Upper Respiratory tract diseases Pathology.pdf

Pathology of the Upper respiratory tract

1. Upper Respiratory Tract
Pathology
Respiratory Pathology

2. OVERVIEW
–Upper respiratory tract lesions
–Pulmonary infections
–Atelectasis (collapse)
–Acute Pulmonary Injury
–Obstructive Pulmonary Disease (COPD)
–Diffuse interstitial (Restrictive, Infiltrative) Lung Diseases
–Vascular Pulmonary Diseases
–Lung tumors
–Pleural lesions

3. The Respiratory Tract (RT)

4. The Upper Respiratory Tract (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
•Common cold
•Pharyngitis
•Epiglottitis
•Laryngitis
•Laryngotracheobronchitis (croup)
•Sinusitis

7. Common cold
•Acute infections of the URT mostly viraland self-
limiting but can predispose to secondary
bacterial infection
•Nasal congestion, watery nasal discharge
(rhinorrhea), sneezing, dry sore throatand a
slight increase in temperatureespecially in young
children, malaise, myalgiaand headache,

8. •More than 200 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 of the URT
•Acute pharyngitis
•Mild accompanying common cold
•Severe cases need to be seriously taken –
•beta-haemolyticstreptococcal infection is associated
with tonsillitis;
•CoxsackievirusA causes pharyngeal vesicles and ulcers;
•Infectious mononucleosis is caused by Epstein-Barr
virus and is another cause of pharyngitis

10. Diffuse tonsillarand
pharyngeal erythema
seen here as a non-
specific finding that
can be produced by a
variety of pathogens

11. Exudative tonsillitis
seen with either
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 old was in
severe distress
and was too
exhausted to hold
its head up.
The epiglottis
appears intensely
red and swollen.

16. •Acute laryngitis
Common cold, allergic reaction or due to inhalation of
irritants
•Tuberculouslaryngitis
•Diphtheriacaused by Corynebacteriumdiphtheriae,
implants in the mucosa and produces an exotoxin that
results in necrosis and a dense fibrinopurulent
exudate forming the classic pseudomembraneof
diphteriawith 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
•

18. Paranasal Sinuses

19. Lateral view of paranasal sinuses

20. Sinusitis
•Bacterial or viral
•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
•Ethmoidsinusitis: edema of eyelids, tearing,
retroorbitalpain, proptosis
•Sphenoid sinusitis: intractable headache,
hypo/hyperesthesia of ophthalmic or maxillary
branches of trigeminal n. (30%)

22. Sinusitis -Inflammation of paranasal sinuses

23. Diagnosis of sinusitis
Dr.Emad Ibrahim Osman
•Nasal swabs not helpful
•Transilluminationof 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 predispose to sinusitis
•Impaired mucociliaryfunction
•Obstruction of sinus ostia
•Immune defects
•Increased risk of microbial invasion
10/2/98

25. Chronic sinusitis
•Symptoms for > 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
Complication Clinical Signs
•Meningitis Headache,fever,
stiff neck lethargy,
rapid death
•Osteomyelitis Pott’spuffy 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
•A polyp 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 is related to the obstruction,
leading to chronic sinusitis, facial pain, bony
erosion.
•Hyposmiaand anosmia.
•Polyps are not pre-malignant, however can be
confused with the pre-malignant lesions.

29. Nasal polyps

30. Histological findings
•Pseudostratified
ciliated columnar
epithelium
•Thickened epithelial
basement membrane
•Oedematous stroma

31. Nasopharyngeal carcinoma
•Strong epidemiological association with
Epstein-Barr virus
•Endemic in Asia especially China
•Squamous cell carcinoma –mostly
undifferentiated carcinoma
•Invades locally, spreads to the cervical lymph
nodesand then distantly
•Radiosensitiveand 5-year survival is 50%

32. Pathology
•WHO I tumors are keratinizing squamous cell carcinomas.
These tumors are not related to EBV infection.
•WHO II tumors are nonkeratinizingsquamous cell
carcinomas. These tumors histologicallyresemble
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.

33. Nasopharyngeal anaplastic carcinoma

34. Laryngeal lesions
•Most common 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 alcoholand
previous radiation exposure,
squamous cell carcinoma-may be glottic,
supraglottic or subglottic

35. The End
Thanks