flashpath - lung - pulmonary interstitial emphysema
TRANSCRIPT
FLASHPATHH A Z E M A L I
PULMONARY INTERSTITIA
L EMPHYSEMA
H A Z E M A L I
CLINICAL• Rare condition commonly occur in preterm infants who
receives high pressure mechanical ventilation as a treatment for respiratory distress
• Characterized by air leakage into interstitial tissues– Due to alveolar rupture from barotrauma
• Causing persistant respiratory distress manifestations
• Air leakage can also occurs in– Pleura “pneumothorax”– Mediastinum “pneumomediastinum”– Peritoneum “pneumoperitoneum”
CLINICAL• Other mechanical ventilation – related problems:
– Bronchopulmonary dysplasia– Retinopathy of prematurity
• Incidence of all these diseases decreased with the use of synthetic surfactant and modern ventilation techniques
• Interstitial pulmonary emphysema have two clinical types:– Acute– Chronic “persistent”
GROSS• Pleura:
– Lines of bubbles are seen through the pleura• (outlining the lung lobules)
– Pleural blebs may be seen– Pneumothorax
• air bubbles when open the pleura under water
• Lung:– Multiple small cysts within parenchyma– If pneumothorax occurred
• lung collapse and mediastinal shift
MICROSCOPY• Pattern:
– Multiple cystic spaces– Have NO lining– Expand (widen) surrounding connective tissue
• Distribution:– Sub-pleural– Interlobular septa– Peri-bronchovascular
• Adjacent parenchyma may show:– Hyaline membrane disease– Bronchopulmonary dysplasia
MICROSCOPYAcute Chronic
“persistent” Giant cell reaction Absent PresentFibrosis Absent Present
DIFFERENTIAL DIAGNOSIS“ O t h e r c o n g e n i t a l / c y s t i c l u n g d i s e a s e s ”• Congenital:
– Pulmonary sequestration– Congenital pulmonary cysts– Congenital pulmonary airway malformation– Congenital lobar emphysema
• Acquired:– Emphysema– Healed abscess– Honeycombing
• Mixed:– Cystic fibrosis
DIFFERENTIAL DIAGNOSISPulmonary lymphangiectasis• Expansion of sub-pleural, Interlobular septa, and peri-bronchovascular
connective tissues by multiple cystic spaces that– Contain lymph– Have endothelial lining “ D2-40 positive “
WWW.
DO NOT FORGET TO SEARCH FOR MORE PICS AND VIRTUAL SLIDES
THANK YOUH A Z E M A L I