• The specimen is a slice of the left lung.
• The upper lobe is relatively normal, except
for an old scar near the apex of the lung
caused by tuberculosis.
• The major abnormality is that the lower lobe
is uniformly consolidated (airless and solid)
due to lobar pneumonia, with inflammatory
cells and exuded plasma filling the airspaces.
• The shaggy material on the pleural surface is
fibrin, a protein derived from fibrinogen in
• Microscopic Appearances:
• Sections through the lower lobe show dilated,
congested blood vessels in the alveolar walls.
• The alveolar spaces are filled with inflammatory
cells, mainly neutrophils, and inflammatory
exudate, including fibrin.
• There are large aggregates of fibrin on the
• Pneumonia is an acute inflammation of the
airspaces of the lung, usually caused by bacterial
• This woman died of pneumonia affecting an entire
lobe of the lung, before the advent of antibiotics.
• Nowadays, it is uncommon to die in the acute
stages of lobar pneumonia
because Streptococcuspneumoniae ("the
pneumococcal"), which is the bacterium that
typically causes a lobar distribution of pneumonia,
is sensitive to various antibiotics.
• However, there is an increasing incidence of
pneumococcal resistance to Penicillin - usually the
most effective antibiotic in this situation. 31
• Abnormal and irreversible dilatation of bronchi
and bronchioles greater than 2.m.m. in diameter
developing secondary to inflammatory weakening
of the bronchial walls.
• Persistent cough with expectoration of copious
amounts of foul smelling purulent sputum.
• Post infectious cases commonly develop in
childhood and early adult life.
• Hereditary and congenital factors
• End bronchial obstruction
• Persistent or recurrent cough with purulent
• Initiating episode: Severe pneumonia, or
insidious onset of symptoms or
asymptomatic or non-productive cough – dry
bronchiectasis in upper lobe,
• Dyspnoea, wheezing – widespread
bronchiectasis or underlying COPD.
• Exacerbation of infection: Sputum volume
increase, purulence or blood.