Difference between revisions of "IPLab:Lab 1:Lung Abscess"

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== Clinical Summary ==
 
== Clinical Summary ==
This 67-year-old male with advanced colon cancer developed obstruction of the bowel and underwent palliative surgery to remove an 8-cm portion of colon containing the obstruction. During the surgery the patient had several episodes of hypotension. After surgery he did not regain consciousness and required ventilator support. Four days after surgery, the patient developed a fever and his white blood cell count was found to be 15,256 cells/cm². Thus, he was started on broad-spectrum antibiotics. A chest x-ray demonstrated infiltrates in both lungs, which worsened over the next several days. His overall condition continued to deteriorate and he died 12 days after surgery.
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This 67-year-old male with advanced colon cancer underwent palliative surgery to remove a bowel obstruction. During the surgery the patient had several episodes of hypotension and after surgery he required ventilator support. Four days later the patient developed a fever and his white blood cell count was 15,256 cells/mm3. A chest x-ray demonstrated infiltrates in both lungs, which worsened over the next several days. His overall condition continued to deteriorate and he died 12 days after surgery.
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At autopsy, the lungs were markedly consolidated and had several focal abscesses that were 2 to 4 cm in diameter. Liquefied material poured out from these abscesses when the lungs were sliced.
  
== Autopsy Findings ==
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== Images ==
At autopsy, metastatic colon cancer was found throughout the abdominal cavity and invading into the liver. The lungs were markedly consolidated and had several focal abscesses that were 2 to 4 cm in diameter. Liquefied material poured out from inside these abscesses when the lungs were sliced.
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<gallery heights="250px" widths="250px">
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File:IPLab1LungAbscess1.jpg|This is a gross photograph of the lungs from this case. Note the abscesses (arrows) especially in the lower lobes. The entire lung is consolidated.
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File:IPLab1LungAbscess2.jpg|This is a closer view of the lung from this case. In this section of upper lobe there are multiple areas of early abscess formation (arrows). Note the circumscribed whitish-tan lesions. These lesions are filled with white blood cells.
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File:IPLab1LungAbscess3.jpg|This low-power photomicrograph of lung from this case demonstrates one of the abscesses (arrows). Note that the material inside the abscess has been degraded and removed. Note the loose necrotic material inside the abscess. This material is made up of inflammatory cells (primarily dead white blood cells) and necrotic lung tissue.
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File:IPLab1LungAbscess5.jpg|This is a low-power photomicrograph of lung tissue containing a large abscess. The center of the abscess contains necrotic debris (1) and there is a rim of viable inflammatory cells (arrows) surrounding this abscess.
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File:IPLab1LungAbscess6.jpg|This high-power photomicrograph demonstrates a small abscess (arrow) with a necrotic center.
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File:IPLab1LungAbscess8.jpg|This high-power photomicrograph shows the center of this abscess which contains inflammatory cells (primarily neutrophils) (arrows). There is a bacterial colony in the center of this abscess (1).
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</gallery>
  
== Images ==
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== Virtual Microscopy ==
{| cellpadding="10"
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=== Lung Abscess ===
| [[Image:IPLab1LungAbscess1.jpg|frameless]]
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<peir-vm>IPLab1LungAbscess</peir-vm>
| This is a gross photograph of the lungs from this case. Note the abscesses (arrows) especially in the lower lobes. The entire lung is consolidated.
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|-
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=== Normal Lung ===
| [[Image:IPLab1LungAbscess2.jpg|frameless]]
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<peir-vm>UAB-Histology-00107</peir-vm>
| This is a closer view of the lung from this case. In this section of upper lobe there are multiple areas of early abscess formation (arrows). Note the circumscribed whitish-tan lesions. These lesions are filled with white blood cells.
 
|-
 
| [[Image:IPLab1LungAbscess3.jpg|frameless]]
 
| This low-power photomicrograph of lung from this case demonstrates one of the abscesses (arrows). Note that the material inside the abscess has been expelled.
 
|-
 
| [[Image:IPLab1LungAbscess4.jpg|frameless]]
 
| This higher-power photomicrograph of lung demonstrates the edge of the abscess. Note the loss of material from the center of the abscess (1) and loose necrotic material that has not been expelled (2). This material is made up of inflammatory cells (primarily dead white blood cells) and necrotic lung tissue.
 
|-
 
| [[Image:IPLab1LungAbscess5.jpg|frameless]]
 
| This is a low-power photomicrograph of lung tissue containing a large abscess. The center of the abscess contains necrotic debris (1) and there is a rim of viable inflammatory cells (arrows) surrounding this abscess.
 
|-
 
| [[Image:IPLab1LungAbscess6.jpg|frameless]]
 
| This high-power photomicrograph demonstrates a small abscess (arrow) with a necrotic center.
 
|-
 
| [[Image:IPLab1LungAbscess7.jpg|frameless]]
 
| This high-power photomicrograph shows the center of an abscess containing neutrophils and necrotic debris.
 
|-
 
| [[Image:IPLab1LungAbscess8.jpg|frameless]]
 
| A high-power photomicrograph of lung from this case demonstrates a small abscess full of inflammatory cells (primarily neutrophils) (arrows). There is a bacterial colony in the center of this abscess (1).
 
|}
 
  
 
== Study Questions ==
 
== Study Questions ==
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=== Images ===
 
=== Images ===
* [http://peir.path.uab.edu/library/index.php?/tags/61-abscess/27-lung PEIR Digital Library: Lung Abscess Images]
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* [{{SERVER}}/library/index.php?/tags/61-abscess/27-lung PEIR Digital Library: Lung Abscess Images]
 
* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html WebPath: Pulmonary Pathology Images]
 
* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html WebPath: Pulmonary Pathology Images]
  
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{{Template:IPLab 1}}
 
{{Template:IPLab 1}}
  
[[Category:IPLab]]
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[[Category:IPLab:Lab 1]]

Latest revision as of 18:23, 1 August 2019

Clinical Summary[edit]

This 67-year-old male with advanced colon cancer underwent palliative surgery to remove a bowel obstruction. During the surgery the patient had several episodes of hypotension and after surgery he required ventilator support. Four days later the patient developed a fever and his white blood cell count was 15,256 cells/mm3. A chest x-ray demonstrated infiltrates in both lungs, which worsened over the next several days. His overall condition continued to deteriorate and he died 12 days after surgery. At autopsy, the lungs were markedly consolidated and had several focal abscesses that were 2 to 4 cm in diameter. Liquefied material poured out from these abscesses when the lungs were sliced.

Images[edit]

Virtual Microscopy[edit]

Lung Abscess[edit]

Normal Lung[edit]

Study Questions[edit]


Additional Resources[edit]

Reference[edit]

Journal Articles[edit]

Images[edit]

Related IPLab Cases[edit]

Palliative surgery provides alleviation but is not curative.

An infiltrate is an accumulation of cells in the lung parenchyma--this is a sign of pneumonia.

Consolidation is the filling of lung air spaces with exudate--this is a sign of pneumonia.

An abscess is a collection of pus (white blood cells) within a cavity formed by disintegrated tissue.

An abscess is a collection of pus (white blood cells) within a cavity formed by disintegrated tissue.

In alcoholics, aspiration pneumonia is common--bacteria enter the lung via aspiration of gastric contents.