PNEUMONIA &

SUPPURATIVE LUNG
DISEASES

Dr. Thin Thin Win @ Safiya

Department of Pathology, PPSP
 PNEUMONIA
Definition

¾ Infection of the lung parenchyma

(consolidation or hardening of lung
parenchyma)
Etiology

„ Result whenever pulmonary defense

mechanism are impaired or resistance
of host is lowered
„ Pulmonary defense mechanism –
1. cough reflex
2. mucociliary apparatus
3. phagocytic alveolar macrophages
Etiology

„ Caused by varieties of infectious agent

such as bacteria, viruses, fungi,
mycoplasma etc:…
„ Mostly bacterial pneumonia -
Pneumococci, Klebsiella pneumoniae,
Staphylococci, Streptococci, H.influenzae,
Pseudomonas aeruginosa
Clearing mechanism can be interfered
with many factors:

1. Loss or suppression of cough reflex -

aspiration of gastric contents in
coma, anesthesia, neuromuscular
disorders, drugs, chest pain –
aspiration pneumonia
2. Injury to mucociliary apparatus –
cigarette smoking, inhalation of hot
or corrosive gases, viral d/s, genetic
disorders
Clearing mechanism can be interfered
with many factors:

3. Interfered phagocytic/ bactericidal

action of alveolar macrophages –
alcohol, smoking, anoxia, O2
intoxication
4. Pulmonary congestion & edema
5. Accumulation of secretions – cystic
fibrosis & bronchial obstruction
Bacterial Pneumonia
(community acquired acute pneumonia)
2 gross patterns

„ Lobar pneumonia
„ Lobular bronchopneumonia
Lobar pneumonia

„ Consolidation of a large portion of a

lobe or an entire lobe
„ (whereas patchy consolidation in
bronchopneumonia)
Lobar pneumonia Bronchopneumonia
A closer view of the lobar
pneumonia demonstrates
the distinct difference
between the upper lobe
and the consolidated lower
lobe.
Uniformly consolidated
lower lobe in lobar
pneumonia ( gray
hepatization) – lower lobe
become airless, liver like
texture, gray white
4 stages of inflammatory response

„ Congestion
„ Red hepatization
„ Gray hepatization
„ Resolution
Stage of congestion

„ Lung – heavy, boggy, red

„ Vascular engorgement
„ Intra-alveolar fluid with few neutrophils
& often numerous bacteria
Stage of red hepatization

„ Massive confluent exudation with red

cells, neutrophils and fibrin filling the
alveolar spaces
„ Gross – lobe appear distinctly red, firm
& airless with liver-like consistency
Stage of red hepatization
Stages of gray hepatization

„ Progressive disintegration of red cells

„ Persistence of fibrinosuppurative
exudates
„ Gross – grayish brown, dry surface
Stages of gray hepatization
Stage of resolution

„ Consolidated exudates within alveolar

spaces undergoes progressive
enzymatic digestion to produce a
granular, semi fluid debris
„ Resorbed & ingested by macrophages,
coughed up or organized by fibroblasts
growing into it
Stage of resolution
Bronchopneumonia

„ Patchy consolidation of lung

„ May be one lobe or multilobar
„ Frequently bilateral & basal
Gross
„ 3 to 4 cm in diameter
„ Slightly elevated, dry, granular, gray-red
to yellow
„ Poorly delimited at margin

Histology
„ Suppurative, neutrophil-rich exudates that
fills bronchi, bronchioles and adjacent
alveolar spaces
At higher magnification,
the pattern of patchy
distribution of a
bronchopneumonia is
seen.
Bronchopneumonia
Viral and Mycoplasmal Pneumonia
(Community acquired atypical pneumonia)
Morphology

„ Patchy or whole lobe

„ Bilateral or unilateral
„ Red-blue, congested & subcrepitant
„ Pleuritis or pleural effusion is infrequent
Viral and Mycoplasmal Pneumonia
(Community acquired atypical pneumonia)
Histology
„ Inflammatory reaction in interstitial
tissue, virtually within the walls of alveoli
„ Alveolar septa – widened, edematous
„ Mononuclear infiltrates of L, H, P & N in
acute cases
„ Alveoli – free of exudates
„ Pink hyaline membrane in alveolar walls
Complication of pneumonia

1. Abscess formation
- due to tissue destruction & necrosis

2. Empyema
- spread of infection to pleura cavity
causing intra-pleural fibrinosuppurative
reaction
Complication of pneumonia

3. Organization of exudates
- convert portion of lung into solid tissue
with fibrous scar

4. Bacterial dissemination to heart valves,

pericardium, brain, kidneys, spleen,
joints resulting metastatic abscesses,
endocarditis, meningitis, suppurative
arthritis
Clinical features

„ Abrupt onset of high fever with chills

„ Productive cough
„ Mucopurulent sputum
„ Pleuritic pain & friction rub
„ Radiologic appearance
- well circumscribed radio-opacity in LP
- focal opacities in BP
 SUPPURATIVE LUNG
DISEASES

„ Bronchiectasis
„ Lung abscess
„ Empyema
 BRONCHIECTASIS

Definition
„ Disease characterized by permanent
dilatation of bronchi & bronchioles
caused by destruction of the muscle &
elastic tissue, resulting from or
associated with chronic necrotizing
infection
Etiology

„ Obstruction & infection – major cause

- obstruction (mucus, tumor, FB) →
impaired normal clearing mechanism →
pooling of secretion distal to obstruction
→ inflammation of airways
„ Severe infection → necrotizing fibrosis
and eventually dilatation of airways
Etiology

„ Congenital or hereditary
- cystic fibrosis
- intralobular sequestration of the lung
- immunodeficiency state
- primary ciliary dyskinesia
- Kartagener syndrome
Morphology

„ Lower lobes, bilaterally

„ Vertical air passages
„ Most severe in more distal bronchi &
bronchioles
Gross

„ Airways – dilated, up to 4 times

„ Long, tube-like enlargement of airways
→ cylindrical bronchiectasis
„ Fusiform or saccular distension →
saccular bronchiectasis
„ Dilated airways can be followed directly
out to pleural surfaces
„ On C.S → cysts filled with mucopurulent
secretions
Bronchiectasis

Bronchial tubes are

extremely dilated with
thicken, fibrotic wall.
Adjacent lung is almost
completely destroyed
Focal area of dilated bronchi with bronchiectasis.
Bronchiectasis
Histology

„ Full-blown, active case → intense acute

& chronic inflammatory exudation within
the walls of bronchi & bronchioles
„ Desquamation of lining epithelium
„ Extensive areas of necrotizing
ulceration
Clinical course

„ Corpulmonale
„ Lung abscess
„ Metastatic brain abscesses
„ Amyloidosis
 LUNG ABSCESS

Definition

„ A local suppurative process within the

lung, characterized by necrosis of lung
tissue
Etiology & Pathogenesis

„ Oropharyngeal surgical procedures,

sinobronchial infection, dental sepsis,
bronchitis

„ Aerobic & anaerobic streptococci ,

Staphylococcus aureus, GN organisms
Mechanisms

„ Aspiration of infective material in acute

alcoholism, coma, anesthesia, sinusitis,
gingivodental sepsis, debilitation →
cough reflexes depressed
„ Antecedent primary bacterial infection →
post-pneumonic abscess, fungal
infection, bronchiectasis
„ Septic embolism
„ Neoplasia
„ Miscellaneous
Morphology

„ Size -few mm to large cavities of 5-6 cm

„ Single or multiple
„ Abscess due to aspiration → more
common on right ( more vertical right
main bronchus ) and more single
„ Abscess from pneumonia or
bronchiectasis → usually multiple,
basal, diffusely scattered
Morphology

„ Cavity filled with suppurative debris

„ If communication with air passage →
partially drain → air-containing cavity
„ Continued infection → large, fetid,
green-black, multilocular cavities
(gangrene of the lung)
„ Suppurative destruction of lung
parenchyma within central area of
cavitation
Seen here are two lung
abscesses, one in the
upper lobe and one in
the lower lobe of this left
lung.
abscessing bronchopneumonia in which several abscesses with irregular,
rough-surfaced walls are seen within areas of tan consolidation.
• Old pulmonary abscess cavity.
• Multiloculated with delicate strands of fibrous tissue crossing the space.
• No evidence of acute inflammation in the wall
• Fairly normal surrounding lung.
Course

„ Most resolve with antimicrobial therapy

„ Extension of infection into pleural cavity
→ empyema
„ Hemorrhage
„ Septic emboli → brain abscess,
meningitis
„ Secondary amyloidosis
 EMPYEMA
„ Collection of pus in pleural cavity
„ Suppurative pleuritis
„ Presence of purulent pleural exudates
„ Characterized by loculated, yellow-
green, creamy pus composed of
neutrophils admixed with other
leukocytes
Etiology

„ Contiguous spread of organisms from

intrapulmonary infection
„ Lymphatic dissemination
„ Haematogenous dissemination
„ Direct extension of infection below
diaphragm (subdiaphragmatic or liver
abscess) especially on right side
Clinical course

„ May resolve by antibiotics

„ Obliterate pleural space or envelope

the lungs → embarrass pulmonary
expansion