IPLab:Lab 6:Tuberculosis - Revision history

Peter Anderson: /* Autopsy Findings */

2020-07-08T23:39:44Z

‎Autopsy Findings

Peter Anderson: /* Clinical Summary */

2020-07-08T23:39:36Z

‎Clinical Summary

Peter Anderson: /* Virtual Microscopy */

2015-09-16T19:42:15Z

‎Virtual Microscopy

Seung Park at 16:19, 3 January 2014

2014-01-03T16:19:19Z

Seung Park: /* Images */

2013-08-30T01:35:55Z

‎Images

Seung Park at 23:53, 22 August 2013

2013-08-22T23:53:25Z

Peter Anderson at 15:34, 21 August 2013

2013-08-21T15:34:36Z

Seung Park at 14:26, 21 August 2013

2013-08-21T14:26:59Z

Seung Park at 14:25, 21 August 2013

2013-08-21T14:25:12Z

Peter Anderson at 20:14, 20 August 2013

2013-08-20T20:14:35Z

← Older revision		Revision as of 23:39, 8 July 2020
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	The patient underwent a thoracotomy, at which time a portion of the upper lobe of the right lung was removed. Examination of the cut surface revealed small white nodules measuring up to 0.2 cm in diameter.		The patient underwent a thoracotomy, at which time a portion of the upper lobe of the right lung was removed. Examination of the cut surface revealed small white nodules measuring up to 0.2 cm in diameter.
−
−	~~== Autopsy Findings ==~~
−	The patient underwent a thoracotomy, at which time a portion of the upper lobe of the right lung was removed. Examination of the cut surface revealed small white nodules measuring up to 0.2 cm in diameter.

	== Images ==		== Images ==

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 == Clinical Summary ==
 During the course of a routine physical examination two months prior to admission, this 57-year-old white male was noted to have a lesion in the upper lobe of the right lung. Initially, he was treated for two weeks with ampicillin. He was then admitted to an outside hospital for further study. All studies including sputum studies for tubercle bacilli, bronchial washings, and bronchoscopy were negative and he was discharged. Review of systems revealed the presence of mild dyspnea on exertion, accompanied by a slightly productive cough. Of interest was the fact that the patient had been PPD positive for the past 4 to 5 years, but this had never been evaluated. On this hospital admission, physical and laboratory examinations were negative. Radiographic examination of the chest revealed a 2 x 2-cm density in the right lower lung field. Several small cavities were identified in this area on CT scan.
 == Autopsy Findings ==

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 == Virtual Microscopy ==
-=== H&E ===
+=== Lung: TB H&E ===
 <peir-vm>IPLab6TB_HE</peir-vm>
-=== AFGT ===
+=== Lung: TB AFGT ===
 <peir-vm>IPLab6TB_AFGT</peir-vm>
 == Study Questions ==

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 File:IPLab6TB6.jpg|This is a high-power (oil immersion) photomicrograph of granuloma stained with an acid-fast stain. Mycobacterium tuberculosis bacilli stain red.
 </gallery>
 == Study Questions ==

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 === Images ===
-* [http://peir.path.uab.edu/library/index.php?/tags/259-tuberculosis PEIR Digital Library: Tuberculosis Images]
+* [{{SERVER}}/library/index.php?/tags/259-tuberculosis PEIR Digital Library: Tuberculosis Images]
 * [http://library.med.utah.edu/WebPath/LUNGHTML/LUNGIDX.html#4 WebPath: Granulomatous Diseases]

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 After a few weeks, T cell-mediated immunity develops and leads to activation of macrophages so they can kill intracellular mycobacteria via reactive nitrogen intermediates. This process leads to formation of epithelioid cell granulomas and clearance of the mycobacteria. Also, CD8+ suppresser T cells kill macrophages that are infected with mycobacteria, resulting in the formation of caseating granulomas. These processes during the primary infection with M. tuberculosis result in a calcified scar in the lung parenchyma and in the hilar lymph node. This combination is called the Ghon complex.
 </spoiler>
 {{IPLab 6}}
 [[Category: IPLab:Lab 6]]

← Older revision		Revision as of 14:25, 21 August 2013
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		+	== Clinical Summary ==
		+	This 29-year-old black female had a history of scleroderma involving the lung, kidney, heart, and skin. Her main clinical problems centered on her restrictive lung disease. She was able to live at home with supplemental oxygen but recently she had developed edema, chest pain, weakness, light-headedness, and a loss of appetite. The patient was admitted to the hospital with a working diagnosis of congestive heart failure brought on by her lung disease. Echocardiographic evaluation revealed a pericardial effusion that was tapped. Soon after this procedure her respiratory status degenerated and she required intubation. Despite aggressive supportive treatment for her cardiac and pulmonary problems, she could not be weaned from the ventilator. Two weeks after admission she became febrile and Gram positive cocci were isolated from sputum culture. She was placed on antibiotics but her condition deteriorated and she developed bradycardia followed by electromechanical dissociation (EMD).
		+
		+	== Autopsy Findings ==
		+	Upon opening the thorax there was 600 cc of cloudy serous fluid in each hemithorax and 100 cc of similar fluid in the pericardial sac. The heart weighed 530 grams and there was thickening of both the left and right ventricular walls. The liver weighed 1880 grams and was congested. The spleen weighed 200 grams and was also congested. The combined lung weight was 1875 grams; the lungs were markedly fibrotic with severe emphysema. In addition, dermal thickening was evident throughout the body and the wall of the esophagus was thickened and firm.
		+
	== Images ==		== Images ==
	<gallery heights="250px" widths="250px">		<gallery heights="250px" widths="250px">

@@ Line 1: / Line 1: @@
 == Images ==
 <gallery heights="250px" widths="250px">
-File:IPLab6TB1.jpg|
+File:IPLab6TB1.jpg|This is a photograph of a section of lung with an apical lesion. This lesion represents an old healed lesion from Mycobacterium tuberculosis infection.
-File:IPLab6TB2.jpg|
+File:IPLab6TB2.jpg|This is a low-power photomicrograph of lung tissue with multiple circumscribed nodules - granulomas (arrows).
-File:IPLab6TB3.jpg|
+File:IPLab6TB3.jpg|This is a higher-power photomicrograph of a TB granuloma. Note the eosinophilic material in the center of this granuloma (caseous necrosis) and the epithelioid macrophages and giant cells around the periphery.
-File:IPLab6TB4.jpg|
+File:IPLab6TB4.jpg|This is a higher-power photomicrograph of a TB granuloma. The area of caseous necrosis is on the left side of the image, there are multinucleated giant cells and epithelioid macrophages throughout the remainder of the tissue.
-File:IPLab6TB5.jpg|
+File:IPLab6TB5.jpg|High-power photomicrograph of a TB granuloma with multinucleated giant cells adjacent to an area of caseous necrosis (to the left).
 </gallery>