—  SPECIALTY CONFERENCE  —

Pulmonary Pathology
 Wednesday, February 15, 2006 - 7:30 PM
Centennial I



Moderator:

Andrew Churg
University of British Columbia Health Science Center
Vancouver, BC, Canada

Prior to this Annual Meeting, slides and case histories for this Specialty Conferences were posted below so they may be reviewed in advance. During the meeting, the slides and protocols were also available for study in the microscope room (Chicago B - F Room) for participants who wished to review them prior to the evening session.

Click here for the handout from this conference.


Click on each slide thumbnail image for an enlarged view
Case 1

Submitted by:
Kevin O. Leslie
Mayo Clinic
Scottsdale, AZ

Clinical Summary:

A 36 year old married Caucasian woman, with systemic lupus erythematosus for 20 years, presented with symptomatic depression and suicidal thoughts. The patient's clinical course had been marked with episodes of hypoxia and a variably severe skin rash. Her pulmonary disease and skin manifestations responded inconsistently to systemic corticosteroid therapy during flare-ups, in part due to patient compliance issues. During the final hospitalization the patient's pulmonary status declined progressively and she expired from cardiopulmonary failure. An autopsy was performed. (Autopsy material courtesy of Thomas V. Colby, MD)


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Case 2

Submitted by:
Julia Flint
University of British Columbia
Vancouver, BC, Canada

Clinical Summary:

This 62 year old woman was admitted to hospital with increasing shortness of breath. She had complaints of exertional dyspnea and fatigue that had begun about a year ago. She had questionable Raynaud's phenomenon. She had been a one pack per day smoker from age 18 to 54 and she had suffered from hypertension. The chest CT scan showed no evidence of pulmonary embolus and it showed prominent bronchial circulation. A mild/moderate pericardial effusion was detected as well as small bilateral pleural effusions. Mild diffuse septal thickening was noted throughout both lungs. The right side of the heart was markedly enlarged. The pulmonary arteries were also enlarged with the main PA measuring 3.2 cm.

She had a right sided cardiac catheterization done which showed the pulmonary artery pressure to be 78/31mmHg with a mean of 47 mmHg. A nitric oxide challenge was performed together with coronary artery angiography. The conclusion was reached that she was suffering from pulmonary hypertension with an unclear response to nitric oxide challenge. She suffered a sudden cardiac arrest and she died in hospital.


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Case 3

Submitted by:
Joseph F. Tomashefski
Case Western Reserve University
Cleveland, Ohio

Clinical Summary:

A 40-year old African-American woman with sickle cell disease and frequent sickle cell crises died 2 weeks after hospitalization for Enterococcus cloacae sepsis. Her hospital course included respiratory failure requiring supplemental oxygen and mechanical ventilation. Echocardiogram revealed an elevated pulmonary artery pressure of 69 mm Hg. The patient was taking hydromorphone and methadone, as well as multiple other medications for pain control, and was on a patient-controlled anesthesia pump.


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Case 4

Submitted by:
Henry D. Tazelaar
Mayo Clinic
Scottdsdale, AZ

Clinical Summary:

A 42 year old man presented with hemoptysis. He had a history of bilateral pleural effusions and at one point in time had received a diagnosis of sclerosing mediastinits. Two previous lung biopsies had shown pleural fibrosis. A bronchoscopy and pulmonary angiogram failed to show a source of bleeding. While in the hospital he died and underwent a thorax only autopsy. The submitting pathologist stated that both the pleura and pericardium were thickened.


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Case 5

Submitted by:
Andrew Churg
University of British Columbia
Vancouver, BC, Canada

Clinical Summary:

A 56 year old woman presented with shortness of breath which had been steadily increasing for the past 2 years. CT scan on admission showed irregular consolidation superimposed on ground glass opacities. In the past she had been admitted for what was thought to be pneumonia on several occasions and a CT scan 2 years before admission showed Abilateral airspace disease@. The patient had a history of chronic renal failure requiring dialysis, and a diagnosis of pauci-immune cresentic glomerulonephritis made 4 years before admission. A lung biopsy was performed. After the lung biopsy, serum ANCA was obtained; this was positive for p-ANCA ( myeloperoxidase).


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