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10614 Pathology

A 62-year-old man is a smoker with a 10-year history of cough productive of copious mucopurulent sputum. Over the past 6 months, he has developed progressive dyspnea. Physical examination shows bilateral pedal edema and a soft but enlarged liver. A chest radiograph shows bilateral pleural effusions and a prominent right heart border. Arterial blood gas values are PO2, 60 mm Hg; PCO2, 52 mm Hg; pH, 7.30; and HCO3-, 29 mEq/L. He is intubated and placed on a ventilator, and he requires increasing amounts of oxygen. Which of the following microscopic findings is most likely to be present in the affected lungs?

ABronchovascular distribution of granulomas
BCarcinoma filling lymphatic spaces
CExtensive interstitial fibrosis
DHypertrophy of bronchial submucosal glands
Pathology
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