A 56-year-old man complains of increasing dyspnea on exertion over the past few days. He is noted to be overweight and cyanotic. He has smoked cigarettes for at least 35 years and has a long-standing history of persistent cough, producing a large amount of thick mucopurulent sputum. Auscultation reveals scattered rhonchi and wheezes. Histological examination of his lung tissue would most likely show which of the following?
(A) expanded alveolar septae infiltrated by mononuclear cells
(B) mucous gland hypertrophy and fibrosis of bronchiolar walls
© neutrophilic exudate occupying the alveoli of an entire lobe
(D) pink, proteinaceous layer lining the alveolar spaces
(E) thickened basement membranes and many eosinophils
(B) This presentation is fairly typical for a patient with chronic bronchitis. Microscopically one would expect to see hypertrophy of bronchial mucous glands accompanied by chronic inflammation and fibrosis of bronchiolar walls. Expanded or thickened alveolar septae infiltrated by mononuclear cells (choice A) would be seen when there is an interstitial response in the lung as, for example, in viral or mycoplasmal pneumonia. Neutrophilic exudate occupying the alveoli of an entire lobe (choice C) is a description of a classic lobar pneumonia. Pink, proteinaceous layer lining the alveolar spaces (choice D) is a hyaline membrane that one might see in shock lung or respiratory distress syndrome. Thickened basement membranes and many eosinophils (choice E) would be seen in asthma.