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A silicotic nodule in lung is seen here. It is composed mainly of bundles of interlacing pink collagen. There is a minimal inflammatory reaction.

Anthracotic pigment ordinarily is not fibrogenic, but in massive amounts (as in "black lung disease" in coal miners) a fibrogenic response can be elicited to produce the "coal worker's pneumoconiosis" seen here.

 

Restrictive Lung Diseases

Disease

Mechanism

 

 

 

 

This idiopathic condition is characterized by granuloma formation. The granulomas

Sarcoidosis are typically non-caseating. Hilar lymph nodes are nearly always involved and can become quite large

At low magnification can be seen multiple small granulomas in this case of sarcoidosis. These numerous interstitial granulomas can produce a restrictive lung disease.

 

Restrictive Lung Diseases

Disease

Mechanism

 

There is antiglomerular basement membrane

 

antibody (that also is directed at pulmonary capillary

Goodpasture

basement membranes) that causes a form of type II

Syndrome

hypersensitivity reaction which damages alveolar

 

capillary basement membranes with subsequent

 

hemorrhage into alveoli

The acute intra-alveolar hemorrhage seen here is a consequence of capillary injury from basement membrane antibody in a patient with Goodpasture syndrome. The glomerular capillaries are targeted as well, leading to a rapidly progressive glomerulonephritis. Circulating anti-glomerular basement membrane antibody can be detected.

Restrictive Lung Diseases

Disease

Mechanism

Hypersensitivity

Pneumonitis

Inhaled allergens produce localized antigen- antibody complexes that lead to an acute extrinsic allergic alveolitis, a form of type III hypersensitivity. If chronic, there can be a type IV hypersensitivity response

In this is an example of hypersensitivity pneumonitis that has become more chronic, a granulomatous type of inflammation is present, indicative of a type IV hypersensitivity reaction.

This is hypersensitivity pneumonitis, a type of interstitial pneumonitis also known as extrinsic allergic alveolitis because it occurs when there is an inhaled organic dust that produces a localized for of type III hypersensitivity (Arthus) reaction from antigen-antibody complexes.

 

Restrictive Lung Diseases

Disease

Mechanism

Therapeutic

Complications

Radiation

Drugs

The lungs can be damaged by radiation and pharmacologic agents used to treat various conditions

External beam radiation therapy, particularly mantle radiation for Hodgkin disease, can result in progressive fibrosis of interstitium and pleura

The chemotherapeutic agents bleomycin and busulfan in particular induce pulmonary fibrosis

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