Page 384 - Concise Pathology for Exam Preparation ( PDFDrive )

13 The Lung 369

• Metastatic brain abscess or meningitis from septic emboli
• Secondary amyloidosis
• Clubbing of the fingers and toes

Q. Write in detail on the aetiopathogenesis, morphological (or
autopsy) findings, sequelae and complications of pulmonary
tuberculosis.
Ans. See Chapter 7.

Q. Classify chronic interstitial lung diseases (ILD). Write briefly on
their clinicopathological features.
Ans. Chronic interstitial lung diseases are a heterogeneous group of disorders character-
ized by the diffuse and chronic involvement of pulmonary connective tissue, principally
the alveolar interstitium.

Classification
1. Fibrosing alveolitis
(a) Usual interstitial pneumonitis (UIP) or idiopathic pulmonary fibrosis
(b) Nonspecific interstitial pneumonia (NSIP)
(c) Cryptogenic organizing pneumonia (COP)
(d) Interstitial lung disease associated with
(i) Collagen vascular diseases
(ii) Pneumoconiosis
(iii) Drug reactions
(iv) Radiation injury
2. Granulomatous ILD
(a) Sarcoidosis
(b) Hypersensitivity pneumonitis
3. Eosinophilic ILD
4. Smoking-related ILD
(a) Desquamating interstitial pneumonia (DIP)
(b) Respiratory bronchiolitis-associated interstitial lung disease
5. Pulmonary alveolar proteinosis

Salient Features
• The aetiopathogenesis of many of the above conditions is unknown or not clearly
understood.
• Patients of ILD usually present with dyspnoea, tachypnoea, end-inspiratory crackles
and cyanosis without wheezing (clinical and pulmonary functional changes are those of
restrictive rather than obstructive nature).
• Classical physiologic features are decreased carbon monoxide diffusing capacity and
reduced lung volume and compliance.
• X-ray chest shows diffuse infiltration by small nodules, irregular lines or ground glass
shadows.
• Eventually, patient goes into secondary pulmonary hypertension and cor pulmonale.
• Scarring or gross destruction of lung leads to end stage or honeycomb lung.

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