A 67-year-old man develops severe respiratory distress and collapses. The emergency medical team finds the patient unresponsive with no pulse and he is unable to be revived despite cardiopulmonary resuscitation. A photograph of the lung as seen at autopsy is shown below. Which of the following underlying histopathological changes are most likely to be seen within this patient's lungs?

Question

A 67-year-old man develops severe respiratory distress and collapses.  The emergency medical team finds the patient unresponsive with no pulse and he is unable to be revived despite cardiopulmonary resuscitation.  A photograph of the lung as seen at autopsy is shown below.  Which of the following underlying histopathological changes are most likely to be seen within this patient's lungs?

Quizplus · Accepted Answer

11ec160b_3a0a_f2b9_9249_9398741c3846_MD0001_00 The gross pathology of this patient's lung shows multiple large subpleural blebs consistent with severe emphysema. Emphysema most commonly develops due to chronic exposure to cigarette smoke via the following mechanisms: The ongoing tissue damage leads to loss of alveolar elasticity and consequent alveolar distension. In severe cases, large air spaces called subpleural blebs can form, mostly in the lung apex. These subpleural blebs can sometimes rupture leading to a spontaneous pneumothorax. (Choice A) Ferruginous bodies embedded within interstitial fibrous tissue is characteristic of pulmonary asbestosis. The ferruginous bodies represent foreign particles enclosed in iron-rich material and they typically appear as brown "barbell" shaped structures on histopathology. (Choice B) Hemosiderin-laden macrophages with congested airways are consistent with cardiogenic pulmonary edema. (Choice D) Multinucleated giant cells surrounding caseating granulomas characterize tuberculosis. (Choice E) Necrotizing arteritis with adjacent palisading epithelioid histiocytes is consistent with granulomatosis with polyangiitis. (Choice F) Patchy interstitial fibrosis with the presence of fibroblastic foci is consistent with idiopathic pulmonary fibrosis. Educational objective: Emphysema (ie, alveolar destruction and enlargement) develops from a combination of inflammation and leukocyte infiltration, increased protease activity, and oxidative stress, usually in response to cigarette smoke exposure. In severe disease, large air spaces known as subpleural blebs can form in the lung apices. __________ References: Pathogenesis of emphysema. (http://www.ncbi.nlm.nih.gov/pubmed/18453358)

A 67-Year-Old Man Develops Severe Respiratory Distress and Collapses