LOBAR PNEUMONIA

Deevon M. Cariaga
FEU-NRMF Institute of Medicine
Etiology

Causative organism of Lobar Pneumonia:

(1)Pneumococcus - type I, II, and III are responsible for 90% cases. Type III
pneumo- cocci are most virulent & mainly seen in patients over 50 years of
age.

(2) Occasionally, Friedlanders pneumobacillus.

Pneumococcus
 Pathogenesis

Edema producing
They pass in the substances of capsular
inflammatory fluid polysaccharide cause The process is known
Pneumococci reach Thus infection spreads The lung is converted
from one alveolus to marked inflammatory consolidation or
alveoli via bronchial throughout the entire into a solid & airless
another through the edema with acute hepatization (liver-
tree. lobe. organ.
alveolar pores of inflammatory like in consistency).
Cohn. exudates filling up
alveoli.
Morphology
Morphology: 1st Stage: Congestion:

Gross: Microscopic features:

(i) Lungs are dark-red color & pits (i) Alveolar capillaries are dilated.
on pressure (due to edema).

(ii) Alveoli contain edema fluid &

(ii) Cut surface: bloodstained pneumococci.
frothy fluid comes out.

(iii) Air is still present in the

alveoli.
Morphology: 2nd Stage Red hepatization

Gross: Microscopic feature:

(i) Affected part of the lung is i) Alveoli are airless & filled up
consolidated, reddish-brown and sinks with inflammatory exudates
in water. It is friable. consisting of RBCs, neutrophils &
fibrin strands.

(ii) Outer surface is covered with

fibrinious exudates. ii) Alveolar wall is thick (due to
edema) with congested blood
vessels (In low power -mosaic
(iii) Cut surface is rough, dry & appearance)
granular.
Morphology: 3rd Stage Grey hepatization
Gross:
(i) Consolidated part is gray colour &
more friable.
(ii) In outer surface pleural exudates
is thicker.
(iii) Cut surface is moist & brownish-
gray colour (bronchial lymphnodes
may be enlarged).
Microscopic features:
(i) Alveolar exudates have lost their
freshness (due to action of
proteolytic enzymes).
RBCs are ghosts, nuclei of
polymorphs are broken & indistinct
and fibrin threads contract to form a
clear zone adjacent to alveolar wall.
(ii) Alveolar wall is thin (due to lack
of edema) and congested blood
vessels disappear.
Morphology: 4th Stage Resolution:

Gross: Microscopic features:

Lung is soft & translucent (jelly (i) Macrophages invade exudates.

like).

(ii) Alveolar exudates is liquefied

by proteolytic enzyme & removed.

Thus the consolidated lung is

restored to normal.
Clinical Significance

80 year old male

High grade fever
Productive cough; yellowish phlegm x 1w
Tachypneic
(+)intercostal retractions
(+)crackles; upper to mid lung fields
Dec. breath sounds
Inc. tactile fremitus in the bases
Condition deteriorated
4th hospital day; Expired.