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Pulmonary Pathology Images

Dean E. Schraufnagel, MD
Professor
Department of Medicine & Pathology
University of Illinois at Chicago
Chicago, IL

Introduction

Images continue to be important for teaching lung pathology to pulmonary fellows in small group settings, for self-learning and for enhancing lectures on lung disease. The world of images, however, has changed since the first Best of the Web-Pulmonary Pathology was written in 2005. The internet now has easily searchable images for essentially every condition making these programs unnecessary for obtaining an image for a talk. Second, digital photography continues to be more readily available. Most microscopes now have digital cameras attached and it is commonplace to insert pictures in medical records, give them to referring physicians and share them widely. Nevertheless, there is still a place for going through pulmonary pathology images in small group sessions and these are the websites reviewed. In a change from previous versions, searching for pulmonary images for lecture slides was decreased in priority, which changed the ratings slightly.

The sites sought displayed both microscopic and gross images of the lung that could be used for pulmonary pathology teaching for group study or self-study. Sites could also be used by fellows studying for pulmonary board examinations or anyone wishing to visualize the cells and matrix involved in a particular lung disease. For this revision, a new search was performed as well as reviewing the sites previously cited.

Last Update: March 2010

Search

A Google™ search with the term “pulmonary pathology” (with quotes) yielded 97,000 sites then clicking on the Google entry “Images” reduced the number to 5,210 images. Searching “pulmonary pathology” (with quotes) and images yielded 27,600 entries. Browsing other sites continues to be a valuable tool for finding more resources. Two of these sites, pathguy.com and pathmax.com, had many valuable links and are excellent resources for those interested in pulmonary pathology on the Internet.

The sources found were most often university pathology departments, commercial laboratories, book reviews, cited articles, cases studies, lectures and pulmonary pathology of specific diseases. Of those that were educational, some were more lectures than atlases. This review focuses on useful images and is restricted to those allowing free access. Sites that did not open, had other serious navigational problems at the time of this review or had restricted access were not included.

These sites offer a great service to those wishing to learn or teach pulmonary pathology. Many reflect an extensive amount of work done by the developers. Before using the images, one should check each site for copyright restrictions. Most sites allow limited use for teaching purposes with acknowledgement of the source.

Best Websites

PathoPic Pathology Image Database

Katharina and Dieter Glatz-Krieger at the Institut für Pathologie in Basel have developed a database of thousands of images, of which about 700 are on the respiratory system. The images of both common and rare lung diseases are of high quality. Each image is classified according to its topography, diagnosis, stain and other features, and is easily searchable. A short description and clinical data are given in English and German. The site is extremely useful for individuals who need to find an image for teaching purposes. It is well designed for finding images, but less easy to demonstrate images serially for group discussions. There have been minor improvements to the already excellent website.

  1. Authority: The authors are not widely recognized as experts in pulmonary pathology and do not include references, but they have published on medical education and have additional input from other Swiss pathology institutes. Rating: 4

  2. Currency: The discussion generally reflects current thinking about these diseases. ATS/ ERS interstitial lung disease classifications are used. Rating: 5

  3. Accuracy: Sharp images show clear examples of pathology representative of the diseases discussed. Rating: 5

  4. Navigation & Readability: There is a "Guided Tour" in English and German which is helpful but it still takes time to learn how to find images. The site is designed for finding images and is less valuable for flipping through images for small group discussion or self-learning. Rating: 4

  5. Utility: The site is extremely useful for individuals who need to find an image for teaching purposes. Rating: 5

Summary: This is an outstanding site. Its strength is the abundant and clear images, although few new images have been added since the last review.*****

Atlas of Granulomatous Diseases

This site developed by Yale Rosen is devoted to granulomata and presents eight topics. Each topic has scores of high-quality images, which reflect the interest of the author and his collection of images amassed over many years. Since the last review, he has added 363 nongranulomatous images making it an outstanding site for general pulmonary pathology as well as granulomatous images. There is also addition discussion of granuloma formation. Pulmonologists, pathologists and basic science researchers will find this site well worth visiting.

  1. Authority: The author takes a classic approach with appropriate references. Rating: 5

  2. Currency: The site continues to make improvements. It is written from a clinical pathologist’s point of view but has added information on the cell processes of granulomata formation. Rating: 4

  3. Accuracy: The text and images appear to be representative of the diagnoses. Rating: 5

  4. Navigation & Readability: It is intuitive and easy to navigate, even though there is no search function. Rating: 5

  5. Utility: For anyone interested in the pathology of granulomata, this is an outstanding, must-read site. Rating: 5

Summary: This is an excellent site to learn about the pathology of granulomata, which are key to many diseases but with its new features also contains much other pulmonary pathology.*****

University of Alabama at Birmingham

Peir.net (pathology education instructional resource), developed under the supervision of Peter Anderson at the University of Alabama at Birmingham (UAB), features a collection of more than 40,000 pathology images from the UAB files and the Armed Forces Institute of Pathology (AFIP) Fascicles. Searching for “respiratory” topics yielded 3194 images. The image quality is good. The viewer has the opportunity to zoom in and out and save the images, but this process is slow.

  1. Authority: The AFIP is one of the most prestigious pathology institutes in the world. UAB also has a very good reputation in pathology. Rating: 5

  2. Currency: The site has diagnoses and images reflecting recent pathology topics, although the search resulted in the same number of images this year as in the last 4 years. Rating: 3

  3. Accuracy: The images are an excellent representation of the diagnoses listed. Rating: 5

  4. Navigation & Readability: It can be searched by diagnosis and keyword. It does not display a series of images by system that could be used as a flip-chart teaching tool. The response is slow, which may result from the large number of images of high resolution. Rating: 2

  5. Utility: The size of the pathology image library alone makes it invaluable. Rating: 4

Summary: This site is a great resource for individuals who need images for lectures and for viewing an image relating to a disease process. It is less useful for small group discussions unless the images are downloaded and placed in a presentation file.****

Webpath (University of Utah Pathology faculty)

This site features an atlas of lung pathology that includes 110 images of normal tissue and common lung diseases. It is part of a larger pathology collection whose purpose is to assist medical students in their study of pathology. It is also useful for review by pulmonary fellows and other medical or scientific personnel. Each image has a two-to-three-sentence basic discussion, as would be found in a textbook of general pathology. For the most part, the images are sharp and clear. Microscopic and gross images are coupled. Many images are accompanied by chest radiographs. The microscopic images and discussion of interstitial and fibrotic lung disease are geared to a general pathology audience.

  1. Authority: The material is good for general pathology, but there is no image or discussion of the recent interstitial pneumonia diagnoses and other highly specialized topics. Rating: 3

  2. Currency: Although most diagnoses do not change much with time, this site does not feature newer pulmonary pathological diagnoses, and there appears to be no change to the site in several years. Rating: 2

  3. Accuracy: The diagnoses corresponded with the tissue showed on the images. Rating: 4

  4. Navigation & Readability: The navigation was excellent and ideal for using cases for a flip-chart discussion. It has a quiz which might be fun for fellows to take but it is difficult to find. It can be accessed best by using “pulmonary pathology quiz” as Google search terms. Rating: 4

  5. Utility: For the purpose of teaching pulmonary fellows in a small group discussion, it is very good. Rating: 4

Summary: This is a useful site for a group discussion of pathology with fellows. Although the collection is limited, there is enough material for at least one or two sessions. Other sites with material are more suited for looking up individual diseases.****

Tulane Pathology Course

This site is part of a general pathology offering and contains seven individual lectures with images, although the access to two sites is restricted. Each of the others contains 40 to 64 images. The lectures are done by different authors and are somewhat uneven in their quality and format. They appear to be cross-linked only at the index page. Lectures are independently indexed in Google, and it is not at first apparent that they are teaching the same course. The one for gross pathology may fit better with the appropriate microscopic topics. The images are generally good. The annotation fits a basic audience, such as second-year medical students. However, the comprehensiveness makes it useful for a broad range of individuals.

  1. Authority: The text and images are appropriate for a general pathology audience. Rating: 4

  2. Currency: The images were prepared for the 2004-2005 academic year. The site has not been substantively updated, although much of the material is time insensitive. Rating: 2

  3. Accuracy: The images are often classic and represent their diagnoses. Rating: 4

  4. Navigation & Readability: The site is relatively easy to navigate but the different lectures and images are not well linked. Rating: 3

  5. Utility: This is a useful site for both individual study and small group review. Rating: 3

Summary: The site offers a large number of lung pathology images that are well labeled and annotated. A strength is its comprehensiveness. It is useful for those preparing talks or engaged in self-study.***

Other Important Sites

  • Johns Hopkins School of Medicine Pathology Department
    http://oac.med.jhmi.edu/Pathology/Viewer/MainMenu.html

    This site has 71 pulmonary pathology images of generally good quality covering obstructive, infectious, neoplastic, interstitial and other lung disease. There are short descriptions of each image.

  • Chilean Image Bank of Systemic Pathology
    http://escuela.med.puc.cl/paginas/Cursos/tercero/AnatomiaPatologica/Imagenes_AP/Indice_Fotos.html

    The Escuela de Medicina Pontificia Universidad Católica de Chile has more than 160 images of common lung diseases including atelectasis, bronchiectasis, emphysema, bronchitis, bronchiolitis, pneumonia, abscess, pneumoconiosis, cancer and tuberculosis. Each contains a short description and about six images. They are well displayed, but the images are not pristine. The material is written in Spanish but is easy to understand.

  • Pulmonary Pathology Atlas (Loyola, Aliya Husain)
    http://www.lumen.luc.edu/lumen/MedEd/medicine/pulmonar/path/lpath_f.htm

    This site has 90 topics of normal lungs and diseases. Each topic provides a good brief description and usually gross and microscopic images. It covers most common topics and provides useful information and images. The image quality, however, is only fair. The viewer has to return to the index to click on a category before going to the next images. It could be a good teaching tool for fellows. It has not been updated in several years.

  • University of Connecticut Department of Pathology
    http://radiology.uchc.edu/eAtlas/nav/msLung.htm

    This has about 124 pulmonary pathology images with gross and microscopic descriptions and clinical information. The material is referenced. The image quality is fair to good.

  • “Gr. T. Popa” University and Pharmacy In Romania
    http://www.pathologyatlas.ro/pulmonary-pathology.php

    This site has nine pulmonary headings and each entry has about three images that are illustrated with arrows and captions in English. The quality of the figures is fair to good.

  • Upstate Medical University in Syracuse
    http://www.ec.upstate.edu/path/cases/cases_cv_ns_blk.html

    The Pathology Department (Ana Katzenstein) of Upstate Medical University in Syracuse, NY has 43 lung images in the Pathology 201 course. The answers follow so that the viewer can take it as a quiz. There is no recent update.

Disclaimer

The author has no personal or financial interest in any of the websites discussed above.