OBSTRUCTIVE LUNG DISEASES

Bronchiectasis

Cystic fibrosis

ARDS/NRDS

Caused by bronchial obstruction, tumor, foreign body, mucus,

chronic infections (cystic fibrosis, IgA deficiency)
Dilated airways in the lower lobes, inflammation and fibrosis of
bronchial walls
Chronic cough with Purulent Sputum, hemoptysis, cyanosis, anemia
Complications: lung and brain abscesses
Imaging: dilated bronchioles with signet-ring appearance
Decreased Hematocrit
KARTAGENER SYNDROME: caused by a defect in dynein. Leading to
immotile cilia. Bronchiectasis, sterility, recurrent sinusitis,
dectrocardia

Autosomal recessive disorder that is caused by a mutation

Defective membrane Cl- channel
Secretion of thick mucus which lodges in lungs, liver, and pancreas
Mucus plugs obstruct bronchioles, hyperplasia and hypertrophy of
goblet cells occurs
Productive cough, pulmonary infections, bronchiectasis, cyanosis,
meconium ileus, infertility in men
High Cl- concentrations in sweat, hypoxia, increased ratio of residual
volume to TLC
Lung transplant the Tx

ARDSo
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NRDSo
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Lung infections, toxin inhalation, sepsis, trauma,

pancreatitis, shock
Damage to alveolar capillary walls and alveolar walls by
cytokines
Increased vascular permeability, and decreased
surfactant leading to edema and collapse
Heavy, Red lung
Intrealveolar edema and inflammation with hyaline
membranes
Diffuse bilateral infiltrates on CXR, mismatch on
Ventilation/Perfusion scan. Hypoxia < 200
Pre-mes, maternal diabetes, c-section. Deficiency of
surfactant
Increased surface tension in the lung, leading to alveolar
collapse
Heavy, Purple lung
Eosinophilic hyaline membranes
PDA, bronchiopulmonary dysplasia

PULMONARY INFECTIONS

TUBERCULOSIS

ACUTE BACTERIAL PNEUMONIA

ATYPICAL PNEUMONIA

MYCOPLASMA TB, Hypersensitivity 4 rxn

Lymphocytes TH-1
Induction of T-cell response
Ghon complex (primary TB)
Through lymphatics -> Miliary TB
Pott disease, meningitis (IFN-GAMMA)
o Primary TB- Ghon complex (upper part of the lower
lobes). Caseous granuloma. Asymptomatic.
o Secondary/Miliary TB- tubercle formation (CAVITY
lesion) in lung apex or hilar lymph nodes. Caseating
granuloma made of Epitheloid cells (hallmark finding),
and giant cells. Fatigue, weight loss, fever, productive
cough with blood

Lobar pneumonia: pneumococcus pneumonia. Strep Pneumo

o Intra-alveolar exudate leading to consolidation
o Four stages: CONGESTION (Heavy red lung, fluid), RED
(RBCs), GRAY (Fibrin and Neutrophils), RESOLUTION
(intra alveolar exudate is absorbed)
o Radio-opaque lobe
Bronchiopneumonia: Staph aureus, H. influenza, klebisella, strep
pyogenes
o Bilateral and multilobar, neutrophil exudate leaks
o Klebsiella- alcoholics, Red currant jelly sputum, fever
o S. pneumo and H. influenza- In COPD patients
o Patchy opacities
Complications: stony dullness on percussion, abscess

Mycoplasma pneumo, viruses (RSV, influenza, adenovirus),

chlamidya pistacci, coxiella burnetii, legionella
Multilobar, patchy infiltration of mononuclear inflammatory exudate
into alveolar walls
Pink hyaline membranes found
Lymphocytes seen
Imaging: lung not clear, interstitial infiltrates with monocytes
Elevated cold agglutinin (causes anemia) seen in M. pneumo
infections
o Pneumocystis carninii pneumonia- most common
opportunistic infection seen in AIDS infections

RESTRICTIVE LUNG DISEASES

SARCOIDOSIS

BLACK WOMEN 20-40

Involves lung, lymph nodes, spleen, fever
Noncaseating granulomas surrounded by Langhans giant cells,
asteroid bodies, and Schaumann bodies
Malaise, fever, hepatosplenomegaly, dyspnea, interstitial lung
disease, erythema nodusom, polyarthritis, uveitis, and peripheral
neuropathy
Bilateral hilar lymphadenopathy, and interstitial infiltrates on CXR
Increased ACE, hypercalciuria, decreased TLC and DLCO

RESTRICTIVE LUNG DISEASES

PNEUMOCONIOSIS

Coal worker pneumoconiosis:

o Coal macules around bronchioles in the UPPER LOBES
o Progressive massive fibrosis, blackened fibrotic nodules
Silicosis:
o Silicotic nodules in lungs that obstruct airways and may
become scars: Honeycomb lung
o Increased susceptibility to TB
o UPPER LOBES
o Whorled pattern, Bifringent light, Eggshell calcification
o Can lead to bronchiogenic carcinoma/mesothelioma
Asbestosis:
o Inhalation of asbestos
o Alveolar macrophages engulf asbestos fibers causing a
fibrostatic response
o LOWER LOBES
o Diffuse interstitial fibrosis
o Ferruginous bodies coated with hemosiderin
o Collagenous plaques on pleura and diaphragm
o Dyspnea and productive cough
o Clubbing of fingers and dry inspiratory crackles

HYPERSENSITIVE
PNEUMONITIS

Caused by sensitization to exposure of specific antigens like

ACTINOMYCETES, hay, animal proteins
IgG antibodies react with antigen to form an inflammatory reaction
with release of cytokines and prostaglandins
Mononuclear cell infuriation (giant cells)
Noncaseating granulomas in peribronchial distribution
Peripheral patchy fibrosis
Acute form develops 4-12 hours after exposure- fever, malaise,
cough
Chronic form presents with progressive dyspnea, insidious weight
loss, and cough
Decreased DLCO
Farmers lung and Bird Fanciers lung
GOODPASTURE
SYNDROME

Antibodies against GBM (Type 2 hypersensitivity)

Men aged 20-30
Intra alveolar hemorrhages, fibrosis, thickening of speta
Hemosiderin-laden macrophages in alveoli
Rapidly progressive crescentic glomerulonephritis
Linear deposits of immunoglobulins
Hemoptysis, nephritic syndrome (edema, HTN, hematuria)
Anti-GBM antibodies, iron-deficiency anemia
Corticosteroids, cyclophosphamides

VASCULAR LUNG DISEASES

PULMONARY HTN

PULMONARY
FIBROSIS

PULMONARY
EMBOLISM

Idiopathic
BMPR2 mutation down regulates smooth muscles
Young women in 20s-40s
Medial hypertrophy and intimal fibrosis of the pulmonary arterioles
Right ventricular hypertrophy, cor pulmonale
Present with dyspnea, fatigue, chest pain, exertional syncope
Complications: thrombosis, cyanosis, right ventricular hypertrophy
Elevated pressures in pulmonary vasculature can be associated with
connective tissue disorders (SLE), interstitial lung dieseases (COPD,
sarcoidosis)

Alveolar epithelial injury, leading to Fibroblast proliferation

resulting in distortion of septa, honeycomb lung
Slow progressive dyspnea, and dry cough
Physical exam: hypoxemia, inspiratory crackles, clubbing
X-ray: honeycombing, reticular opacities
Tx: oxygen supplementation, lung transplant

Emboli can be air, amniotic fluid, foreign bodies, or tumor cells

Thromboemboli are the most common, originating from DVT in the
leg
Hemorrhage or infarct of lung (lower lobes)
Decreased circulation
Venous thrombus (dark red wit pale-grey fibrin strands) lodged in
pulmonary vessel
Mismatch ventilation perfusion scan
Hypoxia, elevated d-dimer levels
Virchow triad- venous stasis, hypercoaguable state, vessel wall
injury
Perfusion defect

OBSTRUCTIVE LUNG DISEASES

EMPHYSEMA

ASTHMA

CHRONIC BRONCHITIS

Smoking and antitrypsin deficiency

Honeycomb lung, Destruction of elastin
Enlargement of air spaces, destruction of alveolar wall
Centriacinar: upper lobes, seen in smokers
Panacinar: associated with antitrypsin deficiency
Pink puffers
Pursed lips
Use of accessory muscles
Dyspnea, cyanosis, tachycardia
Barrel shaped chest
Complications: pneumothorax, cor pulmonale
Imaging: Hyperinflaction and flattened diaphragm
Increased residual volume, and TLC, decreased FEV1/FEVC ratio

Extrinsic: Type 1 hypersensitivity rxn seen in children. Leukotrines

in early phase, cytokines in late
Instrinsic: associated with chronic bronchitis, exercise, or cold seen
in adults
Hypertrophy of bronchial smooth muscle, hyperplasia of bronchial
submucosal glands containing Curshmann spirals and CharcotLeyden crystals
Dyspnea, expiratory wheezing, cough
Use of accessory muscles
Complications: status asthmaticus (prolonged asthma attack),
eosinophilia
Inhaled Beta-Adrenergic agonists (Albuterol)

Chronic irritation caused by smoking, air pollution, or infection

Hyperplasia of submucosal glands leading to mucus plugs (increase
in goblet cells)
Productive cough for at least 3 months over 2+ years
Blue bloaters cyanosis, dyspnea
Complications: cor pulmonale, polycythemia, DVT
Increased residual volume, decreased FEV1/FVC ratio
Reid index>50% (increased mucous gland size)
Beta agonists, inhaled steroids