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Reading of Chest Radiographs Some basic Anatomy and Physiology; including Pleural Fissures, Mediastinal Lines, The Bronchi and Para-Tracheal Lines, Hilar Anatomy, the Pulmonary Lobules, Acini and Lung Cortex, Distribution of Lung Disease in Relation to Anatomy and Physiology, Basic CT and Pathological Anatomy.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Inhaled noxious gases such as cigarette smoke trigger a neutrophil or macrophage reaction, with release of proteases and elastases which (like some bacterial products) destroy lung parenchyma. Protection is afforded by antitrypsin.
Functions of the Respiratory System
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
As the lung parenchyma consists of interconnected alveolar walls and interstitial tissues, the surrounding tissues oppose any local distortion of alveoli. Therefore, when a small area of alveoli begins to collapse, the surrounding tissue is stretched and tends to pull the alveoli back open. This phenomenon, called alveolar interdependence, along with surfactant and collateral ventilation via the pores of Kohn, prevents alveolar collapse. The airways and alveoli distal to a single terminal bronchiole make up a functional unit: the pulmonary lobule.
Fixation of Human Lungs
Published in Joan Gil, Models of Lung Disease, 2020
Marianne Bachofen, H. Bachofen
Gough and Wentworth (1949) fixed whole inflated lungs at autopsy, cut sections from the whole lung, and mounted them on paper. The resulting overviews of the normal and morbid anatomy of lung parenchyma impressively illustrate the extent and distribution pattern of diffuse lung diseases, and may even suggest pathogenetic mechanisms. In addition, whole-lung slices are invaluable tools for teaching. Low-power magnification of thick slices also allowed investigators to visualize the three-dimensional arrangement of peripheral air space structures in healthy and diseased lungs (Heard 1960, 1969).
COVID-related fibrosis: insights into potential drug targets
Published in Expert Opinion on Investigational Drugs, 2021
Giacomo Sgalla, Alessia Comes, Marialessia Lerede, Luca Richeldi
A different, more conservative approach is to start antifibrotic treatment in patients who, once discharged from the hospital, show residual interstitial changes on follow up CT scans. Indeed, antifibrotic therapies may be useful in this case to facilitate the healing process of the lung parenchyma and prevent the establishment of further fibrotic abnormalities. On the other hand, these agents did not demonstrate to reverse the fibrotic process, and benefits could be limited especially in those patients with mild fibrotic sequelae. Moreover, it should be noted that nor pirfenidone or nintedanib ever demonstrated to ameliorate respiratory symptoms in IPF patients; there is insufficient evidence on their effect on symptom relief in post-COVID 19 fibrosis. Case reports have described a general improvement in symptoms [63–66]; however dosage and duration of antifibrotic therapy differed significantly across cases, and no conclusions can be drawn.
Clinico-pathological features in fatal COVID-19 infection: a preliminary experience of a tertiary care center in North India using postmortem minimally invasive tissue sampling
Published in Expert Review of Respiratory Medicine, 2021
Animesh Ray, Deepali Jain, Ayush Goel, Shubham Agarwal, Shekhar Swaroop, Prasenjit Das, Sudheer Kumar Arava, Asit Ranjan Mridha, Aruna Nambirajan, Geetika Singh, S. Arulselvi, Purva Mathur, Sanchit Kumar, Shubham Sahni, Jagbir Nehra, Mouna Bm, Neha Rastogi, Sandeep Mahato, Chaavi Gupta, S Bharadhan, Gaurav Dhital, Pawan Goel, Praful Pandey, Santosh Kn, Shitij Chaudhary, Vishakh C Keri, Vishal Singh Chauhan, Niranjan Mahishi, Anand Shahi, Ragu R, Baidnath K Gupta, Richa Aggarwal, Kapil Dev Soni, Neeraj Nischal, Manish Soneja, Sanjeev Lalwani, Chitra Sarkar, Randeep Guleria, Naveet Wig, Anjan Trikha
Lung parenchyma was sampled in 32 patients. Acute lung injury and DAD were seen in most of the patients (25/32, 78%) with morphological evidence of only acute lung injury in four patients, exudative phase of DAD with hyaline membranes in 10 patients, and organizing phase of DAD with interstitial fibroblastic proliferation and/or intra-alveolar fibroblastic plugs in 11 patients. One biopsy categorized as organizing DAD also showed normal lung parenchyma in some focal areas. Associated bronchopneumonia was seen in 12 of these patients, the majority associated with the organizing phase of DAD (7/12), with occasional cases co-existing with acute exudative DAD (3/12) and acute lung injury (2/12). Bacterial colonies (Gram stain negative), indicating superimposed bacterial infection, were observed in one of the cases associated with organizing DAD. Other associated findings observed in these patients include incidental carcinoma (n = 2), alveolar hemorrhage (n = 2), and pulmonary edema (n = 1) (Figure 1).
Invasive modalities for the diagnosis of peripheral lung nodules
Published in Expert Review of Respiratory Medicine, 2021
Satish Kalanjeri, Anna Abbasi, Munish Luthra, Jeremy C. Johnson
CLE uses a fiber-optic probe and a 488-nm wavelength laser to provide in vivo microscopic examination of the bronchial mucosa and alveolar structures during bronchoscopy. The probe, which is in direct contact with tissue, generates an image which covers an area that is 600 mm in diameter around the probe [9]. Normal lung parenchyma is identified by the thin structure of the alveolar walls and the thicker, more solid-appearing structures of blood vessels. A solid lesion such as cancer shows disruption of normal alveolar structures and may show alveolar thickening, distortion, and friability within the alveolar tissue. Welikoff et, al compared histopathological images of malignant lesions with CLE images obtained from the same area by reviewing the two images side by side. They noted that CLE images correlated with some histopathological findings such as mottled elastin, septal studding and alveolar disruption [10]. Just like radial probe ultrasound, CLE may be used as a standalone tool or adjunct to other technologies while performing bronchoscopy for real-time confirmation of a nodule before tissue sampling.