteoarthropathyosteoarthropathySoft tissue and Soft tissue and periosteal boneperiosteal boneEmphysemaEmphysemaLung cancerLung cancerHeart defectsHeart defects

Anion GapAnion Gap EmphysemaEmphysema

Large airspacesLarge airspacesTrapped in air the Trapped in air the dilated alveolidilated alveoli

causes compression of causes compression of smaller airwayssmaller airwaysHyperinflationHyperinflation

Changes are Changes are irreversibleirreversible

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EmphysemaEmphysema Chronic BronchitisChronic Bronchitis

Chronic BronchitisChronic Bronchitis COPDCOPD

HematocritHematocrit??Ulcer?Ulcer?Complications?Complications?Other conditions?Other conditions?

Premature InfantPremature Infant

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Fetal LungFetal Lung

Hyaline Membrane vs. ARDSHyaline Membrane vs. ARDS

Pathogenesis?Pathogenesis?Differs from ARDS?Differs from ARDS?Toxemia and placenta?Toxemia and placenta?History?History?WhatWhat’’s this?s this?

Placental InfarctsPlacental Infarcts

43 Year43 Year--Old WomanOld Woman

Long termLong termFeverFeverCoughCoughBlood?Blood?CavitaryCavitary

TB Chest XTB Chest X--RayRay

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TB Chest XTB Chest X--RayRay TuberculosisTuberculosis

Mycobacterium tuberculosis Mycobacterium tuberculosis (most cases)(most cases)

Type IV hypersensitivityType IV hypersensitivityGranulomaGranuloma

Primary infectionPrimary infectionPulmonaryPulmonaryPerhaps goes lymphaticsPerhaps goes lymphaticsHopefully it stops here.Hopefully it stops here.

Secondary TBSecondary TBInternal reactivationInternal reactivationPerhaps years laterPerhaps years laterNot all patientsNot all patients

Granuloma FormationGranuloma Formation Primary TBPrimary TB

Secondary or Reactivation TBSecondary or Reactivation TB TuberculosisTuberculosis

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Granulomas of TBGranulomas of TB

Caseous granulomasCaseous granulomasGiant cellsGiant cellsInert bugInert bug

Disseminated TBDisseminated TB

Skin TestSkin Test

PPDPPDInjected intradermallyInjected intradermallyRead in 2 daysRead in 2 daysMeasure swellingMeasure swelling

Not rednessNot redness

Positivity maybe life Positivity maybe life longlong

35 Year35 Year--Old ArtistOld Artist

FeverFeverSudden onsetSudden onsetPleurodyniaPleurodyniaSOBSOBDullnessDullnessCBCCBCSputum?Sputum?

Pulmonary InfectionsPulmonary Infections

PneumoniaPneumoniaInfection in the alveolar spacesInfection in the alveolar spaces

BacteriaBacteriaTBTB

Interstitial tissueInterstitial tissueVirusVirusMycoplasmaMycoplasma

AbscessAbscessBronchitisBronchitisBronchiolitisBronchiolitisPleuritisPleuritis

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Bacterial PneumoniaBacterial Pneumonia

Streptococcal pneumoniaeStreptococcal pneumoniae Acute Bacterial PneumoniaAcute Bacterial Pneumonia

Gram Negative BugsGram Negative Bugs

Typically from body floraTypically from body flora‘‘OpportunisticOpportunistic’’ infectionsinfections

Compromised hostCompromised hostAlcoholicAlcoholic

AspirationAspiration

ChemotherapyChemotherapyTracheostomyTracheostomyBroad spectrum antibiotics that change host Broad spectrum antibiotics that change host floraflora

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Klebsiella PneumoniaKlebsiella Pneumonia

Gram negative rodGram negative rodVery mucoid capsuleVery mucoid capsule

AspirationAspirationHead down in the gutterHead down in the gutter

Rusty sputumRusty sputumHigh feverHigh fever

Pulmonary AbscessPulmonary Abscess

StaphylococcusStaphylococcusAspiration of gastric Aspiration of gastric materialmaterialHole withHole withAirAir--fluid levelfluid level

PneumoniaPneumoniaBxBx??Spread within the Spread within the lungs?lungs?CBC, immature cells?CBC, immature cells?Outcome?Outcome?

35 Year35 Year--Old SmokerOld Smoker

Pack year?Pack year?CoughCoughBlood?Blood?

Bronchiogenic CarcinomaBronchiogenic Carcinoma

Squamous in most casesSquamous in most casesChronic irritant leads to Chronic irritant leads to squamous metaplasia.squamous metaplasia.Continued exposure leads Continued exposure leads to dysplasia and to dysplasia and eventually cancer.eventually cancer.Very aggressive.Very aggressive.Surgery is about it.Surgery is about it.Poor response to Poor response to chemotherapy ands chemotherapy ands radiationradiation

Pulmonary CytologyPulmonary Cytology

Exfoliative cytologyExfoliative cytologyCough it upCough it upWash it outWash it out

Bronchoscopic biopsyBronchoscopic biopsy

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Metaplasia, Dysplasia, CancerMetaplasia, Dysplasia, Cancer Basic Patterns of Bronchiogenic CarcinomaBasic Patterns of Bronchiogenic Carcinoma

What Lung Cancer What Lung Cancer Can DoCan Do

Obstruct bronchus causing Obstruct bronchus causing pneumonia pneumonia Spread widelySpread widelyOdd hormonal activityOdd hormonal activity

Small cell makes ADH and Small cell makes ADH and ACTHACTHSquamous cell makes PTHSquamous cell makes PTH

Multiple sclerosis like Multiple sclerosis like symptomssymptoms

Even without brain metsEven without brain mets

PancoastPancoast’’s tumor s tumor -->>HornerHorner’’s syndromes syndrome

Metastatic Cancer to LungMetastatic Cancer to Lung

Can come from Can come from anywhereanywhereMicroscopic looks like Microscopic looks like tumor of origintumor of originSpreads by bloodSpreads by blood

Isolated masses Isolated masses -->>

Spreads by lymphaticsSpreads by lymphaticsDiffuse involvementDiffuse involvement

58 Year58 Year--Old Old AsthamticAsthamtic

CushingsCushings??Pulmonary studies?Pulmonary studies?CholecystectomyCholecystectomy??

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AsthmaAsthmaBronchoconstrictionBronchoconstriction

EpisodicEpisodicReversibleReversibleVarious stimuliVarious stimuli

Extrinsic AsthmaExtrinsic AsthmaType I hypersensitivityType I hypersensitivityIgEIgEAtopic most frequentAtopic most frequent

Other manifestationsOther manifestations

IntrinsicIntrinsicTriggers are nonimmuneTriggers are nonimmune

AspirinAspirinViral infectionsViral infectionsColdColdStressStress

Asthma, SensitizationAsthma, Sensitization

Sensitization of CD4 Sensitization of CD4 cellscells

The TThe THH2 class2 class

TTHH2 cells release 2 cells release cytokinescytokines

ILIL--4, IL4, IL--5 & IL5 & IL--1313Cause production IgECause production IgEGrowth of mast cellsGrowth of mast cells

Histamine producersHistamine producersActivation of eosinophilsActivation of eosinophils

Typically see 2 phases Typically see 2 phases to an attackto an attack

Early, 30Early, 30--60 minutes60 minutesLate, 4Late, 4--8 hours8 hours

Asthma, ReactionAsthma, Reaction

Asthma, LongAsthma, Long--termterm WhatWhat’’s happening?s happening?

Blood pressure?Blood pressure?Deterioration?Deterioration?Pneumonia, factors?Pneumonia, factors?Death?Death?Histological changesHistological changes

BronchiBronchiEmphysema?Emphysema?