Difference between revisions of "Medical lung diseases"

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Medical lung diseases (view source)

Revision as of 05:15, 13 March 2015

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→‎Asthma: split out
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==Asthma==
==Asthma==
:Cytopathology: ''[[Pulmonary_cytopathology#Asthma|Asthma in pulmonary cytopathology]]''
{{Main|Asthma}}
===General===
*The bread and butter of respirology.
*May be associated with atopy (allergies), medications (e.g. [[NSAID]]s), occupational exposures.<ref name=Ref_PCPBoD8_370>{{Ref PCPBoD8|370}}</ref>
 
====Pathogenesis====
*T-cell response T<sub>H</sub>2 dominant.
 
Sequence:<ref name=Ref_PCPBoD8_370-2>{{Ref PCPBoD8|370-2}}</ref>
*Antigen T<sub>H</sub>2 lymphocyte -> IgE B-cell -> [[mast cell]] IgE Fc -> leukotrienes + other mediators -> bronchospasm, edema, leukocyte recruitment -> airway remodeling.
 
===Gross===
*Lung over-inflation.
*Mucous plugs.
*Focal resorption atelectasis,<ref name=Ref_PCPBoD8_363>{{Ref PCPBoD8|363}}</ref> i.e. collapse.
 
===Microscopic===
Features:<ref name=Ref_Klatt108>{{Ref Klatt|108}}</ref>
*Edema.
*Mucous (plugs).
*+/-Smooth muscle hypertrophy.
*+/-Inflammation - especially with [[eosinophil]]s.
*+/-Charcot-Leyden crystals (formed from eosinophil granules -- breakdown product).
**Sharp edge, diamond shaped, pink on [[H&E]].
 
Images:
*www:
**[http://www.udel.edu/medtech/dlehman/medt372/Ch-lyd.html Charcot-Leyden crystals (udel.edu)].
**[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168024/figure/F1/ Charot-Leyden crystals (nih.gov)].
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Charcot-Leyden_crystals,_HE_3.jpg Charcot-Leyden crystals (WC/Patho)].
**[http://commons.wikimedia.org/wiki/File:Charcot-Leyden_crystals,_HE_2.jpg Charcot-Leyden crystals (WC/Patho)].
 
Notes:
*''Leyden'' in ''Charcot-Leyden'' is also seen written as ''Leiden''.
**Finding associated with hypereosinophilia<ref name=pmid6162378>{{Cite journal  | last1 = Dincsoy | first1 = HP. | last2 = Burton | first2 = TJ. | last3 = van der Bel-Kahn | first3 = JM. | title = Circulating Charcot-Leyden crystals in the hypereosinophilic syndrome. | journal = Am J Clin Pathol | volume = 75 | issue = 2 | pages = 236-43 | month = Feb | year = 1981 | doi =  | PMID = 6162378 }}</ref> - ''not'' pathognomonic for asthma.
*[[Pulmonary cytopathology]]:
**''Curschmann's spirals'' =  spiral-shaped mucous plugs.<ref name=pmid9812228>{{cite journal |author=Cenci M, Giovagnoli MR, Alderisio M, Vecchione A |title=Curschmann's spirals in sputum of subjects exposed daily to urban environmental pollution |journal=Diagn. Cytopathol. |volume=19 |issue=5 |pages=349–51 |year=1998 |month=November |pmid=9812228 |doi= |url=}}</ref>
**''Creola bodies'' = clusters of (ciliated) bronchial epithelial cells.<ref name=pmid2818212>{{Cite journal  | last1 = Isohima | first1 = K. | last2 = Takahashi | first2 = K. | last3 = Soda | first3 = R. | last4 = Hukasaka | first4 = N. | last5 = Tanabe | first5 = K. | last6 = Ozaki | first6 = K. | last7 = Nakato | first7 = H. | last8 = Araki | first8 = M. | last9 = Tuzi | first9 = M. | title = [The clinical significance of Creola body in the sputum of asthmatic patients]. | journal = Arerugi | volume = 38 | issue = 7 | pages = 542-8 | month = Jul | year = 1989 | doi =  | PMID = 2818212 }}</ref>
 
DDx:
*Infection - fungal.
 
===Stains===
Features - crystals:
*PAS-D -ve.
*GMS -ve.
 
===Sign out===
<pre>
BRONCHIAL CAST, RIGHT LOWER LOBE, REMOVAL:
- CHARCOT-LEYDEN CRYSTALS.
- CELLULAR DEBRIS WITH NEUTROPHILS AND ABUNDANT EOSINOPHILS.
- RESPIRATORY MUCOSA WITH PROMINENT SMOOTH MUSCLE.
- NEGATIVE FOR MALIGNANCY.
 
COMMENT:
GMS and PAS-D stains are negative for fungal organisms. The findings are non-specific;
however, they would be compatible with asthma. Clinical and microbiological correlation
is required.
</pre>


==Emphysema==
==Emphysema==
Michael
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