Disease of respiratory system

Pathology Department, Zhejiang University School of Medicine,

maliqin198@zju.edu.cn

Disease

Pneumonia

COPD

Pneumoconiosis

Chronic cor pulmonale

Pneumonia

Type of pneumonia

Exudative inflammation

Lobar pneumonia

Lobular pneumonia

interstitial pneumonia

Lobar pneumonia

1. Concept 2. Etiopathogenisis and pathogenesy3. Pathological changes and Complications

Lobar pneumonia

Concept ：Lobar pneumonia is an acute bacterial infection resulting in fibrinosuppurative consolidation of a large portion of a lobe or of an entire lobe.

Moreover, the same organisms may produce bronchopneumonia in one patient, whereas in the more vulnerable individual, a full-blown lobar involvement develops.

Congestion(充血水肿期,1-2 day): heavy, boggy, and redvascular engorgement, intra-alveolar fluid with few neutrophils, numerous bacteria

Red hepatization (红色肝变期,3-4 day) : red, firm, airless, a liver-like consistency, massive confluent exudation with red cells (congestion), fibrin, bacteria, rusty sputum（铁锈色痰）

Gray hepatization (灰色肝变期,5-6day) : grayish brown, dry, a liver- like consistency, progressive disintegration of red cells , the persistence of a fibrinosuppurative exudate, mucoid sputum （粘液

脓痰）

Resolution (溶解消散期,7-) : the consolidated exudate within the alveolar spaces undergoes progressive enzymatic digestion to produce a granular, debris that is resorbed, ingested by macrophages, coughed up, or organized by fibroblasts growing into it.

Pathological changes

(充血水肿期,1-2 day): heavy, boggy, and red vascular engorgement, intra-alveolar fluid with few neutrophils, numerous bacteria

(红色肝变期,3-4 day) : red, firm, airless, a liver-like consistency, massive exudation with red cells, fibrin, bacteria, rusty sputum

Red hepatization

(灰色肝变期,5-6day) : grayish brown, dry, a liver-like consistency,

Gray hepatization

disintegration of red cells , the persistence of a fibrinosuppurative exudate

(溶解消散期,7-) : the consolidated exudate within the alveolar spaces undergoes progressive enzymatic digestion to produce a granular, debris that is resorbed, ingested by macrophages, coughed up, or organized by fibroblasts growing into it.

Complications

(1) Pulmonary abscess(肺脓肿)：tissue destruction and necrosis, causing abscess formation ;

(2) Empyema (脓胸)：spread of infection to the pleural cavity, causing the intrapleural fibrinosuppurative reaction;

(3) Pulmonary carnification (肺肉质变): organization of the exudate, which may convert a portion of the lung into solid tissue; brown, meat-like fibrous tissue; function of lung lost

(4) Septic shock(感染性休克): bacteremic dissemination to organs, causing metastatic abscesses, such as endocarditis, meningitis, or suppurative arthritis; to blood causing septicaemia, septicopyemia.

Pulmonary carnification

Pulmonary carnification

Lobular pneumonia (Bronchopneumonia)

Lobular pneumonia

1. Concept 2. Etiopathogenisis and pathogenesy3.Pathological changes and Complications

Foci of bronchopneumonia are consolidated areas of acute suppurative inflammation involved the pulmonary lobulus.

Well-developed lesions are usually 3 to 4 cm in diameter, slightly elevated, dry, granular, gray-red to yellow, and poorly delimited at their margins.

Histologically, the reaction usually elicits a suppurative, neutrophil-rich exudate that fills the bronchi, bronchioles, and adjacent alveolar spaces.

Lobular pneumonia

Pathological changes

Gross appearance

Well-developed lesions are usually 3 to 4 cm in diameter, slightly elevated, dry, granular, gray-red to yellow, and poorly delimited at their margins.

Histologically

the reaction usually elicits a suppurative, neutrophil-rich exudate that fills the bronchi, bronchioles, and adjacent alveolar spaces.

Confluent bronchopneumonia(融合性支气管肺炎)

Complications

Respiratory failureCardiac failurePulmonar abscessempyemaSepticopyemia

Distinguish betweenlobar pneumonia and lobular pneumonia

Interstitial pneumonia

1. Concept 2. Etiopathogenisis and pathogenesy3. Pathological changes and Complications

X-ray

Computerized tomographic scanning，CT

Interstitial pneumonia

Interstitial pneumonia

viral inclusion bodies

Chronic obstructive pulmonary disease (COPD, 慢性阻塞性肺病)

Chronic bronchitis

Pulmonary emphysema

Bronchiectasis

Bronchial asthma

Chronic bronchitis(慢性支气管炎)

Bronchus

Mucous gland hyperplasia, hypersecretion

Tobacco smoke, air pollutants

Cough, sputum production

Bronchiectasis(支气管扩张症)

Bronchus

Airway dilation and scarring

Persistent or severe infections

Cough, purulent sputum, fever

Emphysema(肺气肿)

Acinus

Airspace enlargement; wall destruction

Tobacco smoke

Dyspnea

Bronchial asthma(支气管哮喘)

Bronchus

Bronchospasm, mucus plug(粘液栓), eosinophils ,

Sensitinogen

Dyspnea, stridor sound, Emphysema

Chronic bronchitis (慢性支气管炎)

Conception: Chronic nonspecific inflammation involvingtunicamucosa bronchrus and its surroundingtissue.

Pathological change

Epithelium

Mucous gland, goblet cell

Cartilage，smooth muscle， elastic fibers

Inflammatory cell infiltration

Other tissues

Chronic bronchitis

Clinical Features

A persistent cough productive of sputumFor many years, dyspnea (呼吸困难) on exertion

develops

Continued smoking, other elements of COPD may appear, including hypercapnia（高碳酸血症）, hypoxemia(低氧血症), and mild cyanosis（发绀）.

Long-standing severe chronic bronchitis commonly leads to cor pulmonale(肺心病) with cardiac failure.

Pulmonary emphysema

Conception:Emphysema is a condition of the lung characterized by abnormal permanent enlargement of the airspaces distal to

the terminal bronchiole, accompanied by destruction of their walls, termed "overinflation".

Etiopathogenisis and pathogenesy

1. mostly, chronic bronchitis, 2. Obstructive ventilatory disorder 3. Elastase(弹性蛋白酶) increasing 4. Lacking of α1– antitrypsin5. Smoking

Pathological change

Enlarged, InflammationAirway dilationBroken of alveolar septum

Pulmonary emphysema

TypeAlveolar emphysema(肺泡性肺气肿)

① centriacinar emphysema(中央型)

② panacinar emphysema(全腺泡型)

bullous emphysema (大泡性肺气肿)

③ periacinar emphysema (周围型)

Alveolar emphysema

A,

Diagram of normal

structures within the acinus, the fundamental unit of the lung. A terminal bronchiole (not shown) is immediately proximal to the respiratory bronchiole. B,

Centriacinar

emphysema

with dilation that initially affects the respiratory bronchioles. C,

Panacinar

emphysema

with initial distention of the peripheral structures (i.e., the alveolus and alveolar duct); the disease later extends to affect the respiratory bronchioles.

Centriacinar emphysema. Central areas show marked emphysematous damage (E)

centriacinar emphysema

panacinar emphysema

panacinar emphysema

Bullous emphysema with large subpleural bullae

Interstitial emphysema

The entrance of air into the connective tissue stroma of the lung, mediastinum, or subcutaneous tissue is designated interstitial emphysema.

Interstitial emphysema

Others① Senile emphysema

(老年性肺气肿)② Compensatory emphysema

(代偿性肺气肿)

Compensatory emphysema

Clinical manifestation

expiratory dyspnea(呼气性呼吸困难)

barrel-shaped thorax(桶状胸)

pneumocardial disease (PHD,肺心病)

spontaneous pneumothorax (自发性气胸

)

respiratory failure (呼吸衰竭)

pulmonary encephalopathy(肺性脑病)

Bronchiectasis

Bronchiectasis is a disease characterized by permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue, resulting from or associated with chronic necrotizing infections.

To be considered bronchiectasis, the dilation should be permanent; often accompanies viral and bacterial pneumonia.

Normal lung Bronchiectasis

Bronchiectasis

Bronchiectasis

Bronchiectasis

Bronchiectasis

Clinical manifestation

Airway dilation and scarring

Persistent or severe infections

Cough, hemoptysis, purulent sputum, fever

chest pain, pneumonia, lung abscess, emphysema, pneumocardial disease,

Pulmonary interstitial diseases

Pneumoconiosis (尘肺)

Silicosis

Silicosis is a lung disease caused by inhalation of crystalline silicon dioxide (silica).（5um）

Currently the most prevalent chronic occupational disease in the world, silicosis usually presents, after decades of exposure, as a slowly progressing, nodular, fibrosing pneumoconiosis.

Workers in a large number of occupations are at risk, especially sandblasters and many mine workers.

Silicosis is characterized grossly in its early stages by tiny, discrete pale to blackened (if coal dust is also present) nodules in the upper zones of the lungs.

As the disease progresses, these nodules may coalesce into hard, collagenous scars----siliconic nodule.

Histologically, the nodular lesions consist of concentric layers of hyalinized collagen surrounded by a dense capsule of more condensed collagen.

Diffuse interstitial fibrosis

Morphology

Silicosis

Silicosis

Complication

Silicotuberculosis,cor pulmonale, chronic bronchitis, obstructive emphysema, spontaneous pneumothorax

Chronic cor pulmonale

1. Concept 2. Etiopathogenisis and

pathogenesy3. Pathological changes

ConceptCor pulmonale, consists of right ventricular hypertrophy, dilation, and right heart failure secondary to pulmonary hypertension caused by disorders of the lungs, pulmonary vasculature, thoracal disease.

Right atrium

Right ventricle