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Also a chronic obstructive Also a chronic obstructive disease disease Chronic cough with Chronic cough with mucus production for 3 mucus production for 3 months.months.May lead to emphysema May lead to emphysema (especially in smokers).(especially in smokers).COPDCOPDLarger airway narrowingLarger airway narrowingIncreased secretionsIncreased secretions
Goblet cell hyperplasiaGoblet cell hyperplasia
Blue bloaterBlue bloaterCyanoticCyanotic
ClubbingClubbing
Hypertrophic Hypertrophic osteoarthropathyosteoarthropathySoft tissue and Soft tissue and periosteal boneperiosteal boneEmphysemaEmphysemaLung cancerLung cancerHeart defectsHeart defects
Anion GapAnion Gap EmphysemaEmphysema
Large airspacesLarge airspacesTrapped in air the Trapped in air the dilated alveolidilated alveoli
causes compression of causes compression of smaller airwayssmaller airwaysHyperinflationHyperinflation
AspirationAspirationHead down in the gutterHead down in the gutter
Rusty sputumRusty sputumHigh feverHigh fever
Pulmonary AbscessPulmonary Abscess
StaphylococcusStaphylococcusAspiration of gastric Aspiration of gastric materialmaterialHole withHole withAirAir--fluid levelfluid level
PneumoniaPneumoniaBxBx??Spread within the Spread within the lungs?lungs?CBC, immature cells?CBC, immature cells?Outcome?Outcome?
35 Year35 Year--Old SmokerOld Smoker
Pack year?Pack year?CoughCoughBlood?Blood?
Bronchiogenic CarcinomaBronchiogenic Carcinoma
Squamous in most casesSquamous in most casesChronic irritant leads to Chronic irritant leads to squamous metaplasia.squamous metaplasia.Continued exposure leads Continued exposure leads to dysplasia and to dysplasia and eventually cancer.eventually cancer.Very aggressive.Very aggressive.Surgery is about it.Surgery is about it.Poor response to Poor response to chemotherapy ands chemotherapy ands radiationradiation
Pulmonary CytologyPulmonary Cytology
Exfoliative cytologyExfoliative cytologyCough it upCough it upWash it outWash it out
Bronchoscopic biopsyBronchoscopic biopsy
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Metaplasia, Dysplasia, CancerMetaplasia, Dysplasia, Cancer Basic Patterns of Bronchiogenic CarcinomaBasic Patterns of Bronchiogenic Carcinoma
Small cell makes ADH and Small cell makes ADH and ACTHACTHSquamous cell makes PTHSquamous cell makes PTH
Multiple sclerosis like Multiple sclerosis like symptomssymptoms
Even without brain metsEven without brain mets
PancoastPancoast’’s tumor s tumor -->>HornerHorner’’s syndromes syndrome
Metastatic Cancer to LungMetastatic Cancer to Lung
Can come from Can come from anywhereanywhereMicroscopic looks like Microscopic looks like tumor of origintumor of originSpreads by bloodSpreads by blood
Isolated masses Isolated masses -->>
Spreads by lymphaticsSpreads by lymphaticsDiffuse involvementDiffuse involvement