Difference between revisions of "IPLab:Lab 3:Lobar Pneumonia"

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(Autopsy Findings)
 
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On admission, the pertinent findings included a temperature of 104°, a white cell count of 22,700 cells/mm³, nuchal rigidity, elevated spinal fluid pressure, and the presence of Gram-positive diplococci on a smear of spinal fluid (cultures of blood and spinal fluid were subsequently reported positive for Streptococcus pneumoniae). The patient expired 12 hours after admission in spite of intensive antibiotic therapy.
 
On admission, the pertinent findings included a temperature of 104°, a white cell count of 22,700 cells/mm³, nuchal rigidity, elevated spinal fluid pressure, and the presence of Gram-positive diplococci on a smear of spinal fluid (cultures of blood and spinal fluid were subsequently reported positive for Streptococcus pneumoniae). The patient expired 12 hours after admission in spite of intensive antibiotic therapy.
  
== Autopsy Findings ==
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At autopsy the right lung weighed 800 grams. The most striking finding was a marked uniform consolidation of the entire middle lobe which was reddish-gray in color. There was also marked thickening of the pleura overlying the middle lobe.
The right lung weighed 800 grams. The most striking finding was a marked uniform consolidation of the entire middle lobe which was reddish-gray in color. There was also marked thickening of the pleura overlying the middle lobe.  
 
  
 
== Images ==
 
== Images ==
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File:IPLab3LobarPneumonia8.jpg|This is a photomicrograph of alveoli filled with exudate. The alveolar wall outlines (arrows) are barely visible in this section. The alveoli are filled with PMNs, fibrin, and edema fluid. This is a severe acute inflammatory response but the structure of the alveoli remains intact. This tissue is able, with proper treatment, to completely resolve this inflammatory response. Since there has not been necrosis of the lung tissue itself (loss of tissue), this lung could completely recover normal function (resolution).
 
File:IPLab3LobarPneumonia8.jpg|This is a photomicrograph of alveoli filled with exudate. The alveolar wall outlines (arrows) are barely visible in this section. The alveoli are filled with PMNs, fibrin, and edema fluid. This is a severe acute inflammatory response but the structure of the alveoli remains intact. This tissue is able, with proper treatment, to completely resolve this inflammatory response. Since there has not been necrosis of the lung tissue itself (loss of tissue), this lung could completely recover normal function (resolution).
 
</gallery>
 
</gallery>
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== Virtual Microscopy ==
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=== Lung: Lobar Pneumonia ===
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<peir-vm>IPLab3LobarPneumonia</peir-vm>
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=== Normal Lung ===
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<peir-vm>UAB-Histology-00107</peir-vm>
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== Study Questions ==
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* <spoiler text="What is the likely etiology of pneumonia in this case?">Aspiration of gastric contents. Lobar pneumonia is usually caused by ''Streptococcus pneumoniae''.</spoiler>
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* <spoiler text="What makes up the alveolar exudate and what eventually happens to that exudate?">The exudate is mainly composed of PMNs and fibrin. The exudate undergoes progressive enzymatic digestion to produce a granular, semi-fluid material that is reabsorbed, phagocytosed by macrophages, and/or coughed up.</spoiler>
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* <spoiler text="How well does the lung heal after lobar pneumonia?">Often there is complete resolution with no scarring.</spoiler>
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== Additional Resources ==
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=== Reference ===
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* [http://emedicine.medscape.com/article/807499-overview eMedicine Medical Library: Empyema and Abscess Pneumonia]
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* [http://emedicine.medscape.com/article/296198-overview eMedicine Medical Library: Aspiration Pneumonia]
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* [http://emedicine.medscape.com/article/300157-overview eMedicine Medical Library: Bacterial Pneumonia]
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* [http://www.merckmanuals.com/professional/pulmonary_disorders/pneumonia/overview_of_pneumonia.html Merck Manual: Overview of Pneumonia]
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=== Journal Articles ===
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* Domínguez J, Galí N, Matas L, Pedroso P, Blanco S, Giménez M, Prat C, Sopena N, Sabrià M, Ausina V.  [http://www.ncbi.nlm.nih.gov/pubmed/11318817 PCR detection of Streptococcus pneumoniae DNA in serum samples for pneumococcal pneumonia diagnosis].  ''Clin Microbiol Infect'' 2001 Mar;7(3):164-6.
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=== Images ===
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* [{{SERVER}}/library/index.php?/tags/573-lobar_pneumonia PEIR Digital Library: Lobar Pneumonia Images]
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* [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html#1 WebPath: Pneumonias]
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== Related IPLab Cases ==
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* [[IPLab:Lab 3:Bronchopneumonia|Lab 3: Lung: Bronchopneumonia]]
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* [[IPLab:Lab 4:Septic Emboli|Lab 4: Lung and Heart: Septic Emboli]]
  
 
{{IPLab 3}}
 
{{IPLab 3}}
 
  
 
[[Category: IPLab:Lab 3]]
 
[[Category: IPLab:Lab 3]]

Latest revision as of 23:01, 19 June 2020

Clinical Summary[edit]

This 41-year-old black male was brought to the hospital in a comatose state. The patient, who had a history of heavy alcohol intake, was found comatose on the morning of the day of admission. No further history is available.

On admission, the pertinent findings included a temperature of 104°, a white cell count of 22,700 cells/mm³, nuchal rigidity, elevated spinal fluid pressure, and the presence of Gram-positive diplococci on a smear of spinal fluid (cultures of blood and spinal fluid were subsequently reported positive for Streptococcus pneumoniae). The patient expired 12 hours after admission in spite of intensive antibiotic therapy.

At autopsy the right lung weighed 800 grams. The most striking finding was a marked uniform consolidation of the entire middle lobe which was reddish-gray in color. There was also marked thickening of the pleura overlying the middle lobe.

Images[edit]

Virtual Microscopy[edit]

Lung: Lobar Pneumonia[edit]

Normal Lung[edit]

Study Questions[edit]


Additional Resources[edit]

Reference[edit]

Journal Articles[edit]

Images[edit]

Related IPLab Cases[edit]

A normal white blood cell count is 4,000 to 11,000 cells per cubic mm.

Nuchal rigidity is stiffness of the neck, a common sign of meningeal irritation.

CNS infections can lead to increased intracranial pressure, which, if severe, can cause death.

The normal weight of the right lung in an adult is 450 grams (range: 360 to 570 grams).

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

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