Pulmonary edema, pneumonias
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Pulmonary Edema and Pneumonias[edit | edit source]
I. Pulmonary Edema[edit | edit source]
1. Definition[edit | edit source]
Pulmonary edema is a condition characterized by abnormal accumulation of fluid in the lung interstitium and alveolar spaces, leading to impaired gas exchange and respiratory insufficiency.
2. Pathogenesis[edit | edit source]
Fluid accumulation occurs when the balance between:
- Hydrostatic pressure
- Oncotic pressure
- Capillary permeability
- Lymphatic drainage
3. Classification[edit | edit source]
A. Cardiogenic Pulmonary Edema[edit | edit source]
Caused by increased hydrostatic pressure due to heart disease.
Common causes:
- Left-sided heart failure
- Mitral valve disease
- Acute myocardial infarction
- Hypertensive crisis
- Cardiomyopathies
B. Non-cardiogenic Pulmonary Edema[edit | edit source]
Caused by increased capillary permeability.
Common causes:
- Acute respiratory distress syndrome (ARDS)
- Sepsis
- Severe trauma
- Inhalation of toxic gases
- Near drowning
- Acute pancreatitis
4. Morphology[edit | edit source]
Gross Features:[edit | edit source]
- Heavy, wet lungs
- Frothy, blood-tinged fluid on section
Microscopic Features:[edit | edit source]
- Alveoli filled with pale eosinophilic fluid
- Capillary congestion
- In chronic cases: hemosiderin-laden macrophages (“heart failure cells”)
5. Clinical Features[edit | edit source]
- Dyspnea, orthopnea
- Cough with pink frothy sputum
- Cyanosis
- Crackles on auscultation
6. Complications[edit | edit source]
- Hypoxemia
- Secondary infections
- Pulmonary fibrosis (chronic cases)
- Respiratory failure
II. Pneumonias[edit | edit source]
1. Definition[edit | edit source]
Pneumonia is an inflammatory disease of the lung parenchyma, primarily involving the alveoli, usually caused by infectious agents.
2. Etiological Classification[edit | edit source]
A. Bacterial Pneumonia[edit | edit source]
- Streptococcus pneumoniae (most common)
- Staphylococcus aureus
- Klebsiella pneumoniae
- Haemophilus influenzae
B. Viral Pneumonia[edit | edit source]
- Influenza virus
- RSV
- SARS-CoV-2
- Adenovirus
C. Atypical Pneumonia[edit | edit source]
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Legionella pneumophila
D. Fungal Pneumonia[edit | edit source]
- Candida
- Aspergillus
- Histoplasma
3. Anatomical (Morphological) Classification[edit | edit source]
A. Lobar Pneumonia[edit | edit source]
Involves entire lobe of lung.
Stages:
- Congestion
- Red hepatization
- Gray hepatization
- Resolution
Common organism: Streptococcus pneumoniae
B. Bronchopneumonia[edit | edit source]
- Patchy consolidation around bronchioles
- Often bilateral
- Common in children and elderly
C. Interstitial (Atypical) Pneumonia[edit | edit source]
- Involves alveolar septa
- Minimal alveolar exudate
- Usually viral or Mycoplasma
4. Pathogenesis[edit | edit source]
- Entry of organism into alveoli
- Activation of alveolar macrophages
- Recruitment of neutrophils
- Formation of inflammatory exudate
- Impaired gas exchange
5. Morphology[edit | edit source]
Gross:[edit | edit source]
- Consolidated areas
- Firm, airless lung tissue
Microscopy:[edit | edit source]
- Alveoli filled with neutrophils, fibrin, bacteria
- Septal thickening (interstitial pneumonia)
6. Clinical Features[edit | edit source]
- Fever, chills
- Productive cough
- Chest pain
- Dyspnea
- Leukocytosis
7. Complications[edit | edit source]
- Lung abscess
- Empyema
- Bacteremia and sepsis
- Organization → pulmonary fibrosis
- Respiratory failure
CITATION:
- Robbins & Cotran Pathologic Basis of Disease, 10th Edition
- Kumar, V., Abbas, A. K., Aster, J. C.
- Robbins & Cotran Pathologic Basis of Disease, 10th Edition
- Fishman’s Pulmonary Diseases and Disorders
- Fishman, A. P. et al.
- Fishman’s Pulmonary Diseases and Disorders, 5th Edition
- McGraw-Hill
