Difference between revisions of "Medical lung diseases"

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The '''medical lung diseases''' are a huge topic.  Most pathologists have little to do with 'em.  They are the domain of respirology.  An introduction to lung pathology is in the ''[[lung]]'' article, along with a general approach.
The '''medical [[lung]] diseases''' are a huge topic.  Most pathologists have little to do with 'em.  They are the domain of respirology.  An introduction to lung pathology is in the ''[[lung]]'' article, along with a general approach. Interstitial lung disease is dealt with in the ''[[diffuse lung diseases]]'' article.


This article includes a discussion about pulmonary hypertension, which may arise due to [[congenital heart disease]].
==Infectious pneumonia==
{{Main|Pneumonia}}
Includes:
*[[Acute infectious pneumonia]].
*[[Chronic infectious pneumonia]].
*Others.


==Acute infectious pneumonia==
==Asthma==
This is seem in autopsy from time-to-time.
{{Main|Asthma}}


===Radiologic correlate===
==Emphysema==
*Air space disease.
:''Chronic obstructive pulmonary disease'', abbreviated ''COPD'', is dealt with in the ''emphysema'' article.
{{Main|Emphysema}}


===Gross pathology===
==Chronic bronchitis==
*Consolidation - best appreciated by running a finger over the cut surface from normal region to abnormal region.
===General===
*Often seen together with ''[[emphysema]]'' with which it is lumped together with in the term ''COPD''.
*It's a clinical diagnosis - criteria:<ref name=Ref_PCPBoD8_370>{{Ref PCPBoD8|370}}</ref>
**Cough with sputum for thee months in at least two consecutive years.
**No other cause identified.
 
Clinical:<ref name=Ref_PCPBoD8_370>{{Ref PCPBoD8|370}}</ref>
*Blue bloater (carbon dioxide retainers)
*Develop ''[[cor pulmonale]]''.
 
===Microscopic===
Features:<ref name=Ref_PCPBoD8_370>{{Ref PCPBoD8|370}}</ref>
*Mucous gland hypertrophy + mucinous secretions in airway.
*Goblet cell metaplasia.
*Bronchiolar inflammation and fibrosis.
 
==Pulmonary edema==
===General===
*Seen in a number of conditions, e.g. [[congestive heart failure]].


===Microscopy===
===Gross===
Features:
Features - autopsy:
*Alveoli packed with PMNs.
*Bubbles - when squeezed (due to surfactant).
*+/-Clusters of bacteria - small dots or rods.
*Heavy.


===Microscopic===
Features:<ref name=Ref_Klatt102>{{Ref Klatt|102}}</ref>
*Dilated capillaries.
*Blood in airspace, focal.
*Plasma proteins in airspace - light pink acellular junk.
*+/-Hemosiderin-laden macrophages (known as ''heart failure cells'' in this context).


==Idiopathic interstitial pneumonia==
DDx:
*Often [[abbreviated]] '''IIP''', is a term used for a type of [[diffuse lung disease]].
*[[Pulmonary alveolar proteinosis]].
**Diffuse lung disease is also known as ''interstitial lung disease''.
*[[Pulmonary hemorrhage]] - abundant blood.
***Diffuse lung disease is probably a better term... as some diseases lumped into this category have involvement of the alveoli, i.e. are not interstitial.


===Histologic classification of IIP===
Images:
*Can be complex,<ref name="pmid12405906">{{cite journal |author=Nicholson AG |title=Classification of idiopathic interstitial pneumonias: making sense of the alphabet soup |journal=Histopathology |volume=41 |issue=5 |pages=381-91 |year=2002 |month=November |pmid=12405906 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0309-0167&date=2002&volume=41&issue=5&spage=381}}</ref> and the combined efforts of [[clinician]]s, [[radiologist]]s, and [[pathologist]]s can help in the generation of a more specific diagnosis.<ref name="pmid15256390">{{cite journal |author=Flaherty KR, King TE, Raghu G, ''et al'' |title=Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis? |journal=Am. J. Respir. Crit. Care Med. |volume=170 |issue=8 |pages=904-10 |year=2004 |month=October |pmid=15256390 |doi=10.1164/rccm.200402-147OC |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=15256390}}</ref><ref name="pmid16738191">{{cite journal |author=Kim DS, Collard HR, King TE |title=Classification and natural history of the idiopathic interstitial pneumonias |journal=Proc Am Thorac Soc |volume=3 |issue=4 |pages=285-92 |year=2006 |month=June |pmid=16738191 |doi=10.1513/pats.200601-005TK |url=http://pats.atsjournals.org/cgi/pmidlookup?view=long&pmid=16738191}}</ref>
*[http://www.flickr.com/photos/pulmonary_pathology/4337007145/in/photostream Pulmonary edema (flickr.com/Yale Rosen)].
*[http://ect.downstate.edu/courseware/histopath_exercises/histo/cardioIIcase2slide11.html Heart failure cells (downstate.edu)].


[[Idiopathic]] interstitial pneumonia can be subclassified based on [[histologic]] appearance into the following patterns:<ref>Leslie KO, Wick MR. Practical Pulmonary Pathology: A Diagnostic Approach. Elsevier Inc. 2005. ISBN 978-0-443-06631-3.</ref><ref name=atsers>{{cite journal |author= |title=American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001 |journal=Am. J. Respir. Crit. Care Med. |volume=165 |issue=2 |pages=277-304 |year=2002 |month=January |pmid=11790668 |doi= |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=11790668}}</ref>
==Bronchiectasis==
{{Main|Bronchiectasis}}


{| class="wikitable"
==Pulmonary hemorrhage==
|-
{{Main|Pulmonary hemorrhage}}
! Histology
! Clinical Correlates
|-
| [[Desquamative interstitial pneumonia]] (DIP)
| DIP
|-
| [[Diffuse alveolar damage]] (DAD)
| [[ARDS]], [[acute interstitial pneumonia|AIP]], [[Transfusion related acute lung injury|TRALI]]
|-
| [[Nonspecific interstitial pneumonia]] (NSIP)
| NSIP
|-
| [[Respiratory bronchiolitis]]
| [[Respiratory bronchiolitis-associated interstitial lung disease|RB-ILD]]
|-
| [[Usual interstitial pneumonia]] (UIP)
| [[collagen vascular disease|CVD]], [[idiopathic pulmonary fibrosis|IPF]], [[drug toxicity]], [[pneumoconiosis]]
|-
| [[Organizing pneumonia]]
| [[Cryptogenic organizing pneumonia]]
|-
| [[Lymphoid interstitial pneumonia]] (LIP)
| LIP
|}
ARDS = adult respiratory distress syndrome, AIP = acute interstitial pneumonia, TRALI = transfusion related acute lung injury, CVD = collagen vascular disease, IPF = idiopathic pulmonary fibrosis.


==Constrictive bronchiolitis==
*[[AKA]] ''bronchiolitis obliterans'', [[AKA]] ''obliterative broncholitis'',<ref name=pmid16493150/> [[AKA]] bronchiolitis obliterans syndrome (BOS).<ref name=pmid18707652>{{Cite journal  | last1 = Sato | first1 = M. | last2 = Keshavjee | first2 = S. | title = Bronchiolitis obliterans syndrome: alloimmune-dependent and -independent injury with aberrant tissue remodeling. | journal = Semin Thorac Cardiovasc Surg | volume = 20 | issue = 2 | pages = 173-82 | month =  | year = 2008 | doi = 10.1053/j.semtcvs.2008.05.002 | PMID = 18707652 }}</ref>
{{Main|Constrictive bronchiolitis}}


Notes:
==Diffuse lung diseases==
*''Usual interstitial pneumonia'' is the most common type of ILD.<ref name="pmid16738196">{{cite journal |author=Visscher DW, Myers JL |title=Histologic spectrum of idiopathic interstitial pneumonias |journal=Proc Am Thorac Soc |volume=3 |issue=4 |pages=322-9 |year=2006 |month=June |pmid=16738196 |doi=10.1513/pats.200602-019TK |url=http://pats.atsjournals.org/cgi/pmidlookup?view=long&pmid=16738196}}</ref>
{{Main|Diffuse lung diseases}}
These are also known as ''idiopathic interstitial pneumonias''.


==Fibrosis==
==Fibrosis==
Line 76: Line 86:


===Radiologic/gross pathologic DDx by location===
===Radiologic/gross pathologic DDx by location===
Causes of lower lung fibrosis ''BAD RASH'':<ref>TN05 R13</ref>
Causes of lower lung fibrosis ''BAD RASH'':<ref name=Ref_TN2005_R13>{{Ref TN2005| R13}}</ref>
*Brochiolitis obliterans with organizing pneumonia (BOOP),
*[[Bronchiolitis obliterans organizing pneumonia]] (BOOP).
*Asbestosis,
*[[Asbestosis]].
*Drugs (nitrofurantoin, hydralazine, isoniazid (INH), amiodarone),
*Drugs (nitrofurantoin, hydralazine, isoniazid (INH), amiodarone).
*Rheumatologic disease,
*[[Rheumatologic disease]].
*Aspiration,
*[[aspiration pneumonia|Aspiration]].
*Scleroderma,
*[[Scleroderma]].
*Hamman-Rich syndrome (really should be -- ''interstital pulmonary fibrosis'').
*Hamman-Rich syndrome (really should be -- ''[[idiopathic pulmonary fibrosis]]'').


Causes of upper lung fibrosis ''FASSTEN'':<ref>TN05 R13</ref>
Note:
*Farmer's lung,
*''Hamman-Rich syndrome'' is another name for [[acute interstitial pneumonia]].<ref name=Ref_WMSP90>{{Ref WMSP|90}}</ref>
*Ankylosing spondylitis,
 
*Sarcoidosis,
Causes of upper lung fibrosis ''FASSTEN'':<ref name=Ref_TN2005_R13>{{Ref TN2005| R13}}</ref>
*Silicosis,
*[[Farmer's lung]].
*Tuberculosis (miliary),
*[[Ankylosing spondylitis]].
*Eosinophilic granuloma,
*[[Sarcoidosis]].
*Neurofibromatosis.
*[[Silicosis]].
*[[Tuberculosis]] (miliary).
*[[Eosinophilic granuloma]].
*[[Neurofibromatosis]].


===Prognosis===
===Prognosis===
Line 102: Line 115:


=Disease with fibrosis=
=Disease with fibrosis=
There are many of 'em.


==Usual interstitial pneumonia==
*[[Diffuse alveolar damage]].
===General===
*[[Usual interstitial pneumonia]].
*It is sometimes used incorrectly as a synoym for ''idiopathic pulmonary fibrosis''.
*[[Asbestosis]].
*Cannot be diagnosed via bronchoscopic or transbronchial biopsy.<ref>PPP P.186.</ref>
*[[Hypersensitivity pneumonitis]].
 
==Fibrosing pleuritis==
{{Main|Fibrosing pleuritis}}
 
=Lymphocytic lesions of the lung=


===Epidemiology===
{| class="wikitable sortable"
*Disease of the old - rare in under 50 years old.<ref>AC UBC S.102.</ref>
!Diagnosis
*Dismal prognosis - mean survival after diagnosis ~ 2.8 years.<ref name=pmid9445300/>
!Key histologic feature
!Radiology
!Other diagnostic
|-
|[[Lymphocytic interstitial pneumonia]]
|interstitial lymphoid cells, usu. no nodules
|interstitial pattern
|
|-
|[[Follicular bronchiolitis/bronchitis]]
|lymphoid cell around bronchioles / bronchus, normal parenchyma
|interstitial pattern
|
|-
|[[Nodular lymphoid hyperplasia]]
|abundant lymphoid cells in nodules
|nodules /interstitial pattern
|stains to exclude lymphoma; germinal centres do not exclude [[lymphoma]]
|-
|Lymphoma ([[BALToma]])
|abundant lymphoid cells usu. in nodules
|nodules / interstitial pattern
|may require stains to prove, germinal centres may be present
|-
|}


===Differential diagnosis===
==Lymphocytic interstitial pneumonia==
UIP is seen in:<ref name=leslie>{{cite book |author=Wick, Mark R.; Leslie, Kevin |title=Practical pulmonary pathology: a diagnostic approach |publisher=Churchill Livingstone |location=Edinburgh |year=2005 |pages= |isbn=0-443-06631-0 |oclc= 156861539|doi= |accessdate=}}</ref>
{{Main|Lymphocytic interstitial pneumonia}}
*Idiopathic pulmonary fibrosis,
*Asbestosis,
*Chronic hypersensitivity pneumonitis (extrinsic allergic alveolitis),
*Collagen vascular disease and
*chronic drug toxicity.<ref>{{cite journal |author=Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC |title=Pulmonary drug toxicity: radiologic and pathologic manifestations |journal=Radiographics : a review publication of the Radiological Society of North America, Inc |volume=20 |issue=5 |pages=1245-59 |year=2000 |pmid=10992015 |doi=}}</ref>


===Radiologic===
==Follicular bronchitis/bronchiolitis==
*Honeycombing - ''multiple'' defects that obliterate the normal lung architecture - multiple spherical voids in the lung parenchyma; radiologically these are seen as lucencies.<ref>[http://www.medcyclopaedia.com/library/topics/volume_v_1/h/honeycombing.aspx http://www.medcyclopaedia.com/library/topics/volume_v_1/h/honeycombing.aspx]</ref>
{{Main|Follicular bronchitis/bronchiolitis}}
**Usually subplural, i.e. peripheral lung.
**Classically lower lobe predominant.
**Assoc. with interstitial thickening ???


Note:
==Pulmonary nodular lymphoid hyperplasia==
*Cysts - have thin walls (think of emphysema, lymphangioleiomyomatosis et cetera).
{{Main|Pulmonary nodular lymphoid hyperplasia}}
**Cysts may be isolated/not close to a neighbour.
**Medcyclopaedia defines it as: thin-walled, well-demarcated and >1 cm.<ref>[http://www.medcyclopaedia.com/library/topics/volume_v_1/l/lung_cyst.aspx http://www.medcyclopaedia.com/library/topics/volume_v_1/l/lung_cyst.aspx]</ref>


===Histology===
==Lymphoma of the lung==
Features:<ref>PPP P.186-9.</ref>
{{Main|Lymphoma of the lung}}
*Fibroblast foci:
**"Crescent-shaped bulge" of fibroblasts -- a rounded projection of spindle cells into the airspace.
**Location: in the areas of transisition between active inflammation and old inflammation.<ref>[http://www.epler.com/IPFWhat%27sIPFDiseaseInformation2.htm http://www.epler.com/IPFWhat%27sIPFDiseaseInformation2.htm]</ref>
**Note: Technically, ''fibroblast foci'' are composed of myofibroblasts.<ref>PPP P.189.</ref>
*Interstitial inflammation,
*Microscopic honeycombing,
**Typically peripheral - cysts lined by ciliated epithelium.
*Spatial heterogeneity - patchy lesional distribution (areas of abnormal and normal lung may appear beside one another).
*Temporal heterogeneity - lesions of differing age side-by-side.<ref>H. 8 July, 2009.</ref>


Notes:
=[[Smoking]] associated disease=
*Disease worse distant from large airways: lower lung field predominance, typically worse at periphery of lobule and lung.<ref>AC UBC S.103.</ref>
{{Main|Smoking}}
*Heterogeneity of inflammation: airspace macrophages & inflammation minimal in honeycombed foci.
*Respiratory bronchiolitis (RB).
*[[Respiratory bronchiolitis interstitial lung disease]] (RBILD).
*[[Desquamative interstitial pneumonia]] (DIP).
*Eosinophilic granuloma (of lung) - [[AKA]] [[pulmonary langerhans cell histiocytosis]].
*[[Smoking-related interstitial fibrosis]] (SRIF).


==Non-specific interstitial pneumonia==
All of the above are associated with smoking. RBILD & DIP are considered by many to be on a continuum, i.e. RBILD is early DIP.
*Abbreviated ''NSIP''.
*Better prognosis than UIP.
*Some radiologists and pathologists don't believe in this entity.


===Gross/Radiology===
==Respiratory bronchiolitis==
*No honeycombing.
*Diagnosis is based on clinical criteria.
*Fibrosis usually lower lung zone.
*Patchy ground glass.


===Microscopic===
===Microscopic===
*Fibrosis:
Features:
**May be uniform.
*Inflammation.
**"Linear fibrosis" has a good prognosis - should be mentioned in the report.
*No interstitial lung disease, i.e. no fibrosis.
***''Linear fibrosis'' = fibrosis that follows alveolar walls + no architectural distortion.
*+/-Lymphoid nodules - assoc. with collagen vascular disease.


Notes:
==Respiratory bronchiolitis interstitial lung disease==
*Like UIP... also temporally and spatially heterogeneous.
{{Main|Respiratory bronchiolitis interstitial lung disease}}
*Inflammation in NSIP usually more prominent than in UIP.
*No honeycombing - key difference between UIP and NSIP.


===DDx===
==Desquamative interstitial pneumonia==
*Collagen vascular disease.
{{Main|Desquamative interstitial pneumonia}}
*Drug reaction.
*Hypersensitivity pneumonitis (extrinic allergic alveolitis).
 
==Diseases with prominent bronchiolization==
There are many.


==Pulmonary Langerhans cell histiocytosis==
==Pulmonary Langerhans cell histiocytosis==
===General===
*[[AKA]] eosinophilic granuloma of the lung.
*Assoc. with smoking.<ref name=ppp234>PPP P.234.</ref>
{{Main|Pulmonary Langerhans cell histiocytosis}}
*Not assoc. with systemic diseases of Langerhans cells (AKA Hand-Schueller-Christian disease).


Subtypes:<ref name=ppp234/>
=Granulomatous lung disease=
*Cellular form.
:See: ''[[Granulomas]]'' for an introduction to the general topic.
*Fibrotic form.
Most common:
*Infectious - mycobacterial and fungal.<ref name=pmid20441499>{{cite journal |author=Mukhopadhyay S, Gal AA |title=Granulomatous lung disease: an approach to the differential diagnosis |journal=Arch. Pathol. Lab. Med. |volume=134 |issue=5 |pages=667–90 |year=2010 |month=May |pmid=20441499 |doi= |url=}}</ref>


One form usually predominantes.
Noninfectious causes:<ref name=pmid20441499/>
*Aspiration pneumonia.
*Hypersensitivity pneumonitis.
*Hot tub lung.
*Talc granulomatosis.
*Sarcoidosis.
*[[Granulomatosis with polyangiitis]] (Wegener granulomatosis).


===Histology===
==Sarcoidosis==
Features:<ref>PPP P.237.</ref>
{{Main|Sarcoidosis}}
*Langerhans cells:
===General===
**Pale staining nucleus (H&E) with nuclear infolding - "crumpled tissue paper" appearance.
*Diagnosis of exclusion - infection must be excluded.
*+/-Smoker's macrophages.
*Radiologic differential diagnosis includes carcinomatosis.<ref>URL: [http://www.radiologyassistant.nl/en/46b480a6e4bdc http://www.radiologyassistant.nl/en/46b480a6e4bdc]. Accessed on: 23 May 2010.</ref>
*+/-Eosinophilia.


===IHC===
===Microscopic===
*Langerhans cells: S100+ and CD1a+.<ref>PPP P.237.</ref>
Features:
 
*Granulomata, well-formed, non-necrotizing.
=Smoking assoc. disease=
**Negative for microorganisms with special stains ([[PAS-D]], [[GMS]], [[AFB]]).
*RB = respiratory bronchiolitis.
**Granulomata - interstitial location.
*RBILD = respiratory bronchiolitis interstitial lung disease.
*DIP = desquamative interstitial pneumonia.
*Eosinophilic granuloma (of lung) - AKA pulmonary langerhans cell histiocytosis.
 
All of the above are assoc. with smoking.  RBILD & DIP are considered by many to be on a continuum, i.e. RBILD is early DIP.


==Respiratory bronchiolitis==
Image(s):
*No interstitial lung disease.
*[http://commons.wikimedia.org/wiki/File:Asteroid_body_intermed_mag.jpg Sarcoidosis - lung (WC)].
*[http://commons.wikimedia.org/wiki/File:Asteroid_body_very_high_mag.jpg Granulomata in sarcoidosis with asteroid bodies (WC)].


==RBILD==
==Pulmonary talcosis==
===General===
===General===
*Respiratory bronchiolitis interstitial lung disease.
*Associated with herion use.<ref name=pmid6655726>{{Cite journal  | last1 = Davis | first1 = LL. | title = Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis. | journal = J Natl Med Assoc | volume = 75 | issue = 12 | pages = 1225–8 | month = Dec | year = 1983 | doi =  | PMID = 6655726 | PMC=2561715 | url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2561715/ }}</ref>
*Seen in drug users that [[IVDU|intravenously inject crushed pills]] intended to be taken PO.<ref name=pmid20155272>{{Cite journal  | last1 = Marchiori | first1 = E. | last2 = Lourenço | first2 = S. | last3 = Gasparetto | first3 = TD. | last4 = Zanetti | first4 = G. | last5 = Mano | first5 = CM. | last6 = Nobre | first6 = LF. | title = Pulmonary talcosis: imaging findings. | journal = Lung | volume = 188 | issue = 2 | pages = 165-71 | month = Apr | year = 2010 | doi = 10.1007/s00408-010-9230-y | PMID = 20155272 }}</ref>
*X-ray findings similar to [[asbestosis]].


===Histology===
===Microscopic===
Features:<ref>PPP PP.197-8.</ref>
Features:
*Brown pigmented airspace macrophages - ''smoker's macrophages''.
*Granulomas with foreign material.
*Inflammation of the terminal bronchioles.
**Foreign material often polarizes.


Note:  
====Images====
*The histologic features of RBILD may be present peri-tumoural.
<gallery>
Image:Pulmonary_talcosis_low_mag_cropped.jpg | Pulmonary talcosis - low mag. cropped (WC)
Image:Pulmonary_talcosis_low_mag.jpg | Pulmonary talcosis - low mag. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case698.html Pulmonary talcosis - several images (upmc.edu)].


==DIP==
=Miscellaneous diseases=
*Desquamative interstitial pneumonia.
==Pneumoconioses==
*Thought to be advanced RBILD.
{{Main|Pneumoconioses}}
 
===Histology===
*Brown pigmented airspace macrophages - ''smoker's macrophages''.
*Architecture preserved; "linear fibrosis".
 
Notes:
*Some fields of view may be indistinguishable from RBILD.
*Amiodarone toxicity, fibrotic NSIP - may appear similar.
 
==Eosinophilic granuloma of lung==
*Assoc. with smoking.


===Radiology===
==Pneumocytoma==
*Upper lung zones.
*[[AKA]] ''benign sclerosing pneumocytoma''.<ref name=pmid6291188>{{Cite journal  | last1 = Chan | first1 = KW. | last2 = Gibbs | first2 = AR. | last3 = Lo | first3 = WS. | last4 = Newman | first4 = GR. | title = Benign sclerosing pneumocytoma of lung (sclerosing haemangioma). | journal = Thorax | volume = 37 | issue = 6 | pages = 404-12 | month = Jun | year = 1982 | doi = | PMID = 6291188 }}</ref>
 
*Previously known as ''sclerosing hemangioma''.
===Histology===
{{Main|Pneumocytoma}}
*Cellular peribronchiolar nodules with:
**Eosinophils - may be rare.
**Langerhans cells.
**Smoker's macrophages (brown pigmented airspace macrophages).
**Chronic inflammatory cells (lymphocytes).
 
==Hypersensitivity pneumonitis==
*AKA ''extrinsic allergic alveolitis''
*Exposure to stuffs... e.g. moldy hay - ''Farmer's lung'', atypical mycobacteria - ''hot tub lung''.
 
===IHC===
Nodules postive for:
*S-100.
*CD1a.
 
=Miscellaneous diseases=


==Lymphangioleiomyomatosis==
==Lymphangioleiomyomatosis==
===General===
*Abbreviated ''LAM''.
*Abbreviated ''LAM''.
*Clinical: dyspnea, recurrent pneumothorax.
*[[AKA]] lymphangiomyomatosis.
*May be an indication for lung transplantation.
{{Main|Lymphangioleiomyomatosis}}
 
===Epidemiology===
*Associated with [[angiomyolipoma]]s.<ref name=emedicine299545>[http://emedicine.medscape.com/article/299545-overview http://emedicine.medscape.com/article/299545-overview]</ref>
*Associated with [[tuberous sclerosis]]<ref name=emedicine299545/> - abnormality in same gene (TSC2).
*Only affects women - primarily in childbearing years.
*Rare.
 
===Radiology===
*Bullae/thin walled cysts - distributed in all lung fields.
*Lymphadenopathy.
 
Radiologic DDx (of cysts):
*Eosinophilic granuloma (assoc. with smoking).
*Interstitial pulmonary fibrosis (UIP).
*Emphysema.
 
===Histology===
Features:<ref>[http://emedicine.medscape.com/article/299545-diagnosis http://emedicine.medscape.com/article/299545-diagnosis]</ref>
*Spindle cells with small nuclei + larger epithelioid cells with clear cytoplasm and round nuclei.
*Cyst formation.
*Thick arterial walls.
 
IHC:
*HMB-45 +ve
*ER +ve
*PR +ve
*SMA +ve


==Pulmonary alveolar proteinosis==
==Pulmonary alveolar proteinosis==
*Abbreviated ''PAP''.
*Abbreviated ''PAP''.
*Associated with smoking - particularily in men.<ref name=pmid14695413>{{cite journal |author=Trapnell BC, Whitsett JA, Nakata K |title=Pulmonary alveolar proteinosis |journal=N. Engl. J. Med. |volume=349 |issue=26 |pages=2527-39 |year=2003 |month=December |pmid=14695413 |doi=10.1056/NEJMra023226 |url=http://content.nejm.org/cgi/content/extract/349/26/2527}}</ref>
{{Main|Pulmonary alveolar proteinosis}}


Pathophysiology:
==Diffuse panbronchiolitis==
*GM-CSF (granulocyte-macrophage colony stimulating factor) signaling in macrophages/lack of GM-CSF.
*Abbreviated ''DPB''.
**GM-CSF is required by alveolar macrophages to clear surfactant.
{{Main|Diffuse panbronchiolitis}}


Classification:<ref name=pmid14695413/>
==Pulmonary amyloidosis==
#Congenital:
{{Main|Amyloidosis}}
#**Abnormal surfactant.
#**GM-CSF receptor defect.
#Secondary:
#*Infections.
#*Haematologic malignancy.
#Acquired:
#*Dusts - interfere with macrophage function.


Clinical:
===General===
*Dyspnea & cough - gradual onset.
*Rare.<ref name=pmid22692971>{{Cite journal  | last1 = Hagmeyer | first1 = L. | last2 = Stieglitz | first2 = S. | last3 = Röcken | first3 = C. | last4 = Randerath | first4 = W. | title = [Amyloidosis in Pneumology.] | journal = Pneumologie | volume =  | issue =  | pages =  | month = Jun | year = 2012 | doi = 10.1055/s-0032-1309811 | PMID = 22692971 }}</ref>


===Radiology===
===Microscopic===
*CXR: airspace disease.
Features:
*HRCT: "crazy paving" - see: [http://radiographics.rsnajnls.org/cgi/content/figsonly/23/6/1509 http://radiographics.rsnajnls.org/cgi/content/figsonly/23/6/1509].
*Interstitial cotton candy-like material - see ''[[amyloidosis]]''.


===Histology===
DDx:
*Crap in alveoli.
*[[Diffuse lung diseases]].
*"Dense bodies" - dead macrophages ("Chatter" in the alveoli).
**Edema - has pink stuff in the alveoli like PAP but no ''dense bodies''.


DDx - may mimic:
Images:
*Edema.
*[http://pathlabmed.typepad.com/surgical_pathology_and_la/2010/05/digital-case-challenge-pleuropulmonary-amyloidosis.html Pleuropulmonary amyloidosis  - several images (pathlabmed.typepad.com)].
*Pneumocystis.


==Drug reactions==
==Drug reactions==
Line 330: Line 287:


=Pulmonary hypertension=
=Pulmonary hypertension=
{{Main|Pulmonary hypertension}}
General classification:
General classification:
*Primary, i.e. ''primary pulmonary hypertension'', or
*Primary, i.e. ''primary pulmonary hypertension'', or
Line 335: Line 294:


==Non-secondary pulmonary hypertension==
==Non-secondary pulmonary hypertension==
{{Main|Pulmonary hypertension}}
Causes:<ref name=pmid16263465>{{cite journal |author=Bush A |title=Pulmonary hypertensive diseases |journal=Paediatr Respir Rev |volume=1 |issue=4 |pages=361-7 |year=2000 |month=December |pmid=16263465 |doi=10.1053/prrv.2000.0077 |url=}}</ref>
Causes:<ref name=pmid16263465>{{cite journal |author=Bush A |title=Pulmonary hypertensive diseases |journal=Paediatr Respir Rev |volume=1 |issue=4 |pages=361-7 |year=2000 |month=December |pmid=16263465 |doi=10.1053/prrv.2000.0077 |url=}}</ref>
*Primary pulmonary hypertension.
*Primary pulmonary hypertension.
*Pulmonary embolic disease (thromboembolism, and non-thrombotic embolism).
*[[Pulmonary embolism|Pulmonary embolic disease]] (thromboembolism, and non-thrombotic embolism).
*Pulmonary capillary haemangiomatosis (PCH).
*[[Pulmonary capillary haemangiomatosis]] (PCH).
*Pulmonary veno-occlusive disease (PVOD).
*[[Pulmonary veno-occlusive disease]] (PVOD).  
 
Notes:
*Some people consider PCH and PVOD to the be same thing.<ref name=pmid16819327>{{cite journal |author=Lantuéjoul S, Sheppard MN, Corrin B, Burke MM, Nicholson AG |title=Pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis: a clinicopathologic study of 35 cases |journal=Am. J. Surg. Pathol. |volume=30 |issue=7 |pages=850-7 |year=2006 |month=July |pmid=16819327 |doi=10.1097/01.pas.0000209834.69972.e5 |url=}}</ref>
**Both have a poor prognosis.
**Clinically they present the same way.
*PVOD is based on case reports - it is extremely rare.<ref name=pmid3342678>{{cite journal |author=Vevaina JR, Mark EJ |title=Thoracic hemangiomatosis masquerading as interstitial lung disease |journal=Chest |volume=93 |issue=3 |pages=657-9 |year=1988 |month=March |pmid=3342678 |doi= |url=}}</ref>
 
===Primary pulmonary hypertension===
*AKA ''pulmonary plexogenic arteriopathy''.<ref name=dccpad>Lie JT, Silver MD. Diagnostic criteria of cardiovascular pathology: acquired diseases. ISBN 0-397-51630-4. PP.208-9.</ref>
*Like chronic pulmonary hypertension due to congenital heart disease but ''without'' the congenital heart disease.<ref name=dccpad/>
**Classified by ''Heath-Edwards classification'' (see below) into six grades.
 
===Pulmonary veno-occlusive disease (PVOD)===
Features:<ref>PPP PP.393-6.</ref>
*Clinical - gradual dyspnea +/- non-productive cough, +/- clubbing.
*Thrombosis - small veins & venules, particularily at the interlobular septae.
*Associated with mild homogenous peripheral interstitial fibrosis.


DDx: chronic interstitial pneumonia.
===Severity===
*Heath-Edwards classification - see ''[[pulmonary hypertension]]''.


===Pulmonary capillary hemangiomatosis (PCH)===
=Eosinophilic pneumonia=
General:
*First reported in 1978 by Wagenvoort et al..<ref name=pmid730121>{{cite journal |author=Wagenvoort CA, Beetstra A, Spijker J |title=Capillary haemangiomatosis of the lungs |journal=Histopathology |volume=2 |issue=6 |pages=401-6 |year=1978 |month=November |pmid=730121 |doi= |url=}}</ref>
 
Features:
*Proliferating and invasive capillaries.<ref name=pmid3770733>{{cite journal |author=Tron V, Magee F, Wright JL, Colby T, Churg A |title=Pulmonary capillary hemangiomatosis |journal=Hum. Pathol. |volume=17 |issue=11 |pages=1144-50 |year=1986 |month=November |pmid=3770733 |doi= |url=}}</ref>
*Demonstrated by CD34 immunostaining.<ref name=pmid16819327/>
*'''Dilated capillaries'''<ref>MC August 2009.</ref><ref>PPP PP.396-7.</ref> - key feature.
 
DDx:
*Passive congestion (PC).
**Differentiated by fact that PCH has multiple channels in alveolar wall (PC has only one).
 
==Chronic pulmonary hypertension due to congenital heart disease==
*Graded using the ''Heath-Edwards system''.<ref name=pmid13573570>{{cite journal |author=HEATH D, EDWARDS JE |title=The pathology of hypertensive pulmonary vascular disease; a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects |journal=Circulation |volume=18 |issue=4 Part 1 |pages=533-47 |year=1958 |month=October |pmid=13573570 |doi= |url=}}</ref>
*A reason for open lung biopsy in children.<ref name=pmid11426747>{{cite journal |author=Jaklitsch MT, Linden BC, Braunlin EA, Bolman RM, Foker JE |title=Open-lung biopsy guides therapy in children |journal=Ann. Thorac. Surg. |volume=71 |issue=6 |pages=1779-85 |year=2001 |month=June |pmid=11426747 |doi= |url=}}</ref>
 
===Heath-Edwards classification===
Definition:<ref name=pmid13573570>{{cite journal |author=HEATH D, EDWARDS JE |title=The pathology of hypertensive pulmonary vascular disease; a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects |journal=Circulation |volume=18 |issue=4 Part 1 |pages=533-47 |year=1958 |month=October |pmid=13573570 |doi= |url=}}</ref>
*Six grades - based on ''intimal reaction'' and ''media of arteries and arterioles'':
**Grade 1:
***Intima: no intimal reaction.
***Media: hypertrophied.
**Grade 2:
***Intima: '''cellular intimal reaction'''.
***Media: hypertrophied.
**Grade 3:
***Intima: '''fibrous & fibroelastic reaction''' + cellular intimal reaction.
***Media: hypertrophy +/- generalized dilation.
**Grade 4:
***Intima: '''"plexiform lesions"''' + fibrous & fibroelastic reaction, + cellular intimal reaction.
*****Plexiform lesions = multiple channels that are dilated, assoc. with loss of elastic laminae; thought to arise at branch points due to aberant WSS.<ref>[http://pathhsw5m54.ucsf.edu/overview/vessels.html http://pathhsw5m54.ucsf.edu/overview/vessels.html]</ref>
***Media: generalized dilation +/- '''local "dilation lesions"'''.
***Micrographs: [http://pathhsw5m54.ucsf.edu/overview/vessels.html Plexiform lesions (ucsf.edu)], [http://www.pvrireview.org/viewimage.asp?img=PVRIReview_2009_1_1_34_44882_u6.jpg Plexiform lesions (pvrireview.org)].
**Grade 5:
***Intima: as in Grade 4.
***Media: generalized dilation + local "dilation lesions" + '''pulmonary hemosiderosis'''.
**Grade 6:
***Intima: as in Grade 4.
***Media: generalized dilation + local "dilation lesions" + pulmonary hemosiderosis + '''necrotizing arteritis'''.
 
Notes:
*'''Bolded''' text - defining feature.
*It is discussed here: [http://www.pathology.or.kr/studygroup/cardiopulmonary/lecture/lenote/hka.htm http://www.pathology.or.kr/studygroup/cardiopulmonary/lecture/lenote/hka.htm].
 
==Eosinophilic pneumonia==
Specific entities:<ref name=emedicine301070>[http://emedicine.medscape.com/article/301070-overview http://emedicine.medscape.com/article/301070-overview]</ref>
Specific entities:<ref name=emedicine301070>[http://emedicine.medscape.com/article/301070-overview http://emedicine.medscape.com/article/301070-overview]</ref>
*Churg-Strauss syndrome.
*[[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss syndrome).
*Acute eosinophilic pneumonia.
*Acute eosinophilic pneumonia.
*Chronic eosinophilic pneumonia.
*Chronic eosinophilic pneumonia.
Line 413: Line 313:


Entities which may have eosinophilia as prominent feature:
Entities which may have eosinophilia as prominent feature:
*AIDS.
*[[AIDS]].
*Lymphoma.
*Lymphoma.
*Collagen vascular disease.
*[[Collagen vascular disease]].


==Churg-Strauss syndrome==
==Churg-Strauss syndrome==
Features ''GAFE'':
{{Main|Churg-Strauss syndrome}}
*'''G'''ranulomata.
*'''A'''sthma.
*'''F'''ever.
*'''E'''osinophilia.


===General===
===Microscopic===
*AKA ''allergic granulomatous angiitis''.<ref name=emedicine333492>[http://emedicine.medscape.com/article/333492-overview http://emedicine.medscape.com/article/333492-overview]</ref>
Features:
*Small vessel vasculitis.
*Small vessel [[vasculitis]].
*Similar to ''Wegener's granulomatosis'' (classically c-ANCA +ve) and ''microscopic polyangiitis'' (a form of ''polyarteritis nodosa'').<ref>[http://emedicine.medscape.com/article/334024-overview http://emedicine.medscape.com/article/334024-overview]</ref>
*Abundant eosinophils.
*[[Granuloma]]s.
 
=Eosinophilic pleural effusions=
*Definition: 10%+ eosinophils.<ref name=pmid12561030 >{{Cite journal  | last1 = Matthai | first1 = SM. | last2 = Kini | first2 = U. | title = Diagnostic value of eosinophils in pleural effusion: a prospective study of 26 cases. | journal = Diagn Cytopathol | volume = 28 | issue = 2 | pages = 96-9 | month = Feb | year = 2003 | doi = 10.1002/dc.10227 | PMID = 12561030 }}</ref>
*Uncommon  5-16% of effusions.<ref name=pmid15220754>{{Cite journal  | last1 = Kalomenidis | first1 = I. | last2 = Light | first2 = RW. | title = Pathogenesis of the eosinophilic pleural effusions. | journal = Curr Opin Pulm Med | volume = 10 | issue = 4 | pages = 289-93 | month = Jul | year = 2004 | doi =  | PMID = 15220754 }}</ref>
 
Causes - mnemonic ''I'M PAID'':<ref name=pmid15220754/>
*Infection, e.g. [[tuberculosis]].
*Malignancy - uncommon.
*Pulmonary emboli.
*Asbestos exposure.
*Inflammatory diseases.
*Drug reactions.
 
=Lung transplant pathology=
{{Main|Lung transplant pathology}}
This subspecialty is dealt with in its own article.


=See also=
=See also=
Line 440: Line 353:
*[http://www.pilotforipf.org/image_library.php Pulmonary Fibrosis Idenification Lessons for Optimizing Treatment (pilotforipf.org)].
*[http://www.pilotforipf.org/image_library.php Pulmonary Fibrosis Idenification Lessons for Optimizing Treatment (pilotforipf.org)].


[[Category:Lung pathology]]
[[Category:Pulmonary pathology]]

Latest revision as of 14:54, 23 March 2017

The medical lung diseases are a huge topic. Most pathologists have little to do with 'em. They are the domain of respirology. An introduction to lung pathology is in the lung article, along with a general approach. Interstitial lung disease is dealt with in the diffuse lung diseases article.

Infectious pneumonia

Main article: Pneumonia

Includes:

Asthma

Main article: Asthma

Emphysema

Chronic obstructive pulmonary disease, abbreviated COPD, is dealt with in the emphysema article.
Main article: Emphysema

Chronic bronchitis

General

  • Often seen together with emphysema with which it is lumped together with in the term COPD.
  • It's a clinical diagnosis - criteria:[1]
    • Cough with sputum for thee months in at least two consecutive years.
    • No other cause identified.

Clinical:[1]

Microscopic

Features:[1]

  • Mucous gland hypertrophy + mucinous secretions in airway.
  • Goblet cell metaplasia.
  • Bronchiolar inflammation and fibrosis.

Pulmonary edema

General

Gross

Features - autopsy:

  • Bubbles - when squeezed (due to surfactant).
  • Heavy.

Microscopic

Features:[2]

  • Dilated capillaries.
  • Blood in airspace, focal.
  • Plasma proteins in airspace - light pink acellular junk.
  • +/-Hemosiderin-laden macrophages (known as heart failure cells in this context).

DDx:

Images:

Bronchiectasis

Main article: Bronchiectasis

Pulmonary hemorrhage

Main article: Pulmonary hemorrhage

Constrictive bronchiolitis

  • AKA bronchiolitis obliterans, AKA obliterative broncholitis,[3] AKA bronchiolitis obliterans syndrome (BOS).[4]
Main article: Constrictive bronchiolitis

Diffuse lung diseases

Main article: Diffuse lung diseases

These are also known as idiopathic interstitial pneumonias.

Fibrosis

Histomorphological classification

  1. Hyaline membranes - glassy pink material lining airways & alveoli.
  2. Microscopic honeycombing - "holes" in the lung.
  3. Bronchiolization - ciliated (respiratory) epithelium in distal airway.
  4. Uniform alveolar septal thickening - septae look similar at low power.
  5. Peripheral lobular fibrosis - septae thickening peripheral, HRCT shows: irregular peripheral reticular opacities.[5]
    • Reticular = net-like.[6]
  6. Siderophages in alveoli - macrophages with hemosiderin the alveoli.
  7. Fibrinous pleuritis - peripheral only (based on imaging).
  8. Granulomata, non-necrotizing.
  9. Abundance of vacuolated cells.
  10. Chronic inflammation.
  11. Bronchiolocentric scarring - fibrosis concentrated around airway/assoc. with airway.

Radiologic/gross pathologic DDx by location

Causes of lower lung fibrosis BAD RASH:[7]

Note:

Causes of upper lung fibrosis FASSTEN:[7]

Prognosis

  • The pattern and severity of fibrosis seems to be the most important factors prognostically - more important than the underlying cause (ILD, CVD, drug reaction etc.).[9][10]

Patterns of fibrosis:

  • "Linear" - follows alveolar walls, no architectural distortion.
  • UIP-like (honeycombing).

Disease with fibrosis

There are many of 'em.

Fibrosing pleuritis

Main article: Fibrosing pleuritis

Lymphocytic lesions of the lung

Diagnosis Key histologic feature Radiology Other diagnostic
Lymphocytic interstitial pneumonia interstitial lymphoid cells, usu. no nodules interstitial pattern
Follicular bronchiolitis/bronchitis lymphoid cell around bronchioles / bronchus, normal parenchyma interstitial pattern
Nodular lymphoid hyperplasia abundant lymphoid cells in nodules nodules /interstitial pattern stains to exclude lymphoma; germinal centres do not exclude lymphoma
Lymphoma (BALToma) abundant lymphoid cells usu. in nodules nodules / interstitial pattern may require stains to prove, germinal centres may be present

Lymphocytic interstitial pneumonia

Main article: Lymphocytic interstitial pneumonia

Follicular bronchitis/bronchiolitis

Main article: Follicular bronchitis/bronchiolitis

Pulmonary nodular lymphoid hyperplasia

Main article: Pulmonary nodular lymphoid hyperplasia

Lymphoma of the lung

Main article: Lymphoma of the lung

Smoking associated disease

Main article: Smoking

All of the above are associated with smoking. RBILD & DIP are considered by many to be on a continuum, i.e. RBILD is early DIP.

Respiratory bronchiolitis

  • Diagnosis is based on clinical criteria.

Microscopic

Features:

  • Inflammation.
  • No interstitial lung disease, i.e. no fibrosis.

Respiratory bronchiolitis interstitial lung disease

Main article: Respiratory bronchiolitis interstitial lung disease

Desquamative interstitial pneumonia

Main article: Desquamative interstitial pneumonia

Pulmonary Langerhans cell histiocytosis

  • AKA eosinophilic granuloma of the lung.
Main article: Pulmonary Langerhans cell histiocytosis

Granulomatous lung disease

See: Granulomas for an introduction to the general topic.

Most common:

  • Infectious - mycobacterial and fungal.[11]

Noninfectious causes:[11]

Sarcoidosis

Main article: Sarcoidosis

General

  • Diagnosis of exclusion - infection must be excluded.
  • Radiologic differential diagnosis includes carcinomatosis.[12]

Microscopic

Features:

  • Granulomata, well-formed, non-necrotizing.
    • Negative for microorganisms with special stains (PAS-D, GMS, AFB).
    • Granulomata - interstitial location.

Image(s):

Pulmonary talcosis

General

Microscopic

Features:

  • Granulomas with foreign material.
    • Foreign material often polarizes.

Images

  • Pulmonary talcosis - low mag. cropped (WC)

  • Pulmonary talcosis - low mag. (WC)

www:

Miscellaneous diseases

Pneumoconioses

Main article: Pneumoconioses

Pneumocytoma

  • AKA benign sclerosing pneumocytoma.[15]
  • Previously known as sclerosing hemangioma.
Main article: Pneumocytoma

Lymphangioleiomyomatosis

  • Abbreviated LAM.
  • AKA lymphangiomyomatosis.
Main article: Lymphangioleiomyomatosis

Pulmonary alveolar proteinosis

  • Abbreviated PAP.
Main article: Pulmonary alveolar proteinosis

Diffuse panbronchiolitis

  • Abbreviated DPB.
Main article: Diffuse panbronchiolitis

Pulmonary amyloidosis

Main article: Amyloidosis

General

Microscopic

Features:

  • Interstitial cotton candy-like material - see amyloidosis.

DDx:

Images:

Drug reactions

  • Effects are often non-specific.

Website: http://www.pneumotox.com

Pulmonary hypertension

Main article: Pulmonary hypertension

General classification:

  • Primary, i.e. primary pulmonary hypertension, or
  • Secondary, e.g. due to congenital heart disease (like ventricular septal defect), interstitial pulmonary fibrosis.

Non-secondary pulmonary hypertension

Main article: Pulmonary hypertension

Causes:[17]

Severity

Eosinophilic pneumonia

Specific entities:[18]

Entities which may have eosinophilia as prominent feature:

Churg-Strauss syndrome

Main article: Churg-Strauss syndrome

Microscopic

Features:

Eosinophilic pleural effusions

  • Definition: 10%+ eosinophils.[19]
  • Uncommon 5-16% of effusions.[20]

Causes - mnemonic I'M PAID:[20]

  • Infection, e.g. tuberculosis.
  • Malignancy - uncommon.
  • Pulmonary emboli.
  • Asbestos exposure.
  • Inflammatory diseases.
  • Drug reactions.

Lung transplant pathology

Main article: Lung transplant pathology

This subspecialty is dealt with in its own article.

See also

References

  1. ↑ 1.0 1.1 1.2 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 370. ISBN 978-1416054542.
  2. ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 102. ISBN 978-1416002741.
  3. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid16493150
  4. ↑ Sato, M.; Keshavjee, S. (2008). "Bronchiolitis obliterans syndrome: alloimmune-dependent and -independent injury with aberrant tissue remodeling.". Semin Thorac Cardiovasc Surg 20 (2): 173-82. doi:10.1053/j.semtcvs.2008.05.002. PMID 18707652.
  5. ↑ http://www.rsna.org/Publications/rsnanews/may06/jrnl_may06.cfm
  6. ↑ http://dictionary.reference.com/browse/reticular
  7. ↑ 7.0 7.1 Yeung, J.C.; Leonard, Blair J. N. (2005). The Toronto Notes 2005 - Review for the MCCQE and Comprehensive Medical Reference (2005 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. R13. ISBN 978-0968592854.
  8. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 90. ISBN 978-0781765275.
  9. ↑ Bjoraker JA, Ryu JH, Edwin MK, et al. (January 1998). "Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis". Am. J. Respir. Crit. Care Med. 157 (1): 199-203. PMID 9445300. http://ajrccm.atsjournals.org/cgi/content/full/157/1/199.
  10. ↑ AC UBC S.425.
  11. ↑ 11.0 11.1 Mukhopadhyay S, Gal AA (May 2010). "Granulomatous lung disease: an approach to the differential diagnosis". Arch. Pathol. Lab. Med. 134 (5): 667–90. PMID 20441499.
  12. ↑ URL: http://www.radiologyassistant.nl/en/46b480a6e4bdc. Accessed on: 23 May 2010.
  13. ↑ Davis, LL. (Dec 1983). "Pulmonary "mainline" granulomatosis: talcosis secondary to intravenous heroin abuse with characteristic x-ray findings of asbestosis.". J Natl Med Assoc 75 (12): 1225–8. PMC 2561715. PMID 6655726. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2561715/.
  14. ↑ Marchiori, E.; Lourenço, S.; Gasparetto, TD.; Zanetti, G.; Mano, CM.; Nobre, LF. (Apr 2010). "Pulmonary talcosis: imaging findings.". Lung 188 (2): 165-71. doi:10.1007/s00408-010-9230-y. PMID 20155272.
  15. ↑ Chan, KW.; Gibbs, AR.; Lo, WS.; Newman, GR. (Jun 1982). "Benign sclerosing pneumocytoma of lung (sclerosing haemangioma).". Thorax 37 (6): 404-12. PMID 6291188.
  16. ↑ Hagmeyer, L.; Stieglitz, S.; Röcken, C.; Randerath, W. (Jun 2012). "[Amyloidosis in Pneumology.]". Pneumologie. doi:10.1055/s-0032-1309811. PMID 22692971.
  17. ↑ Bush A (December 2000). "Pulmonary hypertensive diseases". Paediatr Respir Rev 1 (4): 361-7. doi:10.1053/prrv.2000.0077. PMID 16263465.
  18. ↑ http://emedicine.medscape.com/article/301070-overview
  19. ↑ Matthai, SM.; Kini, U. (Feb 2003). "Diagnostic value of eosinophils in pleural effusion: a prospective study of 26 cases.". Diagn Cytopathol 28 (2): 96-9. doi:10.1002/dc.10227. PMID 12561030.
  20. ↑ 20.0 20.1 Kalomenidis, I.; Light, RW. (Jul 2004). "Pathogenesis of the eosinophilic pleural effusions.". Curr Opin Pulm Med 10 (4): 289-93. PMID 15220754.

External links

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