Enfermedad pulmonar

obstructiva crónica

Dr. Reynaldo Falcón Escobedo

Profesor Titular

Anatomía Patológica

Facultad de Medicina

UASLP

Enfermedad obstructiva vs. restrictiva

Enfermedad obstructiva (enf. de las vías respiratorias)

Aumento de la resistencia al flujo del aire

Obstrucción parcial o completa de la vía respiratoria

Desde tráquea hasta bronquíolos respiratorios y terminales

Enfermedad restrictiva

Expansión reducida del parénquima pulmonar

Disminución de la capacidad pulmonar total

Trastornos de la pared torácica

Enfermedades intersticiales e infiltrativas agudas o crónicas.

Enfisema

Dilatación permanente de los espacios aéreos distales al bronquíolo terminal

Destrucción de septos ineralveolares

Tipos de enfisema

Centroacinar Afección de partes centrales o proximales del lobulillo formadas por los

bronquíolos respiratorios

Alvéolos distales conservados

Panacinar Acinos uniformemente agrandados, desde el bronquiolo respiratorio

hasta el alvéolo. No afecta a todo el pulmón. Asociado a deficiencia de a1-antitripsina.

Frecuentemente en zonas inferiores del pulmón

Paraseptal Porción proximal normal, afección de la porción distal.

Suele ser periférico, subpleural.

A lo largo de los septos conectivos lobulillares y en los márgenes de los lobulillos.

Aparece junto a zonas de fibrosis, cicatrización o atelectasia

Mitad superior. Diámetro de 0.5 a >2 cm. Prob. asoc. A neumotórax espontáneo

Irregular Probablemente la forma más común de enfisema.

Se asocia casi invariablemente a cicatrrización

Bronquitis crónica

Tos persistente productiva

3 meses al año

2 años consecutivos

Sin ninguna otra causa aparente

Asma

Trastorno inflamatorio crónico de vías aéreas

Con episodios de recurrentes de sibilancias, disnea, tensión torácica y tos (por la noche y primeras h. del día)

Asociados a broncoconstricción difusa variable

Limitación al flujo del aire

Reversible total o parcialmente espontáneamente o con tratamiento.

Figure 15-12 Bronchiectasis in a patient with cystic fibrosis, who underwent lung transplantation. Cut surface of lung shows markedly distended peripheral bronchi filled

with mucopurulent secretions.

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Figure 15-13 Schematic representation of current understanding of the pathogenesis of idiopathic pulmonary fibrosis.

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Figure 15-15 Usual interstitial pneumonia. Fibroblastic focus with fibers running parallel to surface and bluish myxoid extracellular matrix. Honeycombing is present on the

left.

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Figure 15-14 Usual interstitial pneumonia. The fibrosis is more pronounced in the subpleural region. (Courtesy of Dr. Nicole Cipriani, Department of Pathology, University

of Chicago, Chicago, IL.)

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Figure 15-16 Cryptogenic organizing pneumonia. Some alveolar spaces are filled with balls of fibroblasts (Masson bodies), while the alveolar walls are relatively normal.

A, Low power; B, high power.

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Figure 15-17 Progressive massive fibrosis superimposed on coal workers' pneumoconiosis. The large, blackened scars are located principally in the upper lobe. Note the

extensions of scars into surrounding parenchyma and retraction of adjacent pleura. (Courtesy of Drs. Werner Laquer and Jerome Kleinerman, the National Institute of

Occupational Safety and Health, Morgantown, WV.)

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HISTOLOGIC PATTERNS CLINICAL-RADIOLOGIC-

PATHOLOGIC DIAGNOSES

Usual Interstitial Pneumonia Idiopathic Pulmonary Fibrosis/

Cryptogenic Fibrosing Alveolitis

Nonspecific Interstitial Pneumonia Nonspecific Interstitial Pneumonia

(Provisional)‡

Organizing Pneumonia Cryptogenic Organizing Pneumonia †

Diffuse Alveolar Damage Acute Interstitial Pneumonia

Respiratory Bronchiolitis Respiratory Bronchiolitis Interstitial

Lung Disease

Desquamative Interstitial

Pneumonia

Desquamative Interstitial Pneumonia

Lymphocytic Interstitial Pneumonia Lymphocytic Interstitial Pneumonia

HISTOLOGIC PATTERNS CLINICAL-RADIOLOGIC-PATHOLOGIC

DIAGNOSES

Usual Interstitial Pneumonia Idiopathic Pulmonary Fibrosis/

Cryptogenic Fibrosing Alveolitis

Nonspecific Interstitial Pneumonia Nonspecific Interstitial Pneumonia

(Provisional)‡

Organizing Pneumonia Cryptogenic Organizing Pneumonia †

Diffuse Alveolar Damage Acute Interstitial Pneumonia

Respiratory Bronchiolitis Respiratory Bronchiolitis Interstitial

Lung Disease

Desquamative Interstitial

Pneumonia

Desquamative Interstitial Pneumonia

Lymphocytic Interstitial Pneumonia Lymphocytic Interstitial Pneumonia

* Unclassifiable interstitial pneumonia = Some cases are unclassifiable for a variety of reasons (see text)

† COP is the preferred term, but it is synonymous with Idiopathic Bronchiolitis Obliterans Organizing Pneumonia

‡ This group represents a heterogeneous group with poorly characterized clinical and radiologic features that needs further study.

†† Modified From the ATS/ERS Classification of Idiopathic Interstitial Pneumonias1