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Pulmonary Pathology

PNEUMONIA-(TOPIC
OVERVIEW)
Is anInflammatoryCondition of
thelung Affecting Primarily the
microscopic Air Sacs Known
asAlveoli
it is usually caused by airborne infection
with virusesorbacteriaand less
commonly other microorganisms, certain
drugsand other conditions such as
autoimmune diseases, also less common
by Fungi and parasites.
The term`pneumoniais sometimes
more broadly applied to any condition

Pneumonia can be classified base on the degree


of damage/lesion caused:
A.

Segmental / lobular pneumonia (it involves


one segment of a lobe)
B.
Lobara (it involves an entire lobe, one/more
lobes)
C.
Bronhopneumonia (uni/bilateral
disseminated foci of pneumonia)
D. Interstitial (it involves the interstitiumalveolar walls, peribronchial and perivascular
space)

Bacterial Pneumonia
Bacteria are the most common cause ofcommnityacquired pneumonia(CAP)(CAP),
withStreptococcus pneumonia, Streptococcus
Pneumoniaeisolated in nearly 50% of casesOther
commonly isolated bacteria include:Haemophilus
influenzain 20%,Chalamydophila pneumonia 13%,
and Mycoplasma pneumoniae in 3% of
cases;Staphyloccoccus aureus;Moraxella
catarrhails; Legionella pnemophila and Gramnegative bacilli
VIAL PNEUMONIA
In adults, viruses account for approximately a
third[6] and in children for about 15% of
pneumonia cases.[22] Commonly implicated
agents include: rhinoviruses,
coronaviruses,influenza virus, respiratory syncytial

Lobar pneumonia

Lobar pneumonia
is a form of
pneumonia that
affects a large and
continuous area of
the lobe of a lung.
It is one of the two
anatomic,
classifications of
pneumonia.
must commonly
involving
pneumococcus

Lobar pneumonia of the


middle lobe

Lobar pneumonia
Stages
Lobar pneumonia usually has

an acute progression.
Classically, the disease has four
stages:
Congestion in the first 24 hours:
This stage is characterized
histologically by vascular
engorgement, intra-alveolar
fluid, small numbers of
neutrophils, often numerous
bacteria. Grossly, the lung is
heavy and hyperemic.
(prehepatization)
Red hepatization or
consolidation : Vascular
congestion persists, with
extravasation of red cells into

shows the location of


the lungs and airways
in the body.
This figure also shows
pneumonia affecting the

alveolar spaces, along with increased


numbers of neutrophils and fibrin.
This appearance has been likened to that of
the liver, hence the term "hepatization".
Grey hepatization : Red cells disintegrate,
with persistence of the neutrophils and
fibrin. The alveoli still appear consolidated,
but grossly the color is paler and the cut
surface is drier.
Resolution (complete recovery):The exudate
is digested by enzymatic activity, and
cleared by macrophages or by cough
mechanism

Lobar pneumonia,
gross:The lower half
of the specimen
shows consolidation
of an entire
lobe.The picture is
an example of the
phase of Gray
hepatization,
whereby the
inflammatory
exudate is becoming
organized and the
gross appearance

Lobar pneumonia (low power)


(High
Power)
The alveolar spaces are diffusely filled by
neutrophils and neutrophilic debris

Evolution:
Pneumonia may be complicated through
transition to abcess (hepatisation yellow),
organization and fibrosis (carnification) or the
occurrence of septic metastases frequently to
the aortic valve.

Microscopy:

It is found in the alveoli presence of fibrinous


exudate partially lysed (homogeneous filling the
alveoli and is giving to the lung parenchyma the
liver-like consistency) and a significant amount of
PMN granulocytes and macrophages in various
stages of decay, mixed with desquamated
pneumocytes and RBCs.
The general appearance isthe leukocyte alveolitis :
1.Alveolar septa are retained,
2.thickened by capillary congestion,and small
bronchi
3.exudate containing serofibrinos debris mixed
with PMNs.

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