THE LUNG
NORMAL STRUCTURE OF THE LUNG
ANATOMY
HISTOLOGY
FUNCTIONS
DISEASES OF THE LUNG AND PLEURA
Congenital Anomalies of the Lung
Developmental defects of the lung
Pulmonary hypoplasia
Cystic Diseases of the Lung
Congenital cystic disease
Congenital lobar emphysema
Cystic adenomatoid transformation
Foregut cysts
Acquired cystic lung diseases
Mesenchymal cystic hamartoma
Bronchopulmonary Sequestration
Ehlers–Danlos syndromes (EDS)
Honeycomb lung
ACUTE LUNG DISEASES
ACUTE LUNG INJURY
ACUTE RESPIRATORY DISTRESS SYNDROME
(HYALINE MEMBRANE DISEASE)
Definition
Histological manifestation of ARDS
Forms of ARDS
Neonatal ARDS
Etiology
Pathogenesis of Neonatal ARDS
Adult ARDS
Etiology
Pathogenesis of Adult ARDS
Morphology of ARD
Grossly
Microscopically
BRONCHOPULMONARY DYSPLASIA
Definition
Microscopically
Clinical Features & Consequences of ARDS
Desquamative Interstitial Pneumonia (DIP)
Acute interstitial pneumonitis, diffuse fibrosing alveolitis or Hamman–Rich syndrome
Diffuse fibrosing alveolitis, or acute interstitial pneumonitis
Clinically
ATELECTASIS (COLLAPSE)
Acute atelectasis
Resorption atelectasis
Compression (relaxation) atelectasis
Basal atelectasis
Contraction atelectasis
Chronic atelectasis
Right middle lobe syndrome
Rounded atelectasis
Pulmonary Infections
PNEUMONIA & PNEUMONITIS
Definition
Risk factors
Types of PNEUMONITIS/ PNEUMONIA
Pneumoniitis are classified according to
Onset and duration
Acute pneumonitis/pneumonia
Chronic pneumonitis/pneumonia
Morphological types
Lobar pneumonitis/pneumonia
Lobular/Broncho-pneumonitis/pneumonia
Interstitial pneumonitis/pneumonia
Etiological types
Infective pneumonitis/pneumonia
Bacterial pneumonia
Viral pneumonia
Fungal pneumonia
Protozoal pneumonia
Tuberculous pneumonia
Non-infective pneumonitis
Toxins-induced pneumonitis
Chemical pneumonitis
Aspiration pneumonitis
Auto-immune disease associated pneumonitis
Clinical types
Primary/ secondary pneumonitis/pneumonia depending on the mode of infection
Typical/ atypical pneumonitis/pneumonia depending on the presenting symptoms
Community acquired/ hospital acquired pneumonitis/pneumonia depending on where it was acquired
Pneumonitis/pneumonia in immuno-compromised patients
Currently, combined clinical classification put pneumonia in seven distinct clinical settings pneumonia syndrome
Pneumonia Syndromes
Community-Acquired Acute Pneumonia (CAP)
Health Care-Associated Pneumonia
Hospital-Acquired Pneumonia
Aspiration Pneumonia
Chronic Pneumonia
Necrotizing Pneumonia and Lung Abscess
Pneumonia in Immunocompromised Host
Community-Acquired Bacterial Pneumonias (CAP)
Pneumococcal Pneumonia
Hemophilus influenzae pneumonia
Moraxella catarrhalis pneumonia
Staphylococcus aureus pneumonia
Klebsiella pneumoniae pneumonia
Pseudomonas aeruginosa pneumonia
Legionella pneumophila pneumonia
MORPHOLOGY OF BACTERIAL PNEUMONIA
CLINICAL COURSE OF BACTERIAL PNEUMONIA
COMPLICATIONS OF BACTERIAL PNEUMONIA
Lobar pneumonia
Definition
Etiology of lobar pneumonia
Morphology of lobar pneumonia
Stage of congestion (initial phase
Clinically
Grossly
Microscopic
It is characterized by
Stage of red hepatization (early consolidation)
Gross examination
Microscopic picture
Stage of gray hepatization (late consolidation)
Grossly
Histologically
Stage of resolution (final stage)
Grossly
Histologically
Clinical features of lobar pneumonia
Complications of lobar pneumonia
Bronchopneumonia (Lobular Pneumonia)
Definition
Etiology of lobular pneumonia
Morphology of lobular pneumonia
Grossly
Histologically
Clinical features of lobular pneumonia
Complications of lobular pneumonia
Comparison of lobar pneumonia and lobular pneumonia
Community-Acquired Viral Pneumonia
Pathogenesis of viral pneumonia
Severe Acute Respiratory Syndrome (SARS)
Morphology of viral pneumonia
Clinical Course of viral pneumonia
INTERSTITIAL PNEUMONIA/(PRIMARY ATYPICAL PNEUMONIA)
Etiology of Interstitial pneumonia
Morphology of Interstitial pneumonia
Histologically
Clinical features of Interstitial pneumonia
Complications of Interstitial pneumonia
Health Care-Associated Pneumonia (HCAP)
Hospital-Acquired Pneumonia (HAP)
Aspiration pneumonitis/pneumonia
Chronic Pneumonia
PULMONARY TUBERCULOSIS
Histoplasmosis
The clinical presentations
Morphology of Histoplasmosis
Diagnosis of histoplasmosis
Blastomycosis
Morphology of Blastomycosis
Coccidioidomycosis
Morphology of Coccidioidomycosis
Necrotizing pneumonia and Lung Abscess
Lung Abscess
Etiology and Pathogenesis of Lung Abscess
Morphology of Lung Abscess
Clinical Course of Lung Abscess
Complications of Lung Abscess
Pneumonia in the Immunocompromised Host
Lipoid pneumonia
Definition
The exogenous type
The endogenous type
Grossly
Microscopically
Eosinophilic pneumonia
Definition
Clinically
Pulmonary function testing
Indications
Lung volumes
Lung capacities
OBSTRUCTIVE VERSUS RESTRICTIVE PULMONARY DISEASES
OBSTRUCTIVE LUNG (AIRWAY) DISEASES
Definition
Etiology
Smoking
Air pollution
Occupational exposures
Genetics
Others
Protease-antiprotease hypothesis
Patho-Physiology of COPD
CHRONIC BRONCHITIS
Definition
ETIOLOGY OF CHRONIC BRONCHITIS
Smoking
Atmospheric pollution
Occupation
Infection
Familial and genetic factors
PATHOGENESIS OF CHRONIC BRONCHITIS
MORPHOLOGY OF CHRONIC BRONCHITIS
Grossly
Histological examination
Chronic bronchiolitis (small airway disease)
Clinical Features of Chronic Bronchitis
EMPHYSEMA
Definition
PATHOGENESIS OF EMPHYSEMA
Types of Emphysema
Mixed (unclassified) emphysema
MORPHOLOGY OF EMPHYSEMA
Grossly
Microscopically
Morphology of Individual Types of Emphysema
Centriacinar (Centrilobular) Emphysema
Grossly
Microscopically
Panacinar (Panlobular) Emphysema
Grossly
Microscopically
Distal Acinar (Paraseptal) Emphysema
Irregular Emphysema (Para-cicatricial Emphysema)
Mixed (Unclassified) Emphysema
Clinical Features of Emphysema
Contrasting Salient Features of ‘Predominant Bronchitis’ and ‘Predominant Emphysema
Comparison of Symptoms for Chronic Bronchitis and Emphysema
Conditions Related to Emphysema
Compensatory emphysema (Compensatory Overinflation)
Senile Hyperinflation (Aging Lung, Senile Emphysema)
Obstructive Overinflation
Infantile lobar emphysema
Unilateral Translucent Lung (Unilateral Emphysema
Mediastinal (Interstitial) Emphysema
Bullous emphysema
BRONCHIAL ASTHMA
Definition
Atopic, extrinsic, or allergic
Non-atopic, or intrinsic
A third type is a mixed pattern
ETIO-PATHOGENESIS OF BRONCHIAL ASTHMA
The major etiologic factors of asthma are
Types of Asthma
Atopic, extrinsic, or allergic
Non-atopic, intrinsic or idiosyncratic asthma
Drug-Induced Asthma
Contrasting Features of the Two Major Types of Asthma
Mixed type of asthma
MORPHOLOGY OF BRONCHIAL ASTHMA
Grossly
Microscopically
CLINICAL FEATURES OF ASTHMA
BRONCHIECTASIS
Definition
ETIO-PATHOGENESIS OF BRONCHIECTASIS
Bronchial obstruction
Congenital or hereditary conditions
MORPHOLOGY OF BRONCHIECTASIS
Grossly
Cylindrical
Fusiform
Saccular
Varicose
Microscopically
CLINICAL FEATURES OF BRONCHIECTASIS
CHRONIC INTERSTITIAL (RESTRICTIVE, INFILTRATIVE) LUNG DISEASES
Definition
Chronic interstitial diseases
The pulmonary interstitium
Major Categories of Chronic Interstitial Lung Disease
Fibrosing
Granulomatous
Eosinophilic
Smoking-Related
With predominant fibrosis
With predominant granulomatous reaction
Immunologic lung diseases
Smoking-associated ILDs
Obstructive versus Restrictive Pulmonary Diseases
Fibrosing Diseases
Idiopathic Pulmonary Fibrosis (IPF)
Pathogenesis of Idiopathic Pulmonary Fibrosis
Morphology of Idiopathic Pulmonary Fibrosis
Grossly
Microscopically
Clinical Features of Idiopathic Pulmonary Fibrosis
Nonspecific Interstitial Pneumonia
Cryptogenic Organizing Pneumonia
Organizing pneumonia
Pulmonary Involvement in Collagen Vascular Diseases
Scleroderma (Progressive Systemic Sclerosis)
Rheumatoid Arthritis
Systemic Lupus Erythematosus (SLE
Sjögren’s Syndrome
Dermatomyositis and Polymyositis
Wegener’s granulomatosis
Microscopically
PNEUMOCONIOSES
Definition
Factors which determine the extent of damage caused by inhaled dusts are
The tissue response to inhaled dust
Pathogenesis of Pneumoconiosis
Classification of Pneumoconiosis
Mineral Dust–Induced Lung Disease
Coal Worker’s Pneumoconiosis (CWP)
Definition
Pathogenesis of Coal Worker’s Pneumoconiosis
Factors have been implicated in this transformation
Morphology of Pneumoconiosis
SIMPLE COAL-WORKERS’ PNEUMOCONIOSIS
Definition
Grossly
Histologically
PROGRESSIVE MASSIVE FIBROSIS; PMF
Definition
Grossly
Histologically
RHEUMATOID PNEUMOCONIOSIS (CAPLAN’S SYNDROME
Histologically
Clinical Features of CWP
Silicosis
Definition
Pathogenesis of Silicosis
Morphology of Silicosis
Grossly
Histologically
Clinical Features of Silicosis
Asbestosis and Asbestos-Related Diseases
Definition
Pathogenesis of Asbestosis
Morphology of Asbestosis
Over-exposure to asbestos is associated with 3 types of lesions
ASBESTOSIS
Grossly
PLEURAL DISEASE
Pleural effusion
Visceral pleural fibrosis
Pleural plaques
Grossly
Microscopically
TUMOURS
Bronchogenic carcinoma
Malignant mesothelioma
Clinical Features of Asbestosis
Drug- and Radiation-Induced Pulmonary Diseases
Radiation pneumonitis
Acute radiation pneumonitis
Chronic radiation pneumonitis
Granulomatous Diseases
Sarcoidosis
Definition
Pathogenesis
Morphology
Grossly
Histologically
Berylliosis
Berylliosis
Beryllium
Acute Berylliosis
Chronic Berylliosis
Clinical Features of Berylliosis
Hypersensitivity Pneumonitis
Etio-pathogenesis
Farmers’ lung
Bagassosis
Byssinosisis
Bird-breeders’ (Bird-fanciers’)
Mushroom-workers’ lung
Malt-workers’ lung
Maple-bark disease
Silo-fillers’
Morphology of Hypersensitivity Pneumonitis
Interstitial non-caseating granulomas
Clinical Features Hypersensitivity Pneumonitis
Pulmonary Eosinophilia
Acute eosinophilic pneumonia with respiratory
Simple pulmonary eosinophilia (Loeffler syndrome
Tropical pulmonary eosinophilia
Secondary chronic pulmonary eosinophilia
Idiopathic chronic eosinophilic pneumonia
Hyper-eosinophilic syndrome
Morphological features
Grossly
Microscopically
Smoking-Related Interstitial Diseases
Desquamative interstitial pneumonia (DIP)
Microscopically
Respiratory bronchiolitis associated ILD
Microscopically
PULMONARY LANGERHANS CELL HISTIOCYTOSIS
Microscopically
PULMONARY DISEASES OF VASCULAR ORIGIN
Pulmonary Edema
Definition
Signs and symptoms
Types of Pulmonary Edema
Cardiogenic pulmonary edema
Non-cardiogenic pulmonary edema
Other causes of pulmonary edema
Hypostatic Pneumonia
Pulmonary Hypertension
Definition
Primary (Idiopathic) Pulmonary Hypertension
Etio-Pathogenesis
Secondary Pulmonary Hypertension
Causes
Antecedent heart disease (Passive pulmonary hypertension)
Hyperkinetic (Reactive) pulmonary hypertension (Congenital left to right shunts
Vaso-occlusive pulmonary hypertension
Pathogenesis of Pulmonary Hypertension
Morphology of Pulmonary Hypertension
Arterioles and small pulmonary arteries
Medium-sized muscular pulmonary arteries
Large pulmonary arteries
Clinical Features of Pulmonary Hypertension
Diffuse Alveolar Hemorrhage Syndromes
Good pasture’s Syndrome
Definition
Etio-pathogenesis
Morphology of Goodpasture Syndrome
Grossly
Microscopically
Clinical features of Goodpasture Syndrome
Idiopathic Pulmonary Hemosiderosis
DISEASES OF THE PLEURA
Normal Structure
Microscopically
Important primary disorders
Primary intrapleural bacterial infections
Primary neoplasm of the pleura known as malignant mesothelioma
Hydrothorax
An exudate, and pleuritis
Causes of pleural exudate formation
Inflammation of the Pleura
PLEURITIS
Serous, fibrinous, and sero-fibrinous pleuritis
Supprative pleuritis (Empyema)
Hemorrhagic pleuritis
Non-Inflammatory Pleural Effusions
Hydrothorax
Hemothothorax
Chylothorax
PNEUMOTHORAX
Spontaneous pneumothorax
Traumatic pneumothorax
Therapeutic (artificial) pneumothorax