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Questions and Answers
What causes the brown color observed in chronic pulmonary congestion?
What causes the brown color observed in chronic pulmonary congestion?
What type of cellular response reflects chronic pulmonary congestion?
What type of cellular response reflects chronic pulmonary congestion?
What characterizes the shape and appearance of an infarcted area in the lung?
What characterizes the shape and appearance of an infarcted area in the lung?
Which histological feature is indicative of pulmonary infarction?
Which histological feature is indicative of pulmonary infarction?
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What is an essential mechanism in the pathogenesis of thromboembolism?
What is an essential mechanism in the pathogenesis of thromboembolism?
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Which component is primarily involved in the initial stages of granulation tissue formation in the hyperemic rim?
Which component is primarily involved in the initial stages of granulation tissue formation in the hyperemic rim?
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What microscopic change can indicate the presence of acute inflammation in infarcted lung tissue?
What microscopic change can indicate the presence of acute inflammation in infarcted lung tissue?
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Which staining method is commonly used in the histological examination of lung tissue?
Which staining method is commonly used in the histological examination of lung tissue?
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What is a characteristic macroscopic change observed in lungs affected by edema?
What is a characteristic macroscopic change observed in lungs affected by edema?
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Which of the following is NOT a type of edema described?
Which of the following is NOT a type of edema described?
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In chronic pulmonary congestion, which feature is commonly observed microscopically?
In chronic pulmonary congestion, which feature is commonly observed microscopically?
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What is a potential clinical feature of lymphatic edema caused by filaria parasites?
What is a potential clinical feature of lymphatic edema caused by filaria parasites?
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Which type of fluid is primarily found in alveolar edema?
Which type of fluid is primarily found in alveolar edema?
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What does the presence of anthracotic pigment indicate during a histological examination of lung tissue?
What does the presence of anthracotic pigment indicate during a histological examination of lung tissue?
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During a histological examination, what appearance will edema fluid likely have in alveolar spaces?
During a histological examination, what appearance will edema fluid likely have in alveolar spaces?
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What might help identify chronic pulmonary congestion during an autopsy?
What might help identify chronic pulmonary congestion during an autopsy?
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What is the primary cause of lung infarction as defined in the content?
What is the primary cause of lung infarction as defined in the content?
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Which of the following features is characteristic of chronic pulmonary congestion?
Which of the following features is characteristic of chronic pulmonary congestion?
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Which clinical feature is commonly associated with pulmonary congestion?
Which clinical feature is commonly associated with pulmonary congestion?
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What kind of infarction is described as characterized by a hyperemic narrow rim around an early infarct?
What kind of infarction is described as characterized by a hyperemic narrow rim around an early infarct?
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What can lead to congestion in lung tissues based on the content?
What can lead to congestion in lung tissues based on the content?
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Which etiology is associated with chronic pulmonary congestion?
Which etiology is associated with chronic pulmonary congestion?
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What is a potential complication of lung infarction?
What is a potential complication of lung infarction?
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Which histological feature is indicative of chronic pulmonary congestion?
Which histological feature is indicative of chronic pulmonary congestion?
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What is the main characteristic of a red (hemorrhagic) infarct?
What is the main characteristic of a red (hemorrhagic) infarct?
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In the pathogenesis of congestion, which factor does NOT contribute?
In the pathogenesis of congestion, which factor does NOT contribute?
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Study Notes
Pulmonary Thromboembolism
-
Macroscopic Infarcted Area:
- Triangular shaped infarct, with the tip pointing towards the hilum
- Occluded vessel is located at the tip of the infarct
- Well defined, dark red color
-
Macroscopic Chronic Pulmonary Congestion:
- Lungs are increased in weight
- They have a brown color due to the presence of siderophages
- They have a firm consistency (brown induration)
-
Microscopic Infarcted Area:
- Well defined, red color due to erythrocyte flooding.
- Preserved alveolar architecture with loss of nuclei, giving a "ghost-like appearance" or "Hiroshima effect" indicating necrosis.
-
Microscopic Chronic Pulmonary Congestion:
- Thick fibrotic interalveolar septa, due to:
- Hypoxia
- Reaction to deposited hemosiderin and cardiac cells/ heart failure cells/ siderophages
- Thick fibrotic interalveolar septa, due to:
-
Microscopic Hyperemic Narrow Rim:
- Hypercellular area separating the infarcted tissue from the surrounding parenchyma
- Composed of congested vessels, extravasated erythrocytes, and acute inflammatory infiltrate
- Granulation tissue starts forming in this area with macrophages, fibroblasts, fibrocytes, and leukocytes.
-
Microscopic Pulmonary Thromboembolism:
- Thromboembolus present within a large branch of the pulmonary artery.
Pulmonary Infarction + Chronic Pulmonary Congestion
-
Definition of Infarction:
- Tissue death or necrosis due to insufficient arterial/oxygenated blood supply caused by sudden vascular occlusion, more frequent in arteries.
-
Definition of Congestion:
- A passive process caused by decreased venous outflow of blood from tissue.
- Can be systemic, as in cardiac failure, or localized, as in isolated venous obstruction.
-
Pathogenesis of Congestion:
- Heart failure
- Restricted respiratory movement
- Compression of the cava vein
-
Etiology of Chronic Pulmonary Congestion:
- Chronic left ventricular failure
- Mitral stenosis/incompetence
Clinical Features of Pulmonary Congestion and Infarction
-
Pulmonary Congestion:
- Dyspnea
- Cough
- Clubbing fingers (chronic hypoxia)
- Auscultation reveals crackles (air bubbling and fluid)
-
Pulmonary Infarction:
- Pyramidal, wedge-shaped, or triangular shape (occluded vessel at the apex)
- Early infarct: bulging area delimited by a hyperemic narrow rim
- Old infarct: retracted scar tissue
Evolution and Complications of Pulmonary Congestion and Infarction
-
Pulmonary Congestion:
- Superinfection
- Pulmonary fibrosis
- Chronic cor pulmonale
-
Pulmonary Infarction:
- Organization/scarring
- Encapsulation
- Ulceration (cavity)
- Superinfection (abscess)
Classification
-
Pulmonary Congestion:
- Acute pulmonary congestion:
- Alveolar capillaries are engorged with blood
- Serum extravasation due to increased intracapillary hydrostatic pressure and increased capillary permeability
- Alveolar and septal edema
- Chronic pulmonary congestion:
- Pulmonary fibrosis and sclerosis (thickening of septa)
- Intraalveolar and septal hemosiderin-laden macrophages
- Brown induration of the lungs
- Acute pulmonary congestion:
-
Pulmonary Infarction:
- White/anemic infarct: in solid/compact tissues such as Myocardium (heart attack), Spleen, Kidney, Brain (liquefactive necrosis), Liver (hepatic artery), Limb (gangrene)
- Red (hemorrhagic) infarct: in spongy tissues with dual or collateral circulation, such as Lungs and Intestine
- Zahn infarction: a pseudo-infarction in the liver caused by portal vein obstruction; the area of congestion atrophies but no necrosis occurs.
Lymphatic Edema
-
Causes:
- Filaria parasites
- Surgical removal of the lymph nodes
- Congenital
- Milroy disease
- Elephantiasis: a severe consequence of Lymphatic edema, characterized by extreme swelling of the limbs, particularly the legs.
Morphology of Edema
- Macroscopic changes appear when the quantity of intercellular fluid increases with 10%:
- Tissues become swollen and pasty
- Finger-shaped depressions appear
- Gelatinous aspect on section
- Tissues can appear in different colors depending on the cause:
- Blue: venous and cardiogenic edema
- Pale: hypoalbuminemic edema
- Red: inflammatory edema
Macroscopic Description of Pulmonary Edema
-
Lungs:
- Distended
- Hyperemic
- Increased volume and weight
- Do not collapse on the autopsy table
- Pink-gray color, darker in dorsal and basal areas
- Pasty in consistency (wet sponge)
-
Pleura:
- Distended
- Thin
- Transparent
- Smooth and shiny
- Rib imprints on the pleural surface
-
Compression of the cut surface:
- Elimination of a pink-red foamy, frothy fluid containing edema fluid, a few erythrocytes, and air bubbles.
Microscopic Description of Pulmonary Edema
-
Lung parenchyma:
- Alveolar spaces filled with homogeneous or slightly granular eosinophilic material (edema fluid).
- Two types of edema:
- Septal edema: edema fluid inside alveolar septa
- Alveolar edema: edema fluid mixed with air bubbles and rare cellular elements like desquamated alveolocytes, alveolar macrophages, and leukocytes.
-
Congested Vessels:
- Excessive accumulation of blood
- Dilated capillaries
-
Anthracotic pigment:
- Black color pigment resulting from inhalation of carbon particles, ingested by alveolar/interstitial macrophages and accumulated in connective tissue and/or regional lymph nodes.
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Description
Test your knowledge on the macroscopic and microscopic characteristics of pulmonary thromboembolism. This quiz covers topics such as infarcted areas and the implications of chronic pulmonary congestion. Understand the pathological changes and their significance in this critical condition.
