enfermedad pulmonar obstructiva crónica
TRANSCRIPT
Enfermedad pulmonar
obstructiva crónica
Dr. Reynaldo Falcón Escobedo
Profesor Titular
Anatomía Patológica
Facultad de Medicina
UASLP
Enfermedad obstructiva vs. restrictiva
Enfermedad obstructiva (enf. de las vías respiratorias)
Aumento de la resistencia al flujo del aire
Obstrucción parcial o completa de la vía respiratoria
Desde tráquea hasta bronquíolos respiratorios y terminales
Enfermedad restrictiva
Expansión reducida del parénquima pulmonar
Disminución de la capacidad pulmonar total
Trastornos de la pared torácica
Enfermedades intersticiales e infiltrativas agudas o crónicas.
Enfisema
Dilatación permanente de los espacios aéreos distales al bronquíolo terminal
Destrucción de septos ineralveolares
Tipos de enfisema
Centroacinar Afección de partes centrales o proximales del lobulillo formadas por los
bronquíolos respiratorios
Alvéolos distales conservados
Panacinar Acinos uniformemente agrandados, desde el bronquiolo respiratorio
hasta el alvéolo. No afecta a todo el pulmón. Asociado a deficiencia de a1-antitripsina.
Frecuentemente en zonas inferiores del pulmón
Paraseptal Porción proximal normal, afección de la porción distal.
Suele ser periférico, subpleural.
A lo largo de los septos conectivos lobulillares y en los márgenes de los lobulillos.
Aparece junto a zonas de fibrosis, cicatrización o atelectasia
Mitad superior. Diámetro de 0.5 a >2 cm. Prob. asoc. A neumotórax espontáneo
Irregular Probablemente la forma más común de enfisema.
Se asocia casi invariablemente a cicatrrización
Bronquitis crónica
Tos persistente productiva
3 meses al año
2 años consecutivos
Sin ninguna otra causa aparente
Asma
Trastorno inflamatorio crónico de vías aéreas
Con episodios de recurrentes de sibilancias, disnea, tensión torácica y tos (por la noche y primeras h. del día)
Asociados a broncoconstricción difusa variable
Limitación al flujo del aire
Reversible total o parcialmente espontáneamente o con tratamiento.
Figure 15-12 Bronchiectasis in a patient with cystic fibrosis, who underwent lung transplantation. Cut surface of lung shows markedly distended peripheral bronchi filled
with mucopurulent secretions.
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Figure 15-13 Schematic representation of current understanding of the pathogenesis of idiopathic pulmonary fibrosis.
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Figure 15-15 Usual interstitial pneumonia. Fibroblastic focus with fibers running parallel to surface and bluish myxoid extracellular matrix. Honeycombing is present on the
left.
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Figure 15-14 Usual interstitial pneumonia. The fibrosis is more pronounced in the subpleural region. (Courtesy of Dr. Nicole Cipriani, Department of Pathology, University
of Chicago, Chicago, IL.)
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Figure 15-16 Cryptogenic organizing pneumonia. Some alveolar spaces are filled with balls of fibroblasts (Masson bodies), while the alveolar walls are relatively normal.
A, Low power; B, high power.
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Figure 15-17 Progressive massive fibrosis superimposed on coal workers' pneumoconiosis. The large, blackened scars are located principally in the upper lobe. Note the
extensions of scars into surrounding parenchyma and retraction of adjacent pleura. (Courtesy of Drs. Werner Laquer and Jerome Kleinerman, the National Institute of
Occupational Safety and Health, Morgantown, WV.)
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HISTOLOGIC PATTERNS CLINICAL-RADIOLOGIC-
PATHOLOGIC DIAGNOSES
Usual Interstitial Pneumonia Idiopathic Pulmonary Fibrosis/
Cryptogenic Fibrosing Alveolitis
Nonspecific Interstitial Pneumonia Nonspecific Interstitial Pneumonia
(Provisional)‡
Organizing Pneumonia Cryptogenic Organizing Pneumonia †
Diffuse Alveolar Damage Acute Interstitial Pneumonia
Respiratory Bronchiolitis Respiratory Bronchiolitis Interstitial
Lung Disease
Desquamative Interstitial
Pneumonia
Desquamative Interstitial Pneumonia
Lymphocytic Interstitial Pneumonia Lymphocytic Interstitial Pneumonia
HISTOLOGIC PATTERNS CLINICAL-RADIOLOGIC-PATHOLOGIC
DIAGNOSES
Usual Interstitial Pneumonia Idiopathic Pulmonary Fibrosis/
Cryptogenic Fibrosing Alveolitis
Nonspecific Interstitial Pneumonia Nonspecific Interstitial Pneumonia
(Provisional)‡
Organizing Pneumonia Cryptogenic Organizing Pneumonia †
Diffuse Alveolar Damage Acute Interstitial Pneumonia
Respiratory Bronchiolitis Respiratory Bronchiolitis Interstitial
Lung Disease
Desquamative Interstitial
Pneumonia
Desquamative Interstitial Pneumonia
Lymphocytic Interstitial Pneumonia Lymphocytic Interstitial Pneumonia
* Unclassifiable interstitial pneumonia = Some cases are unclassifiable for a variety of reasons (see text)
† COP is the preferred term, but it is synonymous with Idiopathic Bronchiolitis Obliterans Organizing Pneumonia
‡ This group represents a heterogeneous group with poorly characterized clinical and radiologic features that needs further study.
†† Modified From the ATS/ERS Classification of Idiopathic Interstitial Pneumonias1