3. Enfermedad pulmonar
obstructiva crónica
Dr. Reynaldo Falcón Escobedo
Profesor Titular
Anatomía Patológica
Facultad de Medicina
UASLP

4. 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.

6. Enfisema
 Dilatación permanente de los espacios aéreos
distales al bronquíolo terminal
 Destrucción de septos ineralveolares

7. 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

16. Bronquitis crónica
 Tos persistente productiva
 3 meses al año
 2 años consecutivos
 Sin ninguna otra causa aparente

19. 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.

24. 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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© 2005 Elsevier

25. Figure 15-13 Schematic representation of current understanding of the pathogenesis of idiopathic pulmonary fibrosis.
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© 2005 Elsevier

26. 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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© 2005 Elsevier

27. 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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© 2005 Elsevier

28. 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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© 2005 Elsevier

29. 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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© 2005 Elsevier

30. 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

31. 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