A 75 year old patient presented with shaking chills, fever, malaise with pleuritic chest pain, dyspnoea and cough with expectoration.
On examination,the lung picture showed the following picture.What can be the most probable diagnosis?
A. Lobar Pneumonia
C. Atypical Pneumonia
D. Lung Abscess
- First: The pleural surface of the specimen of the lung shows serofibrinous exudate. The sectioned surface shows multiple, small, grey-brown, firm, patchy areas of consolidation around bronchioles (arrow). while the intervening lung is spongy.
- Second:Microscopic appearance of bronchopneumonia. The bronchioles as well as the adjacent alveoli are filled with exudate consisting chiefly of neutrophils. The alveolar septa are thickened due to congested capillaries and neutrophilic infiltrate.
- Bronchopneumonia or lobular pneumonia is infection of the terminal bronchioles that extends into the surrounding alveoli resulting in patchy consolidation of the lung.
- The condition is particularly frequent at the extremes of life (i.e. in infancy and old age), as a terminal event in chronic debilitating diseases and as a secondary infection following viral respiratory infections such as influenza, measles etc.
- The common organisms responsible for bronchopneumonia are staphylococci, streptococci, pneumococci, Klebsiella pneumoniae, Haemophilus influenzae, and gram-negative bacilli like Pseudomonas and coliform bacteria.
- Grossly, bronchopneumonia is identified by patchy areas of red or grey consolidation affecting one or more lobes, frequently found bilaterally and more often involving the lower zones of the lungs due to gravitation of the secretions.
- On cut surface, these patchy consolidated lesions are dry, granular, firm, red or grey in colour, 3 to 4 cm in diameter, slightly elevated over the surface and are often centred around a bronchiole.
- Histologically, the following features are observed :
- i) Acute bronchiolitis. ii) Suppurative exudate, consisting chiefly of neutrophils, in the peribronchiolar alveoli. iii) Thickening of the alveolar septa by congested capillaries and leucocytic infiltration. iv) Less involved alveoli contain oedema fluid.