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Upper Respiratory tract diseases Pathology.pdf
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- 2. OVERVIEW –Upper respiratory tractlesions – Pulmonary infections – Atelectasis (collapse) – Acute Pulmonary Injury – Obstructive Pulmonary Disease (COPD) – Diffuse interstitial (Restrictive, Infiltrative) Lung Diseases – Vascular Pulmonary Diseases – Lung tumors – Pleural lesions
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- 4. The Upper RespiratoryTract (URT) includes the: • nose • nasal cavity • frontal sinuses • maxillary sinus • larynx • trachea
- 5. Overview • Acute infections •Nasal polyps • Nasopharyngeal carcinoma • Laryngeal lesions
- 6. Acute infections • Commoncold • Pharyngitis • Epiglottitis • Laryngitis • Laryngotracheobronchitis (croup) • Sinusitis
- 7. Common cold • Acuteinfections of the URT mostly viral and self- limiting but can predispose to secondary bacterial infection • Nasal congestion, watery nasal discharge (rhinorrhea), sneezing, dry sore throat and a slight increase in temperature especially in young children, malaise, myalgia and headache,
- 8. • More than200 viruses with seasonal variation Transmission - • Direct contact with infected secretions • Hand - to - hand • Hand - to environmental surface - to hand • Spread by aerosols Pathogenesis • Incubation period 1 - 4 days • Begins in posterior pharynx • Viral shedding days 3 - 4 • May be complicated by otitis media or sinusitis • Use of antibiotics – no benefit, do not reduce bacterial complications, emergence of resistant organisms
- 9. Localized infections ofthe URT • Acute pharyngitis • Mild accompanying common cold • Severe cases need to be seriously taken – • beta-haemolytic streptococcal infection is associated with tonsillitis; • Coxsackievirus A causes pharyngeal vesicles and ulcers; • Infectious mononucleosis is caused by Epstein-Barr virus and is another cause of pharyngitis
- 10. Diffuse tonsillar and pharyngealerythema seen here as a non- specific finding that can be produced by a variety of pathogens
- 11. Exudative tonsillitis seen witheither Group A Beta-hemolytic streptococcal or Epstein-Barr virus infection.
- 13. Acute bacterial epiglottitis– • usually in young children • caused by H. influenzae • can be fatal due to airway obstruction
- 14. Epiglottitis This 2-yr oldwas in severe distress and was too exhausted to hold its head up. The epiglottis appears intensely red and swollen.
- 16. • Acute laryngitis Commoncold, allergic reaction or due to inhalation of irritants • Tuberculous laryngitis • Diphtheria caused by Corynebacterium diphtheriae, implants in the mucosa and produces an exotoxin that results in necrosis and a dense fibrinopurulent exudate forming the classic pseudomembrane of diphteria with the hazard of airway obstruction. Absorption of the exotoxin causes myocarditis and peripheral neuropathy.
- 17. • Laryngotracheobronchitis (croup) •In children mostly caused by parainfluenza virus • Self-limiting but can cause severe inspiratory stridor and harsh persistent cough •
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- 19. Lateral view ofparanasal sinuses
- 20. Sinusitis • Bacterial orviral • Fever (50%), purulent nasal discharge, swelling, facial pain worse on percussion, headache, nasal obstruction, loss of smell • Children: facial pain, swelling, malodorous breath (50%), cough (80%), nasal discharge (76%), fever (63%), sore throat (23%) • Maxillary toothache, colored nasal discharge, poor response to nasal decongestants, abnormal transillumination, purulent secretions, cough > 7 days
- 21. • Frontal sinusitiswith tenderness and headache - thin barrier to CNS, treat for 10-14 days • Ethmoid sinusitis: edema of eyelids, tearing, retroorbital pain, proptosis • Sphenoid sinusitis: intractable headache, hypo/hyperesthesia of ophthalmic or maxillary branches of trigeminal n. (30%)
- 22. Sinusitis - Inflammationof paranasal sinuses
- 23. Diagnosis of sinusitis Dr.EmadIbrahim Osman • Nasal swabs not helpful • Transillumination of maxillary and frontal sinuses • Sinus x-rays: air-fluid level, complete opacity, mucosal thickening • CT scan not indicated - unless chronic infection, immunocompromised, suspected intracranial or orbital complication • Direct sinus aspiration 10/2/98
- 24. Factors that predisposeto sinusitis • Impaired mucociliary function • Obstruction of sinus ostia • Immune defects • Increased risk of microbial invasion 10/2/98
- 25. Chronic sinusitis • Symptomsfor > 3 months • Allergies, inadequately treated • Aerobes and anaerobes • ENT evaluation for endoscopy or CT scan • Antibiotics for 3-4 weeks
- 26. Intracranial Complications of Sinusitis ComplicationClinical Signs • Meningitis Headache, fever, stiff neck lethargy, rapid death • Osteomyelitis Pott’s puffy tumor • Epidural abscess Headache, fever • Subdural empyema Headache, seizures hemiplegia, rapid death • Cerebral abscess Convulsions, headache, personality change • Venous sinus thrombosis Picket-fence fever, rapid death • Cavernous sinus Orbital edema, ocular palsies
- 27. Nasal polyps • Apolyp is an edematous semi-translucent mass in the nasal and paranasal cavities, mostly originating from the mucosal linings of the sinuses and prolapsing into the nasal cavities. • Etiology is unknown (-itis, -oma, -plasia) • Hypothesis: formation of polyps involve rupture of the surface epithelium and prolapse of the lamina propria as a result of tissue pressure from edema. • Allergic and infectious etiologies are the most frequently discussed
- 28. • Morbidity isrelated to the obstruction, leading to chronic sinusitis, facial pain, bony erosion. • Hyposmia and anosmia. • Polyps are not pre-malignant, however can be confused with the pre-malignant lesions.
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- 30. Histological findings • Pseudostratified ciliatedcolumnar epithelium • Thickened epithelial basement membrane • Oedematous stroma
- 31. Nasopharyngeal carcinoma • Strongepidemiological association with Epstein-Barr virus • Endemic in Asia especially China • Squamous cell carcinoma – mostly undifferentiated carcinoma • Invades locally, spreads to the cervical lymph nodes and then distantly • Radiosensitive and 5-year survival is 50%
- 32. Pathology • WHO Itumors are keratinizing squamous cell carcinomas. These tumors are not related to EBV infection. • WHO II tumors are nonkeratinizing squamous cell carcinomas. These tumors histologically resemble transitional cell bladder cancer, and are also called transitional cell carcinoma. These tumors are related to EBV infection. • WHO III tumors are undifferentiated carcinomas and include lymphoepithelioma. They account for the majority of nasopharyngeal carcinomas in the United States and worldwide. These tumors are related to EBV infection.
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- 34. Laryngeal lesions • Mostcommon presenting symptom is hoarseness • Nonmalignant lesions: vocal cord nodules (polyps) laryngeal (squamous) papilloma • Carcinoma – age more than 40 years, more common in males, smokers, association with alcohol and previous radiation exposure, squamous cell carcinoma - may be glottic, supraglottic or subglottic
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