Question

A patient collapses with breathlessness and pink frothy sputum. Autopsy shows hemosiderin-laden macrophages. In which condition is this not seen?

• A. Protein-losing enteropathy
• B. Right heart failure
• C. Volume overload
• D. Pulmonary vein obstruction

Hint:

Hemosiderin-laden macrophages in lungs are heart failure cells, seen in chronic pulmonary congestion.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
The clinical symptoms (pink frothy sputum) and histological findings (hemosiderin-laden macrophages, also known as "heart failure cells") are characteristic of chronic passive congestion of the lungs due to left-sided heart failure or pulmonary venous hypertension. We need to find the condition where this would not occur.
Step 2: Detailed Explanation:

Heart Failure Cells: When there is increased pressure in the pulmonary capillaries, red blood cells leak into the alveoli. Alveolar macrophages phagocytose these RBCs, and the hemoglobin is converted into hemosiderin. These pigmented macrophages are a hallmark of chronic pulmonary congestion.

Conditions with Pulmonary Congestion:
- Left Heart Failure: Leads to back-up of blood into the lungs. Note: The question says Right heart failure (Option B) is where it is "not seen." However, in clinical practice, chronic left heart failure leads to right heart failure. Let's re-evaluate the pathology. Isolated right heart failure causes systemic congestion (liver/spleen) but not pulmonary congestion.
- Volume Overload (C): Increases hydrostatic pressure globally, including pulmonary vessels.
- Pulmonary Vein Obstruction (D): Directly blocks outflow from the lungs, causing massive leakage into alveoli.

Protein-losing enteropathy (A): This condition leads to loss of serum proteins through the gut, causing severe hypoalbuminemia. While this leads to generalized edema (anasarca) due to low oncotic pressure, it does not typically cause the micro-hemorrhages into alveoli that produce hemosiderin-laden macrophages.

Step 3: Final Answer:
Protein-losing enteropathy causes low oncotic pressure and transudative edema, but not the chronic congestion and RBC leakage required to form hemosiderin-laden macrophages.