1.
This 53-year-old man had a long history of alcoholism and
repeated past hospitalizations for pneumonia
PNEUMONIA
-is a form of acute respiratory infection that affects the lung.
-Normally in healthy person the lung alveoli are filled with air.
However, in an individual with pneumonia the alveoli are
filled with fluid, which limits oxygen intake. (source: WHO)
Pic of normal lung:
How do you know its normal?
Lung with edema (GROSS)
-2-3x there normal weight
-sectioning yields frothy (?) blood tinge fluid
What is the disease?
Is this inflammatory? Neoplastic? Normal?
long history of alcoholism
-According to (nhlcbi) Alcoholism have well documented
effects on the human immune system, leading to increased
susceptibility to infections, like bacterial pneumonia.
(possible etiology, if doc vc will ask what is the etiology of the
bacterial infection)
-Robbins: In a person with long history of alcoholism the
possible etiologic agent would be Klebsiella pneumoniae
2.He was found by the police asleep in an alley and was
arrested as a vagrant.
-Vagrant means – the patient does not have a permanent
residence, wanders from place to place
3.However, because he was very ill on the following day, he
was transferred to the University Hospital.
-It could be the because he was very ill
4.On admission he had a
fever : 40.60 degree Celsius (37.5 and below)
Respiratory rate : 38 (12-20 cycles per minute)
BP : 100/68 mmHg (120/80)
Pulse rate 120 (60-100 beats per minute)
Interpretation
-the patient is febrile, tachypneic (inc breathing) , tachycardic
(inc heart rate), hypotensive (decrease BP)
-
5.There was dullness to percussion, and increased breath
sounds with a friction rub over the right posterior chest.
-dullness to percussion
-caused by the replacement of normally air-filled alveoli by
fluid or consolidation of lungs
(normally, lungs would be resonant upon percussion
*plexor*pleximeter)
-consolidation
-refer to solidification of the lung because the lung is filled
with liquid instead of air
----------------------------------------------------------------------------------
-edema :
-is the accumulation of the fluid in the tissues.
It is the result of the movement of fluid from the vasculature
into the interstitial spaces
-the fluid may be (protein poor) Transudate (protein rich)
Exudate
Microscopic/Histologically/under the microscope:
- clearing and separation of the extracellular matrix & subtle
cell swelling
*Edema can be inflammatory or non-inflammatory
Inflammatory – exudate (protein rich)
GROSS (usually cloudy due to presence of white cells)
Non-inflammatory – transudate (low protein content)
GROSS(translucent and straw colored)
Edema may be caused by:
1.Increased Hydrostatic Pressure
2.Decreased colloid osmotic pressure
3.Increased Vascular permeability (eg. Inflammation)
4.Lymphatic Obstruction (eg. Infection or neoplasia)
* If the rate of fluid movement exceeds the lymphatic
drainage, fluid accumulates (edema)
5.Sodium and Water retention
DRAW Figure 4-2 (Page 115 9th Ed)
increased breath sounds with a friction rub over the right
posterior chest.
Friction rub
- it is an adventitious (extra) breath sound
- characterized by a creaky grating sound -A healthy lung GROSSLY appears color (pink) and with
Why? spongy consistency
(there is inflammation in the surfaces of the visceral and What is spongy?
parietal pleura, the friction between the pleura increases (like the sponge used in washing dishes)
because of decreasing production of lubricating fluid )
-However in this picture you can see a LUNG, GROSSLY
His WBC was 2.1x109/L with a marked left shift and the WBCs APPEARS with liver like consistency there is paler areas
showed toxic granulation What is liver like consistency?
-
If there is infection why is it that the WBC is low? What is that paler areas?
Interpretation: -consolidation : middle & lower lobe
There is increase consumption of neutrophils so the body Consolidation
compensate by releasing immature/band neutrophils in the -refer to solidification of the lung because the lung is filled
blood this indicates severe inflammation with liquid instead of air
GROSS:
What is toxic granulation? MICROSCOPIC:
-the increase granulation & toxic vacuolation of PMNs see in
severe in infection (??? Not sure)

Pic 2
Despite antibiotics, oxygen, and digitalization, the patient In this picture you can see marked pulmonary congestion
died on the following day. Resulting for the affected area to appear dark red in color
Why red?
What is Digitalis? -
-Cardiac glycoside(used for conditions like Heart Failure & Diff hyperemia and congestion
Arrythmias -Both stem from increase blood volume within the tissue
-it works by strengthening the heart muscles & regulate the however have different underlying mechanism
heart beat
-Hyperemia
-active process in which arteriolar dilation leads to increase
blood flow

-Congestion
-passive process resulting from reduced outflow of blood
from the tissue

Pic 3
This picture you can see edema (clearing and separation of
the extracellular matrix & subtle cell swelling)

Point where the edema is

-

Normal Histology of the lung

-

Pic 1 Pic 4
-This is a picture of a lung. This picture you can see congestion.
This is the right lung because it has 3 lobes in contrast with What is congestion?
the left lung with 2 lobes. It doesn’t have lingula (pic) which is - passive process
present in the left.
-resulting from a reduced OUTFLOW of blood from a tissue,
because of isolated venous obstruction, that commonly leads
to edema.

There are 2 types of pulmonary congestion.

Acute pulmonary congestion
Microscopically APC:
Identify the following in the slide
Exhibit engorged (full) alveolar capillaries,
Alveolar septal edema,
Focal intraalveolar hemorrhage

CPC:
He might ask you to draw this
Septa are thickened and fibrotic
Alveoli often contains:
1.Numerous hemosiderin laden macrophages
(heart failure cells)
MICROSCOPIC HF cells:
-

Why is it acute and not chronic?

-HFC