RESPIRATORY DISEASE
Ed Friedlander, M.D., Pathologist
scalpel_blade@yahoo.com

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Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected. No texting or chat messages, please. Ordinary e-mails are welcome.

I am active in HealthTap, which provides free medical guidance from your cell phone. There is also a fee site at www.afraidtoask.com.


If you have a Second Life account, please visit my teammates and me at the Medical Examiner's office.

Freely have you received, give freely With one of four large boxes of "Pathguy" replies.

I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

Numbers in {curly braces} are from the magnificent Slice of Life videodisk. No medical student should be without access to this wonderful resource.

I am presently adding clickable links to images in these notes. Let me know about good online sources in addition to these:

Freely have you received, freely give. -- Matthew 10:8. My site receives an enormous amount of traffic, and I'm still handling dozens of requests for information weekly, all as a public service.

Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.

Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.

Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

If you're a private individual who's enjoyed this site, and want to say, "Thank you, Ed!", then what I'd like best is a contribution to the Episcopalian home for abandoned, neglected, and abused kids in Nevada:

I've spent time there and they are good. Write "Thanks Ed" on your check.

Help me help others

My home page
More of my notes
My medical students

Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

I cannot examine every claim that my correspondents share with me. Sometimes the independent thinkers prove to be correct, and paradigms shift as a result. You also know that extraordinary claims require extraordinary evidence. When a discovery proves to square with the observable world, scientists make reputations by confirming it, and corporations are soon making profits from it. When a decades-old claim by a "persecuted genius" finds no acceptance from mainstream science, it probably failed some basic experimental tests designed to eliminate self-deception. If you ask me about something like this, I will simply invite you to do some tests yourself, perhaps as a high-school science project. Who knows? Perhaps it'll be you who makes the next great discovery!

Our world is full of people who have found peace, fulfillment, and friendship by suspending their own reasoning and simply accepting a single authority that seems wise and good. I've learned that they leave the movements when, and only when, they discover they have been maliciously deceived. In the meantime, nothing that I can say or do will convince such people that I am a decent human being. I no longer answer my crank mail.

This site is my hobby, and I do not accept donations, though I appreciate those who have offered to help.

During the eighteen years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and KCUMB as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at KCUMB for making it possible, and my teaching assistants over the years.

Whatever you're looking for on the web, I hope you find it, here or elsewhere. Health and friendship!

PicoSearch
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More of Ed's Notes: Ed's Medical Terminology Page

Perspectives on Disease
Cell Injury and Death
Accumulations and Deposits
Inflammation
Fluids
Genes
What is Cancer?
Cancer: Causes and Effects
Immune Injury
Autoimmunity
Other Immune
HIV infections
The Anti-Immunization Activists
Infancy and Childhood
Aging
Infections
Nutrition
Environmental Lung Disease
Violence, Accidents, Poisoning
Heart
Vessels
Respiratory
Red Cells
White Cells
Coagulation
Oral Cavity
GI Tract
Liver
Pancreas (including Diabetes)
Kidney
Bladder
Men
Women
Breast
Pituitary
Thyroid
Adrenal and Thymus
Bones
Joints
Muscles
Skin
Nervous System
Eye
Ear
Autopsy
Lab Profiling
Blood Component Therapy
Serum Proteins
Renal Function Tests
Adrenal Testing
Arthritis Labs
Glucose Testing
Liver Testing
Porphyria
Urinalysis
Spinal Fluid
Lab Problem
Quackery
Alternative Medicine (current)
Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

Pulmonary Pathology
Sampurna Roy, MD
Lots of photos and good text

Lung and Pleura
Photo Library of Pathology
U. of Tokushima

Lung
Taiwanese pathology site
Good place to go to practice

Respiratory System
Surgical Pathology Atlas
Nice photos, hard-core

Herbert Spencer Image Library
Wonderful collection from
the great lung pathologist

Upper Respiratory Images
University of Washington
Pictures and comments

Lung pathology
Aliya Husain MD -- Thanks!
Loyola U.

Pulmonary
Utah cases for path students
Juliana Szakacs MD

Lung Pathology
Loyola
Nice pictures and comments

Respiratory
Iowa Virtual Microscopy
Have fun

Lung Pathology
Photomicrograph collection
In Portuguese

Pathology of respiratory infections
Great site
Yutaka Tsutsumi MD

Respiratory Diseases
First Section
Chaing Mi, Thailand

Respiratory Diseases
Second Section
Chaing Mi, Thailand

Pulmonary
Brown Digital Pathology
Some nice cases

Lung Exhibit
Virtual Pathology Museum
University of Connecticut
Includes some gunshot wounds

Lung Transplant Pictures
Great site
Transplant Pathology Internet Services

Pulmonary
Photos, explanations, and quiz
Indiana U.

Lung Pathology
Fantastic images
Martha Warnock -- UCSF

Ordinary anthracosis of the lung
Brazil Pathology Cases
In Portuguese

Pulmonary pathology photostream
Flickr
Personal photosite -- great work & thanks

KCUMB Students
"Big Robbins" -- Lung
Lectures follow Textbook

QUIZBANK: Respiratory

OVERVIEW OF RESPIRATORY DISEASE

Learn First!

CHEST WALL PROBLEMS

OBSTRUCTED UPPER AIRWAY

OBSTRUCTED LARGE BRONCHI

CONSTRICTED SMALL BRONCHI

FIBROTIC REPSIRATORY BRONCHIOLES... SILICOSIS; OBSTRUCTIVE BRONCHIOLITIS

COLLAPSED RESPIRATORY BRONCHIOLES... EMPHYSEMA/"CHRONIC BRONCHITIS"

FLUID-FILLED ALVEOLAR SPACES

FLUID-FILLED ALVEOLAR SEPTA

FIBROSIS AROUND ULCERATED BRONCHI...BRONCHIECTASIS

FIBROSIS OF ALVEOLAR SEPTA

COLLAPSED ALVEOLI

NECROTIC LUNG ("cavities", etc.)

PULMONARY ARTERIAL HYPERTENSION

HIGH PaCO2... all whole-lung ventilation problems

LOW PO2...

STUDY OBJECTIVES

Describe the essential gross and microscopic anatomy of the airways, from trachea to alveolar sacs. Distinguish the two principal types of pneumocytes (I and II). Describe the anatomic and functional barrier to gas exchange at the alveolar-capillary level.

Describe the factors that influence PaCO2 and PaO2. Describe how PaO2 correlates with the actual oxygen content of the blood. Give the conditions when cyanosis will appear.

List the principal causes of edema in the lung, and compare these to things that cause edema anywhere else in the body. Distinguish interstitial and alveolar edema. Explain why edema of the lung is bad for one's health.

Describe pulmonary congestion, and mention its pathologic sequelae.

Review the pathology and pathophysiology of pulmonary thromboemboli. Describe their frequency and clinical correlations.

List the common causes of increased resistance in the pulmonary arteries (the usual cause of "pulmonary hypertension"), and other causes of pulmonary hypertension. Explain why these things are so harmful. Explain hypoxic pulmonary vasoconstriction, why it is useful in health, and why it is such a problem in disease.

Define acute / adult respiratory distress syndrome and list a few of the many synonyms. Tell about the etiologies, gross and microscopic pathology, the pathophysiology, and the common clinical picture.

Explain the pathophysiology and clinical correlations of neonatal respiratory distress syndrome.

Define atelectasis. Tell how lung collapses due to obstruction, compression, airway obstruction, and lack of surfactant, and give clinical examples of each situation.

Define "sudden infant death syndrome". Briefly describe what we think causes genuine "SIDS", and give a "differential diagnosis".

Ed on Blood Gases * Review how to order "arterial blood gases", what you get, and what they tell you. (Be able to do this at 3 AM as the only doctor on the ward.) This might be a good time to look at the Blood Gases" handout.

Describe the abnormal anatomy and functional problems that every cigaret smoker should expect.

Explain the importance of elastic recoil in keeping respiratory bronchioles patent during exhalation. Explain how this relates to the classic definition of emphysema as "an abnormal, permanent dilatation of part of all of the acinus, with destruction of alveolar walls."

Distinguish the two "classic" types of emphysema, and mention their alleged causes. Tell what we think causes emphysema in cigaret smokers and alpha-1 antitrypsin deficient patients. Tell what a "pink puffer" looks like clinically, and how emphysematous lungs look at autopsy. Describe the complication of "bullous emphysema".

Define "chronic bronchitis" and mention its common causes. Describe the gross and microscopic pathology and the pathophysiology. Be able to define the "Reid Index". Tell what a "blue bloater" looks like clinically, and mention the common organisms that superinfect these patients' lungs.

Define bronchial asthma. Describe its important causes, and distinguish "allergic" and "idiosyncratic" kinds. Describe the common pathophysiology. Tell what you will see at the autopsy of an asthmatic. Mention other causes of wheezing.

Define bronchiectasis. Describe the important causes, the abnormal anatomy, and the typical clinical picture.

Describe the various breathing problems that occur during sleep. Recognize sleep apnea as a common cause of several illnesses.

Describe the normal flora of the lungs in non-smokers and smokers, and recognize the range of micro-organisms that have caused lung infections. Recognize the tremendous clinical importance of lung infections.

Distinguish bronchopneumonia, lobar pneumonia, and pneumonitis. Describe the typical histopathology of lung infections caused by various agents.

List the etiologic agents of lobar pneumonia, the classic stages in its progression, the major complications, and those at risk for each form.

Describe the causes, underlying problems, pathophysiology, and morbid anatomy of bronchopneumonia, aspiration pneumonia, aspiration pneumonitis, legionellosis, pneumocystosis, lung abscess, and viral and mycoplasmal pneumonias. Describe the distinctive features of hantavirus infection and SARS (the 2003 epidemic).

Describe the anatomic pathology, pathophysiology, and clinical picture of the "idiopathic pulmonary fibrosis" family of diseases. Identify "Hamman-Rich" syndrome, and mention how we distinguish it and what may cause it.

Define sarcoidosis, and describe a typical sarcoidosis patient. Explain the usual effects of sarcoidosis on the lungs, skin, and eyes. Mention the serious consequences of untreated sarcoidosis. Describe the histology, and give a differential diagnosis for a granuloma found on biopsy. Explain how sarcoidosis causes abnormalities of calcium metabolism. Recognize the Kveim test as of limited usefulness. Tell how to make the diagnosis of sarcoidosis, and how to treat sarcoid patients.

Explain the essential lesion of Goodpasture's disease involving the lung, and mention the clinical picture and diagnostic lab test, and essential treatment. Mention some "related" (?) causes of bleeding from the pulmonary alveoli.

Briefly describe the eosinophilic pneumonias, and the various lipid pneumonias and lipoproteinosis, focusing on their histopathology.

Give the numbers of new cases of lung cancer in U.S. men and women expected this year. Explain how rates are changing, and why. Describe the risk factors for lung cancer, mentioning the importance of cigaret smoking, industrial exposure, radon in the home, and indoor air pollution.

Barney Rubble Explain how and why pathologists subclassify lung cancers. Be generally familiar with the unsatisfactory WHO-2004 classification:

Describe the important distinctions among these tumors:

. Identify the lung cancers listed above under the microscope. Explain how pathologists use each of these to distinguish primary lung tumors:

Describe what we know about the emerging entity "never-smoker's cancer".

Tell how bronchogenic carcinomas present. Describe the various paraneoplastic syndromes seen with lung cancer, especially the hypercalcemia syndromes and the small cell undifferentiated carcinoma syndromes.

Identify bronchial carcinoid, tell how it looks grossly and microscopically, how to recognize it, and describe its origin and its variants.

List the common problems that affect the larynx or trachea. List the different kinds of pleural effusions, and tell the significance of each. Describe the various kinds of pneumothorax and why they are important. Tell how pleural plaques look and what causes them.

Identify the cell of origin, risk factor, gross and microscopic appearance, and prognosis for malignant mesothelioma.

Mention the basic biology of ciliary dyskinesia syndromes, tell when you would suspect one, and how you would verify it.

As usual, given a gross lung or larynx, or a biopsy of any level of the respiratory tract, recognize any of the lesions exhibited in this section with at least 70% accuracy.

Healthy lungs
Freshly-opened at autopsy
WebPath

Healthy lung
Formalin-inflated
WebPath

Pulmonary surface lymphatics
A bit accentuated due to pulmonary edema
WebPath

Healthy lung
Photomicrograph
WebPath

Life is not measured by the number of breaths you take, but by the number of moments that take your breath away.

NORMAL ANATOMY AND PHYSIOLOGY

* BIRTH DEFECTS involving the lungs are uncommon. If the diaphragm did not form properly and the abdominal contents are in the chest cavity, or there was insufficient amniotic fluid ("oligohydramnios") or the ribs or the large airways did not develop, there may not be sufficient lung tissue to allow life outside the womb.

PULMONARY CONGESTION AND EDEMA

{37956} pulmonary edema gestalt

{10145} pulmonary edema (just enough protein content to stain...)
{11666} pulmonary edema

Pulmonary edema
Great labels
Romanian Pathology Atlas

Congested lung
Great labels
Romanian Pathology Atlas

Pulmonary Edema
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Pulmonary edema
Some stainable protein, hence an exudate
WebPath

Heart Failure Cells
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office

Heart Failure Cells
Hemosiderin-laden macrophages in the lung
KU Collection

PULMONARY EMBOLIZATION ("embolism") AND INFARCTION (NEJM 358: 1209, 2008; Lancet 363: 1295, 2004; the enormity of the deep-vein-thrombosis problem and what may lie ahead Lancet 379: 1835, 2012.)

{29052} pulmonary embolus, ancient, organized and turned into fibrous bands

Pulmonary thromboembolus
Autopsy photo
KU Collection

Pulmonary Thromboembolus
Australian Pathology Museum
High-tech gross photos

Pulmonary infarct
Great labels
Romanian Pathology Atlas

Pulmonary thromboembolus
WebPath

Saddle embolus
WebPath

Lung infarct
WebPath

Lung infarct
WebPath

Pulmonary embolus
Actually, ALL antemortem thrombi are layered
WebPath

Pulmonary embolus
WebPath

Pulmonary embolus
WebPath

Pulmonary embolus
WebPath

Pulmonary embolus
Animation

Thanks, Webpath

Old pulmonary embolus
Organized
WebPath

Pulmonary infarct
Urbana Pathology

PULMONARY HYPERTENSION

Pulmonary Arterial Sclerosis
From Chile
In Spanish

Talc in the lungs
Pulmonary hypertension in druggies
WebPath

Plexiform lesion
WebPath

Pulmonary hypertension
Narrowed artery
WebPath

Crystals in the lungs of drug abusers
Lung pathology series
Dr. Warnock's Collection

ACUTE / ADULT RESPIRATORY DISTRESS SYNDROME (ARDS -- update Lancet 369: 1553, 2007; Am. Fam. Phys. 85: 352, 2012)

Gassed
WWI painting
Mustard gas victims
John Singer Sargent

ARDS
WebPath

ARDS
Hyaline membrane
WebPath

ARDS
UHS Case
Photo by Ed

ARDS
Urbana Pathology

ARDS (sepsis / peritonitis)
Early hyaline membranes
KCUMB Team

ARDS
Photomicrograph
KU Collection

{06359} ARDS

NEONATAL RESPIRATORY DISTRESS SYNDROME ("hyaline membrane disease", HMD, RDS, etc.)

{11427} hyaline membrane disease, newborn
{20014} hyaline membrane disease, newborn
{20015} hyaline membrane disease, newborn

Neonatal respiratory distress syndrome
Great labels
Romanian Pathology Atlas

Hyaline membrane disease
WebPath Photo

Newborn aspiration
WebPath Photo

Newborn aspiration
WebPath Photo

ATELECTASIS

Atelectasis
From Chile
In Spanish

Carcinoid with obstructive pneumonia
AFIP
Wikimedia Commons

Golden cholesterol pneumonia
Smoker, behind a lung cancer
KCUMB Team

Atelectasis
This was from a hemothorax
WebPath

{10228} atelectasis (left lung of a baby whose left bronchus failed to form)

SUDDEN INFANT DEATH SYNDROME ("SIDS", "crib death", "cot death", "continues to be the leading cuase of death for infants aged between 1 month and 1 year in developed countries" Lancet 370: 1578, 2007; NEJM 361: 496, 2009; "the seventh leading cause of years of potential life lost before age 65, commensurate with AIDS" -- MMWR 37: 644, 1988, etc., etc.). The following will upset you.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD, chronic air flow obstruction, * COAD, * CAWO, * chronic airway obstruction; review Lancet 379: ): The most common cause of activity-restricting disability in the U.S. Morphology and pathophysiology review explaining the obstruction: Lancet 364: 709, 2004. Clinical review (no surprises): Lancet 362: 1053, 2003.

Healthline COPD
For patients
Nice site, by a cyberfriend

EMPHYSEMA

Emphysema
Lung pathology series
Dr. Warnock's Collection

Emphysema
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Emphysema I
From Chile
In Spanish

Emphysema II
From Chile
In Spanish

Emphysema
Good blebs
WebPath

Emphysema
Supposedly centrilobular
WebPath

"Types of emphysema"
Lung pathology series
Dr. Warnock's Collection

Centrilobular emphysema
Formalin-inflated lung
KU Collection

Emphysema
Supposedly centrilobular
WebPath

Emphysema
Trashed, overstretched alveoli
WebPath

Centrilobular emphysema
Inflated; easy to tell
Wikimedia Commons

Emphysema
Australian Pathology Museum
High-tech gross photos

{11506} emphysema
{20239} emphysema
{20993} emphysema
{29153} emphysema
{38362} emphysema
{38365} emphysema
{49068} "pan-acinar emphysema"
{49069} "centrilobular emphysema"


Huckleberry Finn smoking
Tobacco smoke augments elastases, inhibits anti-proteases, and promotes infection with further release of elastases. We do not know why some smokers get much worse emphysema than others.

{10778} blebs in emphysema

Emphysema patient
Barrel chest
Well-developed arms

CHRONIC BRONCHITIS ("smoker's cough" -- never trivial)

{08761} chronic bronchitis (chronic inflammation, missing epithelium)

Chronic Bronchitis
From Chile
In Spanish

Chronic bronchitis
Lung pathology series
Dr. Warnock's Collection

BRONCHIAL ASTHMA (Review for pathologists, emphasizing the pathology and the bewildering array of chemical and physiological abnormalities: Arch. Path. Lab. Med. 130: 447, 2006; update for science types Nat. Med. 18: 631, 2012 and several articles in this issue).

Asthma, great pictures
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Asthma
Australian Pathology Museum
High-tech gross photos

Asthma
Hyperinflated lungs
WebPath

Asthmatic mucus plugs
WebPath

Asthmatic airway
WebPath

Asthmatic airway
The kind with the eosinophils
WebPath

Asthma
Plug and wall changes
KU Collection

Asthma
Lung pathology series
Dr. Warnock's Collection

{08228} asthma, hyperinflated lungs (notice that they completely cover the heart in front)
{08231} asthma, mucus plugging airways
{08234} asthma, plugs
{29236} asthma, plugs
{07564} asthma, thick basement membrane
{08240} asthma, thick basement membrane, lots of smooth muscle, lots of epithelial cells lying around
{08243} asthma, thick basement membrane, mucus plug (trichrome stain)
{09899} Curschmann's spirals
{25999} Curschmann's spirals
{27492} occupational asthma; isocyanates are infamous

OBSTRUCTIVE BRONCHIOLITIS ("constrictive bronchiolitis"; extreme cases are "obliterative bronchiolitis"; update NEJM 370: 1820, 2014)

BRONCHIECTASIS ("ectasia", or "pulling wide" of the bronchi; Chest 134: 815, 2008; named by Laennec)

Bronchiectasis I
From Chile
In Spanish

Bronchiectasis II
From Chile
In Spanish

Bronchiectasis
Lung pathology series
Dr. Warnock's Collection

Cystic fibrosis
Bronchiectasis
KU Collection

Bronchiectasis
WebPath

Bronchiectasis
WebPath

Bronchiectasis
WebPath


Bronchiectasis
WebPath

Bronchiectasis
WebPath

Bronchiectasis
WebPath Photo

Bronchiectasis

WebPath Photo

{05762} bronchiectasis
{10787} bronchiectasis
{24542} bronchiectasis
{27242} bronchiectasis
{38383} bronchiectasis
{38389} bronchiectasis

PRIMARY CILIARY DYSKINESIA SYNDROMES (Am. J. Resp. CCM. 151: 1559, 1995).

OBSTRUCTIVE SLEEP APNEA: NEJM 347: 498, 2002

LUNG INFECTIONS

Bacteria in the sputum
Rogues' gallery
Yutaka Tsutsumi MD

Lobar pneumonia

Yutaka Tsutsumi MD

Pneumonia
Neutrophils and a fibrin web
KCUMB Team

Lobar Pneumoonia
Great labels
Romanian Pathology Atlas

Lobar Pneumonia
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Lobar pneumonia
Gray hepatization
KU Collection

Pneumonia
Tom Demark's Site

Lobar Pneumonia
Australian Pathology Museum
High-tech gross photos

Pneumonia

WebPath Photo

Middle lobe pneumonia
This was nocardiosis

WebPath

Nocardiosis
Acid fast stain
WebPath

Pneumonia, going chronic
This was nocardiosis

WebPath

Actinomycosis of the lung

Yutaka Tsutsumi MD

Actinomycosis of the lung

Yutaka Tsutsumi MD

Aspergillosis of the lung

Yutaka Tsutsumi MD

Candida in the lung

Yutaka Tsutsumi MD

Aspergillus
Fungus ball in the making
WebPath

Aspergillus
Fungus ball in the making
WebPath

Aspergillus
Fungus ball
WebPath

Aspergillus
Fungus hyphae
WebPath

Aspergillus
Fungus hyphae
WebPath

Coccidioides granuloma
WebPath

Coccidioides

WebPath Photo

Coccidioidomycosis of the lung

Yutaka Tsutsumi MD

Coccidioides
Nice spherule
WebPath

Aspergilloma
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Blastomycosis of the lung

Yutaka Tsutsumi MD

Histoplasmosis of the lung

Yutaka Tsutsumi MD

Aspergilloma
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Chronic necrotizing aspergillosis
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Chronic necrotizing aspergillosis
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Aspergillus tracheobronchitis
Lung pathology series
Dr. Warnock's Collection

Coccidioidomycosis
Silver stain
Wikimedia Commons

Coccidioides
CDC
Wikimedia Commons

{11435} cryptococcal pneumonia

Cryptoccal granuloma of lung

Yutaka Tsutsumi MD

BRONCHOPNEUMONIA ("lobular pneumonia")

Bronchopneumonia I
From Chile
In Spanish

Bronchopneumonia II
From Chile
In Spanish

Bronchopneumonia
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Bronchopneumonia
Great labels
Romanian Pathology Atlas

Bronchopneumonia
WebPath

Bronchopneumonia
Inflated lung
WebPath

Bronchopneumonia
Formalin-inflated lung
WebPath

Bronchopneumonia
WebPath

Pneumonia
WebPath

Pneumonia
WebPath

Pneumonia
WebPath

Necrotizing pneumonia
WebPath

Necrotizing pneumonia
WebPath

Necrotizing bacterial lung infection
WebPath

{10148} bronchopneumonia (patchy)
{49076} bronchopneumonia

Aspiration pneumonia

Yutaka Tsutsumi MD

Aspiration bronchopneumonia
Great labels
Romanian Pathology Atlas

Aspiration
Foreign body reaction
WebPath

Aspiration pneumonia
Lung pathology series; follow the arrows
Dr. Warnock's Collection

{12638} vicious case of staph pneumonia

Pneumonia
never mind the exotic bug...
Pittsburgh Illustrated Case

LOBAR PNEUMONIA

{27689} pneumococci in sputum; gram stain

Pneumococcal pneumonia
Sputum gram stain
KU Collection

Pneumonia I
From Chile
In Spanish

Pneumonia II
From Chile
In Spanish

Abscessing pneumonia

WebPath Photo

Klebsiella pneumonia

Yutaka Tsutsumi MD

Lung Abscess
From Chile
In Spanish

Lung abscesses
WebPath

Lung abscess
WebPath

Lung abscesses
WebPath

Lung Abscess
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

{12641} staph producing abscess

Suppurative pleuritis
Not quite empyema
WebPath

{49077} empyema

{39530} organizing pneumonia; balls of fibrin in the alveoli

Lobar pneumonia
WebPath

Lobar pneumonia
WebPath

{11431} lobar pneumonia
{11732} lobar pneumonia
{11733} lobar pneumonia
{11734} streptococci in lobar pneumonia, gram stain
{12464} lobar pneumonia
{17565} lobar pneumonia
{17567} lobar pneumonia

LEGIONNAIRE'S DISEASE (legionellosis, "Pontiac fever", etc.)

{08179} legionella demonstrated with a silver stain

Legionella
Lung pathology series
Dr. Warnock's Collection

Legionella pneumonia

Yutaka Tsutsumi MD

PNEUMOCYSTIS PNEUMONIA

{00456} pneumocystis pneumonia

Pneumocystis carinii
H&E, see the froth
KU Collection

Pneumocystosis

Yutaka Tsutsumi MD

Pneumocystis
Lung pathology series, great photos
Dr. Warnock's Collection

LUNG ABSCESS

VIRAL AND MYCOPLASMAL PNEUMONIA ("primary atypical pneumonia", "chest cold", etc.)

Adenovirus pneumonia
Can you find smudge cells?
Yutaka Tsutsumi MD

Measles pneumonia
Can you see the "Warthin Findeldey" measles cells?
Yutaka Tsutsumi MD

Influenza

Yutaka Tsutsumi MD

Measles pneumonia

Yutaka Tsutsumi MD

CMV pneumonia

Yutaka Tsutsumi MD

Herpes simplex pneumonia

Yutaka Tsutsumi MD

Varicella-zoster pneumonia

Yutaka Tsutsumi MD

Respiratory syncytial virus
Bad pneumonitis
WebPath

Respiratory syncytial virus
Syncytia
WebPath

Viral Pneumonia
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

{38402} bad viral pneumonia; the lung is nearly solid from all the inflammatory stuff in the alveolar septa

Lymphocytic interstitial pneumonia
Pittsburgh Pathology Cases

Kaposi's in the lung
Lung pathology series
Dr. Warnock's Collection

TUBERCULOSIS ("TB", "the white plague" -- covered twice in R&F). Update Lancet 378: 57, 2011. Also here.

Tuberculosis
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Pulmonary TB
Great labels
Romanian Pathology Atlas

Tuberculosis of the lung
Classic drawing
Adami & McCrae, 1914

Tuberculosis

Yutaka Tsutsumi MD

Atypical mycobacteria in the lung

Yutaka Tsutsumi MD

Tuberculosis
Autopsy lung
KU Collection

Tuberculosis
WebPath Photo

Pathology of TB
WebPath Tutorial

{08333} TB, lymph node
{08336} TB, lymph node

{08459} cavitary TB
{10230} TB in the lung, good cavity
{21151} disseminated, miliary TB in liver

Miliary TB

WebPath Photo

Miliary TB

WebPath Photo

TB

WebPath Photo

Miliary TB
See millet seed also!
Dr. Warnock's Collection

Tuberculosis; white pneumonia
Lung pathology series; follow the arrows
Dr. Warnock's Collection

{05949} TB eroding through the chest wall
{08187} TB, kidney
{08188} TB, lung
{08190} TB, lung
{08193} TB, lung

{11423} old TB

* WHEN I HAVE FEARS

When I have fears that I may cease to be
Before my pen has gleaned my teeming brain,
Before high-piled books, in charactery,
Hold like rich garners the full-ripened grain;
When I behold, upon the night's starred face,
Huge cloudy symbols of a high romance,
And think that I may never live to trace
Their shadows, with the magic hand of chance;
And when I feel, fair creature of an hour,
That I shall never look upon thee more,
Never have relish in the faery power
Of unreflecting love! -- then on the shore
Of the wide world I stand alone, and think
Till Love and Fame to nothingness do sink.

-- John Keats

Keats went to medical school for a year and was licensed as a physician and surgeon. He quit to devote his life to writing poetry.

In this sonnet, he shares his fear that he may die before had has time to get all his ideas into writing.

With his medical training, he had good reason to be afraid. A few days before he wrote the poem, he had experienced his first episode of hemoptysis. Three years later he was dead of tuberculosis.

Tuberculosis
WebPath

Tuberculosis
WebPath

Tuberculosis
WebPath

TB
How cavities form
WebPath

TB
Urbana Pathology

TB
How cavities form
WebPath

TB
Ghon complex
WebPath

TB
Granulomas, not very good caseation
WebPath

TB
Granulomas, low power
WebPath

TB
Good caseation
WebPath

TB granuloma
Joke also
WebPath

TB
Acid fast bugs
WebPath

Miliary TB
Bad pneumonitis
WebPath

TB
Miliary
WebPath

TB granulomas

WebPath Photo

Reminder: In most chronic inflammatory diseases of lung, clubbing of the nails ("Hippocratic change") often develops because megakaryocytes embolize through the new vascular channels formed in the lungs.

INTERSTITIAL RESTRICTIVE LUNG DISEASE ("stiff lung"; "fibrosing alveolitis"; "honeycomb lung")

Interstitial Lung Disease
Notes on processing tissue; great photos
Dr. Warnock's Collection

Wegener's granulomatosis
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Wegener's granulomatosis
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Wegener's granulomatosis
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Wegener's granulomatosis
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Wegener's with capillaritis
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Busulfan lung
Lung pathology series
Dr. Warnock's Collection

Chronic Pneumonia (not really organizing)
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Cryptogenic organizing pneumonia
Idiopathic case
KCUMB Team

Farmer's lung
Trust me
WebPath

IDIOPATHIC PULMONARY FIBROSIS ("Hamman-Rich syndrome"; "cryptogenic (idiopathic) fibrosing alveolitis", "usual interstitial pneumonitis" and its kindred: Chest 128(5 S 1): 526-S, 2005; CMAJ 171: 153, 2004)

Usual interstitial pneumonitis
Lung pathology series
Dr. Warnock's Collection

Fibrosing alveolitis
Lung pathology series
Dr. Warnock's Collection

Hamman-Rich
WebPath

Hamman-Rich
Trichrome
WebPath

{40688} Hamman-Rich, gross, remember scar is white
{40685} Hamman-Rich, histology, the alveoli are slits

SARCOIDOSIS ("sarcoid", "Boeck's sarcoid"; * "sarcoid" literally means "the fleshy disease"): "A multi-system disorder of unknown etiology characterized by formation of noncaseating granulomas" (Baby Robbins) in many organs of the body, with variable clinical course. Reviews Lancet 361: 1111, 2003; JAMA 305: 391, 2011.

Sarcoidosis
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Sarcoid
Classic x-ray
WebPath

Sarcoid
Lymph node
Wikimedia Commons

{08756} sarcoid in the lung
{11417} sarcoid in a node, asteroid body
{11464} sarcoid, odd stain
{11774} sarcoid, lymph node
{12376} lupus pernio
{10976} sarcoid granuloma
{10979} sarcoid granuloma
{14427} sarcoid granuloma
{15474} brain sarcoid
{20220} sarcoid, lymph node
{23380} sarcoid, granulomas
{34913} sarcoid, lung
{35945} sarcoid, muscle
{38416} gross, sarcoid
{42030} sarcoid, marrow

GOODPASTURE'S DISEASE: Antibodies against the basement membranes of lung and kidneys -- type II immune injury.

{24848} Goodpasture's, lung
{29104} Goodpasture's, lung, iron stain
{29581} Goodpasture's
{29584} Goodpasture's

Lupus and Goodpasture's
Lung pathology series
Dr. Warnock's Collection

EOSINOPHILIC PNEUMONIAS ("pulmonary eosinophilia", "Loeffler's", etc.; Med. Clin. N.A. 95: 1163, 2011)

Dirofilariasis
Advanced students
Yutaka Tsutsumi MD

Histiocytosis X with Birbeck granules
Lung pathology series
Dr. Warnock's Collection

Eosinophilic granuloma
Lung pathology series, follow the arrows
Dr. Warnock's Collection

LIPID PNEUMONIA

{38464} lipid pneumonia

Lipid aspiration; probably animal
fat by all the inflammation
KCUMB Team

Lipid pneumonia
WebPath

Lipid pneumonia
This was exogenous
WebPath

Lipid pneumonia
Endogenous, golden surfactant pneumonia
WebPath

Lipid pneumonia
Lung pathology series
Dr. Warnock's Collection

Amiodarone lung
Lung pathology series
Dr. Warnock's Collection

* MISCELLANEOUS LESIONS

LUNG CANCER

Bronchogenic Carcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

LungCancerCauses.org
Support site for patients
Nice work

Lung Cancer
From Chile
In Spanish

Lung Cancer Images
University of Washington
Pictures and comments

Future pathologists: See Arch. Path. Lab. Med. 133: 1106, 2009! Non-small-cell: Lancet 378: 1727, 2011; small-cell Lancet 378: 1756, 2011. Clinicians CA 61: 91, 2011. How pathologists approach the molecular diagnosis today: Am. J. Clin. Path. 138: 332, 2012; Arch. Path. Lab. Med. 137: 481 & 1191 & 1274, 2013.

The vast majority of primary malignant neoplasms of the lungs are some form of BRONCHOGENIC CARCINOMA.

Risk factors are well-established (Chest 103-S1: 20-S, 1993)

    CIGARET AND CIGAR SMOKING: This is still the overriding risk factor (so much so that never-smoker's cancer seems to be a separate entity).

    * PIGEON KEEPING: Possible promoter, but not a mega-risk factor (Br. Med. J. 305: 986 & 989, 1992). A 1992 flap about keeping a canary or parakeet being a risk factor for lung cancer was laid to rest by a bunch of negative studies (Br. Med. J. 313: 1218, 1996 -- see Am. J. Pub. Health 102: 2018, 2012 which discussed the pet-bird scare in the context of the tobacco companies and their paying for "zombie science" -- continuing research after many negative results).

Classification scheme:

More about these below. EM, immunohistochemistry, and genomics have further complicated things.

Regardless of histologic type, the majority of lung cancers present at stage IV (very inoperable and thus totally incurable).

* My old friend Barrie R. Callileth and the rest of the integrative medicine team share an no-BadScience update on complementary therapies for the lung cancer patient, distinguishing the cynical frauds that pretend to affect the natural course of the disease to a host of treatments that can probably make people happier and more comfortable (Chest 132(S-3): 340-S, 2007).

Lung cancer
Large hilar tumor, emphysematous lung
KU Collection

SQUAMOUS CELL CARCINOMA ("Epidermoid carcinoma")

Squamous Lung Cancer
From Chile
In Spanish

Squamous Cell Lung Cancer
Australian Pathology Museum
High-tech gross photos

Squamous cell carcinoma
Lung pathology series
Dr. Warnock's Collection

Well-differentiated squamous lung cancer
AFIP
Wikimedia Commons

Squamous cell carcinoma
Big central lesion
WebPath

Squamous cell carcinoma
Big central lesion
WebPath

Squamous cell carcinoma
Big central lesion
WebPath

Squamous cell carcinoma
WebPath

Squamous cell carcinoma
Nice desmosome prickles
WebPath

Squamous cell carcinoma
Nice squamous pearl
WebPath

Squamous Lung Cancer
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Squamous lung cancer
AFIP
Wikimedia Commons

{17520} squamous cell carcinoma of lung, large mass at hilum
{20994} squamous cell carcinoma of lung, find the cavity
{20996} squamous cell carcinoma of lung, gross
{17525} squamous cell carcinoma of lung, poorly differentiated
{15401} tonofilaments
{15402} desmosome

Dysplasia in bronchial epithelium
Surprise finding at autopsy
KCUMB Team

ADENOCARCINOMA

Adenocarcinoma
From Chile
In Spanish

Lung Adenocarcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Adenocarcinoma
This was a scar cancer
Tom Demark's Site

Adenocarcinoma
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Adenocarcinoma
Peripheral cancer
WebPath

Poorly-differentiated lung adenocarcinoma
AFIP
Wikimedia Commons

Primary lung adenocarcinoma
AFIP
Wikimedia Commons

Lung adenocarcinoma, preinvasive
H&E
Wikimedia Commons

{20997} peripheral adenocarcinoma

Bronchioloalveolar carcinoma
Freshly-opened at autopsy
WebPath

Bronchioloalveolar carcinoma
WebPath

Atypical adenomatous hyperplasia
Forme fruste of bronchioloalveolar
cell carcinoma?

Bronchioloalveolar cell carcinoma, great case
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Bronchioloalveolar cell carcinoma
Various cell types can give rise to it
Dr. Warnock's Collection

Alveolar Cell Carcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Bronchioloalveolar carcinoma
AFIP
Wikimedia Commons

Bronchioloalveoliar carcinoma
Mucus is red
Wikimedia Commons

Bronchiolo-Alveolar Carcinoma
High magnification
KU Collection

{11454} bronchiolo-alveolar carcinoma; very small cells growing along the alveolar septa
{12608} bronchiolo-alveolar carcinoma; the lung is solidified by mucus in the alveoli

LARGE CELL UNDIFFERENTIATED CARCINOMA ("hundred-day cancer"; "non-small-cell carcinoma not otherwise specified")

Oat Cell / Large Cell Anaplastic
From Chile
In Spanish

Large cell and adenocarcinomas
Lung pathology series
Dr. Warnock's Collection

Large-cell lung cancer
"Hundred-day cancer"
KCUMB Team

Large cell lung cancer
AFIP
Wikimedia Commons

Large cell undifferentiated lung cancer
AFIP
Wikimedia Commons

SMALL-CELL UNDIFFERENTIATED CARCINOMA ("OAT CELL") (Lancet 378: 1741, 2011)

Oat cell carcinoma
Looks like sushi
WebPath

Oat cell carcinoma
Follows the bronchi
WebPath

Oat cell carcinoma
WebPath

Oat cell CA with Azzopardi phenomenon
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Oat cell carcinoma
Tom Demark's Site

Oat cell carcinoma

KU Collection

Oat Cell Carcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Small cell lung cancer
AFIP
Wikimedia Commons

Oat cell carcinoma
Lots of necrosis
Wikimedia Commons

Oat cell carcinoma
High magnification
Wikimedia Commons

Oat cell carcinoma
These actually look like oats
Wikimedia Commons

{11428} oat cell carcinoma, spreading along the bronchi
{10475} oat cell carcinoma, growing down between the cartilage rings
{10435} oat cell carcinoma
{11693} oat cell carcinoma
{12578} oat cell carcinoma
{14076} oat cells, spinal fluid
{12581} oat cells in sputum
{38521} oat cell
{38527} oat cell
{09082} oat cell carcinoma, electron micrograph showing neurosecretory granules

PREINVASIVE LESIONS

CLINICAL MANIFESTATIONS OF BRONCHOGENIC CARCINOMA

{18764} brain "mets"

{18774} adrenal "mets", this may well have produced adrenal insufficiency
{18778} bone "mets", this hurts

BRONCHIAL CARCINOIDS

Lung carcinoid
AFIP
Wikimedia Commons

Trabecular carcinoid
AFIP
Wikimedia Commons

OTHER TUMORS

Tumorlets
Lung pathology series
Dr. Warnock's Collection

Tumorlet
Lung pathology series
Dr. Warnock's Collection

Carcinoid and oat cell
Lung pathology series
Dr. Warnock's Collection

Bronchial hamartoma
Lung pathology series
Dr. Warnock's Collection

Hamartoma
WebPath

Hamartoma
Cartilage and epithelium
WebPath

Lung hamartoma
AFIP
Wikimedia Commons

{38506} lung hamartoma, gross

Metastases to Lung
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Cancer metastatic to lungs
"Cannonball metastases"
KU Collection

Metastases to the lung
WebPath

Metastases to the lung

WebPath

Metastases to the lung

WebPath

{21001} pulmonary lymphatic carcinomatosis (white strings)

Cholangiocarcinoma in lung lymphatics
Super-well differentiated
KCUMB Team

Lymphatic carcinomatosis

WebPath

Metastasis on the pleura

WebPath

! ! ! ! !

UPPER AIRWAY, LARYNX AND TRACHEA

Larynx Exhibit
Virtual Pathology Museum
University of Connecticut

Nasopharyngeal teratoma
WebPath Photo

Pansinusitis
Exotic fungus
Pittsburgh Pathology Cases

Frontal sinus cancer
Pittsburgh Pathology Cases

Alveocapillary dysplasia
Lung pathology series
Dr. Warnock's Collection

Throat
Ed's Histology Notes

Tube pressure ulcers
Larynx
WebPath Photo

{11696} laryngeal squamous cell carcinoma, supraglottic

Laryngeal cancer, fatal
Ed Lulo's Pathology Gallery

Larynx, Squamous Cell Carcinoma
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Laryngeal squamous carcinoma
In French
Wikimedia Commons

PLEURAL DISEASES

Hemothorax

WebPath

Hemothorax
Urbana Atlas of Pathology

Three KingsI
"Three Kings". George Clooney treats teammate...
Three Kings
...Mark Wahlberg's tension pneumothorax

Mesothelioma
Lung pathology series
Dr. Warnock's Collection

Mesothelioma
Autopsy specimen
KU Collection

Elongated microvilli
Mesothelioma
Photo from NEJM

Mesothelioma Information Group
Resources and advocacy
Also asbestosis and bronchogenic CA

Mesothelioma Network
Informational site by lawyers
Some pathology

Mesothelioma
Good gross photo from
some asbestos lawyers

Mesothelioma and asbestosis
Nice photos from
some asbestos lawyers

Mesothelioma
Includes EM of spaghetti
microvilli; UCSF

Mesothelioma
Chest block
Wikimedia Commons

Mesothelioma

WebPath

Mesothelioma

WebPath

Asbestos

WebPath

Asbestos

WebPath

Asbestos, pleural plaques

WebPath

Asbestos, pleural plaque

WebPath

Mesothelioma Pathology
Sampurna Roy, MD
Lots of photos and good text

Metastases to the pleura
Carcinoma en cuirasse
Tell from mesothelioma microscopically

{27597} mesothelioma, gross

*  *  * 

* The Fellowship of those who bear the Mark of Pain. Who are the members of this fellowship? Those who have learned by experience what physical pain and bodily anguish mean, belong together all the world over; they are united by a secret bond. Praise God! One and all they know the horrors of suffering to which man can be exposed, and one and all they know the longing to be free from pain. He who has been delivered from pain must not think he is now free again, and at liberty to take life up just as it was before, entirely forgetful of the past. He is now a "man whose eyes are open" with regard to pain and anguish, and he must help to overcome those two enemies (so far as human power can control them) and to bring to others the deliverance which he has himself enjoyed. The man who, with a doctor's help, has been pulled through a severe illness, must aid in providing a helper such as he had himself, for those who otherwise could not have one. He who has been saved by an operation from death or torturing pain, must do his part to make it possible for the kindly anaesthetic and the helpful knife to begin their work, where death and torturing pain still rule unhindered. The mother who owes to medical aid that the child still belongs to her, and not to the cold earth, must help, so that the poor mother who has never seen a doctor may be spared what she has been spared. Where a man's death agony might have been terrible, but could fortunately be made tolerable by a doctor's skill, those who stood around his deathbed must help, that others, too, may enjoy that same consolation when they lose their dear ones.

Such is the Fellowship of those who bear the Mark of Pain.

* SLICE OF LIFE REVIEW

{11512} lung, normal
{11739} lung, normal
{14900} epiglottis, normal
{14901} olfactory epithelium, normal
{14902} olfactory epithelium, normal
{14903} trachea (false & true vocal cords)
{14904} trachea (false & true vocal cords)
{14905} trachea, normal
{14906} respiratory epithelium (of trachea)
{14907} respiratory epithelium (of trachea)
{14908} bronchus, normal
{14909} bronchus, normal
{14910} bronchiole, normal lung
{14911} bronchiole, normal lung
{14912} respiratory epithelium, normal
{14913} respiratory bronchiole, normal
{14914} respiratory bronchiole, normal
{14915} alveolar duct, normal
{14916} alveolar duct, normal
{14917} alveolus, normal
{14918} alveolus, normal
{15145} trachea
{15147} trachea
{15148} lung
{15149} lung
{15150} lung, normal
{15151} lung, normal
{15152} lung
{15154} pneumocytes, type Ii lung
{15289} trachea, normal
{15290} trachea, normal
{15291} epiglottis, normal
{15292} epiglottis, normal
{15293} epiglottis, normal
{15294} trachea, * seromucous glands
{15295} trachea, normal
{15297} lung, normal
{15298} bronchiole, respiratory bronchiole
{15299} pneumocyte, type Ii
{15300} bronchus, normal
{15302} bronchiole, normal
{15303} bronchus, * seromucous gland
{15763} lung, normal
{15764} lung, normal
{15765} lung, normal
{15766} lung, normal
{15767} lung, normal
{15768} lung, normal
{15791} larynx, normal
{15792} larynx, normal
{17521} bronchus, normal
{17566} lung, normal
{20898} trachea
{20899} trachea, seromucous gland
{20900} cilia, tracheal epithelial cells
{20902} epiglottis
{20903} epiglottis
{20904} trachea
{20907} trachea, epithelium
{20909} alveolus, lung
{20910} lung, respiratory duct
{20911} lung, terminal bronchiole ?
{20912} lung, terminal bronchiole ?
{20913} bronchus, lung
{25654} lung, normal
{27215} lung, normal
{27218} lung, normal
{27221} lung, normal
{27224} lung, normal
{27227} lung, normal
{27468} lung, normal
{29168} bronchitis, chronic with normal to compare
{37604} lung, normal
{37619} bronchus, normal
{41517} lung, normal cast of capillary bed
{46452} xerogram laryngeal, normal
{15289} trachea, normal



* From far, from eve and morning,
And yon twelve-winded sky,
The stuff of life to knit me
Blew hither: here am I.
Now -- for a breath I tarry
Nor yet disperse apart
Take my hand quick and tell me,
What have you in your heart.
Speak now, and I will answer;
How shall I help you, say;
Ere to the wind's twelve quarters
I take my endless way.

NOTE: You may not share Mr. Housmann's "scientific" nihilism. I'm always surprised and pleased when such folks at least pay lip service to basic human goodness.

BIBLIOGRAPHY / FURTHER READING

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Teaching Pathology

Pathological Chess


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