Académique Documents
Professionnel Documents
Culture Documents
G
r
o
s
s
,
c
u
t
s
u
r
f
a
c
e
T
h
e
l
u
n
g
h
a
s
a
r
e
d
,
h
y
p
e
r
e
m
i
c
c
u
t
s
u
r
f
a
c
e
,
r
e
f
l
e
c
t
i
n
g
p
a
s
s
i
v
e
c
o
n
g
e
s
t
i
o
n
,
d
u
e
t
o
i
n
c
r
e
a
s
e
d
h
y
d
r
o
s
t
a
t
i
c
p
r
e
s
s
u
r
e
,
a
s
s
e
e
n
i
n
c
a
s
e
s
o
f
l
e
f
t
h
e
a
r
t
f
a
i
l
u
r
e
.
T
h
e
t
r
a
n
s
u
d
a
t
e
,
m
i
x
e
d
w
i
t
h
a
i
r
i
n
t
h
e
a
l
v
e
o
l
i
,
g
i
v
e
s
t
h
e
c
u
t
s
u
r
f
a
c
e
a
f
r
o
t
h
y
a
p
p
e
a
r
a
n
c
e
.
L
u
n
g
,
a
c
u
t
e
p
u
l
m
o
n
a
r
y
c
o
n
g
e
s
t
i
o
n
a
n
d
e
d
e
m
a
G
r
o
s
s
,
c
u
t
s
u
r
f
a
c
e
T
h
e
l
u
n
g
h
a
s
a
r
e
d
,
h
y
p
e
r
e
m
i
c
c
u
t
s
u
r
f
a
c
e
,
r
e
f
l
e
c
t
i
n
g
p
a
s
s
i
v
e
c
o
n
g
e
s
t
i
o
n
,
d
u
e
t
o
i
n
c
r
e
a
s
e
d
h
y
d
r
o
s
t
a
t
i
c
p
r
e
s
s
u
r
e
,
a
s
s
e
e
n
i
n
c
a
s
e
s
o
f
l
e
f
t
h
e
a
r
t
f
a
i
l
u
r
e
.
T
h
e
t
r
a
n
s
u
d
a
t
e
,
m
i
x
e
d
w
i
t
h
a
i
r
i
n
t
h
e
a
l
v
e
o
l
i
,
g
i
v
e
s
t
h
e
c
u
t
s
u
r
f
a
c
e
a
f
r
o
t
h
y
a
p
p
e
a
r
a
n
c
e
.
L
u
n
g
,
a
c
u
t
e
p
u
l
m
o
n
a
r
y
c
o
n
g
e
s
t
i
o
n
a
n
d
e
d
e
m
a
G
r
o
s
s
,
c
u
t
s
u
r
f
a
c
e
T
h
e
l
u
n
g
h
a
s
a
r
e
d
,
h
y
p
e
r
e
m
i
c
c
u
t
s
u
r
f
a
c
e
,
r
e
f
l
e
c
t
i
n
g
p
a
s
s
i
v
e
c
o
n
g
e
s
t
i
o
n
,
d
u
e
t
o
i
n
c
r
e
a
s
e
d
h
y
d
r
o
s
t
a
t
i
c
p
r
e
s
s
u
r
e
,
a
s
s
e
e
n
i
n
c
a
s
e
s
o
f
l
e
f
t
h
e
a
r
t
f
a
i
l
u
r
e
.
T
h
e
t
r
a
n
s
u
d
a
t
e
,
m
i
x
e
d
w
i
t
h
a
i
r
i
n
t
h
e
a
l
v
e
o
l
i
,
g
i
v
e
s
t
h
e
c
u
t
s
u
r
f
a
c
e
a
f
r
o
t
h
y
a
p
p
e
a
r
a
n
c
e
.
Gross
cut
surface
Lung
acute
pulmonary
congestio
n and
edema
Lung, chronic passive venous
congestion - Gross
This is caused by any chronic condition that retards the
outflow of pulmonary venous blood from the lungs to the
left side of the heart
(----- name some causes-------------).
Pooling of blood in the lung capillaries and associated
microhemorrhages produce a dark brown discoloration,
noted here.
In addition, septal fibrosis causes the lung to become
stiff. The fibrosis causes the lung to feel firm to the
touch; also, the fibrosis causes the cut edges to be
raised or to stand up. This gross appearance is also
called brown induration of the lung.
What is the brown pigment that is derived from
hemoglobin?
Hemosiderin.
What is the pathogenesis of pulmonary edema?
Left ventricular failure (eg, caused by a
myocardial infarct) causes pump failure, and
secondarily there is impaired flow of blood from
the lung to the left atrium. This causes increased
hydrostatic pressure in pulmonary alveolar
capillaries and subsequent transudation of fluid
into alveoli.
How does this type of edema differ from that seen in
acute inflammation?
The fluid in pulmonary edema is a transudate (ie, it is
protein poor, has low specific gravity, and does not
contain inflammatory cells). Edema in inflammation is an
exudate.
What effect would such a histologic picture have on
gaseous exchange in the lung?
It would be markedly impaired
What might the symptoms be?
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea,
and cough.
What are the major morphologic changes in
multiple organ failure in a patient who dies of
shock?
Kidneys: Acute tubular necrosis.
Brain: Laminar cortical necrosis.
Lungs: Shock lung (diffuse alveolar damage)
with hyaline membranes (seen mainly in septic
shock).
Heart: Foci of necrosis, hemorrhage,
contraction band necrosis. GI: Hemorrhages.
Liver: Central hemorrhagic necrosis, fatty
change.
What is the name of that type of thrombi?
Vegetations.
What complications may arise from this lesion?
Infected vegetations on the mitral valve may
embolize systemically and cause infarcts,
abscesses, or septicemia .
Could this person develop a cerebral infarct?
What would be the appearance of such an
infarct of the brain?
This patient could develop a cerebral infarct
from embolization. The infarct would be an area
of liquefactive necrosis along with an acute
inflammatory response to the bacteria in the
embolus, resulting in brain abscess formation.