Coin lesion -- considered malignant until proved otherwise
Hamartoma - benign cartilaginous lesion
Cannon balls
metastatic lesions
Metastases- irregularly sized and shaped lesions -- compare to previous CXR
Squamous cell carcinoma - large, irregular nuclei with keratin
more common men than women, most arise in bronchi, obstruction is presenting feature
Adenocarcinoma -- tall, columnar cells mucin (+)
women, non-smokers <40 yoa, associated with scars, slow growing but metastasize early
Large cell carcinoma -- aggressive
Small cell carcinoma- basophilic cells with areas of necrosis, lymph-like cells (oat cells) derived from neuro-endocrine cells
Associated with paraneoplastic syndromes
Small cell carcinoma
Endobronchial carcinoma
This one is too high to be resected
A small endobronchial carcinoid (right). Histologically, there are well-defined nests of homogeneous cells with uniform nuclei (left).
Mesothelioma -- related to which type of asbestos?
Amphibole (straight)
Pleural effusion
must tap to determine if transudate or exudate
Squamous carcinoma -- hyperkeratosis, associated with alcohol and smoking
Presentation:
persistent hoarseness
Mesothelioma -- uniform cells invading pleura
Pneumocystis carinii
hypoxemia, no infiltrate
common in immunosuppressed pts
Pneumocystis carinii biopsy -- fluffy alveolar infiltrates
Lobar pneumonia -- classically what bt?
Strep pneumo
Lobar pneumonia
Stage 3 Gray hepatization -- PMNs ingesting and destroying RBCs
Acute bacterial pneumonia -- early red hepatization with neutrophils
Bacterial pneumonia -- PMNs in alveoli
Bronchopneumonia -- common organisms?
Strep pneumo, H flu, Legionella, Pseudomonas
Legionaire’s disease
Bronchopneumonia -- some normal alveoli, congestion near bronchi
Interstitial pneumonia -- lungs look fluffy
Interstitual pneumonia -- somealveoli filled, few inflammatory cells
Interstitial pneumonia -- thickened septa
Fluorescent stain for Tb
Acid fast stain for Tuberculosis
Caseating granuloma -- immune competent pt
Ghon’s complex -- primary focus plus regional lymph node
Tuberculosis -- reactivation in upper lobes
Miliary Tb -- disseminated