WBR0394

Author	[[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Pulmonology
Prompt	[[Prompt::A 72-year-old man presents to the pulmonary clinic for chronic cough and recent onset dyspnea on exertion. He reports that he has been admitted to the hospital at least 4 times in the past 60 days for the treatment of pneumonia. After initial work-up is unrevealing, the physician decides to perform a bronchoscopy with bronchoalveolar lavage (BAL). A centrifuged sample of the BAL specimen is shown below. Which of the following conditions are associated with this patient's findings? ]]
Answer A	AnswerA::Fungal colonization of the lung
Answer A Explanation	AnswerAExp::Fungal colonization of the lung would show mold or yeast species on microscopy.
Answer B	AnswerB::Chronic obstructive lung disease
Answer B Explanation	AnswerBExp::Patients with chronic obstructive lung diseases usually have excess sputum production with Curschmann's spirals often seen on sputum microscopy.
Answer C	AnswerC::Helminth infection in the lungs
Answer C Explanation	AnswerCExp::Helminth infection in the lungs is not associated with Curschmann's spirals. Eosinophils are usually abundant on BAL.
Answer D	AnswerD::Small cell lung carcinoma
Answer D Explanation	AnswerDExp::Small cell lung carcinoma does not produce Curschmann's spirals that can be seen on BAL examination.
Answer E	AnswerE::Chronic asbestos exposure
Answer E Explanation	AnswerEExp::Chronic asbestos exposure is associated with Asbestos bodies on BAL that are golden-brown structures resembling dumbbells.
Right Answer	RightAnswer::B
Explanation	[[Explanation::Curschmann's spirals are spiral shaped mucus plugs found in the sputum of patients who suffer from asthma or chronic bronchitis or those who have been chronic smokers. They are associated with excess sputum production and are composed mainly of glycoproteins. Although they have little diagnostic significance, they are a classic sign of obstructive lung diseases. In asthma, they are usually seen with Charcot-Leyden crystals. Educational Objective: Curschmann's spirals are spiral shaped mucus plugs found in the sputum of patients who suffer from asthma or chronic bronchitis or in chronic smokers. References: Antonakopoulos GN, Lambrinaki E, Kyrkou KA. Curschmann's spirals in sputum: Histochemical evidence of bronchial gland ductal origin. Diagn. Cytopathol. 1987;3(4):291-294.]]
Approved	Approved::Yes
Keyword	WBRKeyword::COPD, WBRKeyword::Curschmann's spirals, WBRKeyword::Asthma
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::