Disease of respiratory system
Pathology Department, Zhejiang University School of Medicine,
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