flashpath - lung - pulmonary interstitial emphysema
TRANSCRIPT
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FLASHPATHH A Z E M A L I
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PULMONARY INTERSTITIA
L EMPHYSEMA
H A Z E M A L I
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CLINICAL• Rare condition commonly occur in preterm infants who
receives high pressure mechanical ventilation as a treatment for respiratory distress
• Characterized by air leakage into interstitial tissues– Due to alveolar rupture from barotrauma
• Causing persistant respiratory distress manifestations
• Air leakage can also occurs in– Pleura “pneumothorax”– Mediastinum “pneumomediastinum”– Peritoneum “pneumoperitoneum”
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CLINICAL• Other mechanical ventilation – related problems:
– Bronchopulmonary dysplasia– Retinopathy of prematurity
• Incidence of all these diseases decreased with the use of synthetic surfactant and modern ventilation techniques
• Interstitial pulmonary emphysema have two clinical types:– Acute– Chronic “persistent”
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GROSS• Pleura:
– Lines of bubbles are seen through the pleura• (outlining the lung lobules)
– Pleural blebs may be seen– Pneumothorax
• air bubbles when open the pleura under water
• Lung:– Multiple small cysts within parenchyma– If pneumothorax occurred
• lung collapse and mediastinal shift
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MICROSCOPY• Pattern:
– Multiple cystic spaces– Have NO lining– Expand (widen) surrounding connective tissue
• Distribution:– Sub-pleural– Interlobular septa– Peri-bronchovascular
• Adjacent parenchyma may show:– Hyaline membrane disease– Bronchopulmonary dysplasia
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MICROSCOPYAcute Chronic
“persistent” Giant cell reaction Absent PresentFibrosis Absent Present
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DIFFERENTIAL DIAGNOSIS“ O t h e r c o n g e n i t a l / c y s t i c l u n g d i s e a s e s ”• Congenital:
– Pulmonary sequestration– Congenital pulmonary cysts– Congenital pulmonary airway malformation– Congenital lobar emphysema
• Acquired:– Emphysema– Healed abscess– Honeycombing
• Mixed:– Cystic fibrosis
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DIFFERENTIAL DIAGNOSISPulmonary lymphangiectasis• Expansion of sub-pleural, Interlobular septa, and peri-bronchovascular
connective tissues by multiple cystic spaces that– Contain lymph– Have endothelial lining “ D2-40 positive “
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