Pathology of lung, upper airways and pleura

Tuberculosis

• Mycobacterium tuberculosis
• Ziehl-Neelsen – acid-fast red rod
• inhalation  lungs
• T cells mediated immunity
• organism resistance
• tissue hypersensitivity – caseous necrosis
• caseating granulomas
• central caseous necrosis
• epithelioid cells + multinucleated giant cells (Langhans)
• T-lymphocytic rim

Primary TBC

• previously unexposed (unsensitized) person
• Ghon focus
• lung middle line + subpleural location
• 1-1.5 cm, gray-white lesion
• Ghon complex: + TBC hilar LNitis
• + lympho / hematogenous dissemination
• under immune control

Primary TBC - further course

• 1. healed lesions – fibrocalcific scar
• 2. latent lesions (dormant TBC organisms)
• 3. cervical LNitis („scrophula“)
• 3. progressive primary TBC
• miliary („millet“) TBC - 2 mm, yellow-white
• pulmonary
• lymphatics – thoracic duct – venous circulation – right heart – pulmonary a. – lungs
• pleural effusion, TBC empyema
• systemic
• pulmonary veins – left heart – systemic circulation
• liver, BM, spleen, adrenals, menings, kidneys, fall.t., epid.

Secondary TBC

• in previously sensitized person
• 1. exogenous reinfection
• 2. reactivation
• pulmonary TBC (from adenobronchial fistula)
• upper lobes apex
• cavitation – airways dissemination – progressive pulmonary TBC
• bronchus erosion - endo-bronchial,-tracheal, laryngeal TBC
• blood vessel erosion – hemoptysis
• pulmonary + systemic miliary TBC
• isolated-organ metastasis (from primary TBC metast.)
• TBC meningitis, epinephritis, osteomyelitis, salpingitis

Summary

• 1. Atelectasis
• 2. Obstructive lung diseases
• 3. Restrictive lung diseases
• 4. Vascular lung diseases
• 5. Pulmonary infections
• 6. Lung tumors
• 7. Pleural lesions
• 8. Lesions of upper RT