On the cover

The background image was obtained using threedimensional, micro-computed tomography (microCT) on a lung specimen from a normal donor. Airways
and blood vessels are shown penetrating alveolar
ducts and alveoli. Imaging was performed at 8-m
isotropic resolution (McDonough JE, Yuan R, Suzuki M, et al. Smallairway obstruction and emphysema in chronic obstructive pulmonary
disease. N Engl J Med. 2011;365(17):15671575. PMCID: PMC3238466).
The clinical CT images in the insets are still frames captured from the
corresponding online video, which can be accessed by scanning the
adjacent QR code. The top image, a maximum-intensity projection of
a reformatted coronal section, shows contrast-enhanced pulmonary
vasculature. The bottom image, a volume rendering of a similar reformatted coronal section using inverted gray scale, reveals the airways.
The initial portion of the video, comprised of a coronal view from a
contrast-enhanced chest CT scan obtained from a normal, 25-year-old
woman, shows volume rendering of the bony thorax and pulmonary
vasculature. The video transitions to volume rendering of the lungs,

trachea, and bronchi. Shown subsequently is a rotating tomographic

section of the distal airways. A red box in the section indicates the
general location from which a lung specimen was obtained from a
separate, normal donor for micro-CT imaging. The last segment of
this portion of the video shows rectangular volume rendering of the
specimen, which then transitions to a rotating tomographic depiction.
Blood vessels (solid arrow), alveolar ducts (dashed arrow), and alveoli
(dotted arrow) are identified. The second portion of the video demonstrates an unenhanced CT scan from a 63-year-old female lung transplant recipient who had severe COPD. The patients chest x-ray is shown
on the left and axial CT images on the right. The red box indicates the
location from which a specimen was obtained from the explanted
emphysematous lung for micro-CT imaging. The micro-CT segment in
the video includes rectangular volume rendering of the emphysematous lung specimen and, subsequently, a rotating tomographic section
of the tissue sample. Loss of alveolar structure is evident. Blood vessels
(solid arrow), alveolar ducts (dashed arrow), and alveoli (dotted arrow)
are noted. In this specimen, blood vessels are filled with residual blood.

Images courtesy of James C. Hogg, MD, PhD, John E. McDonough, PhD (both from the University of British Columbia), Joel D. Cooper, MD, Warren B. Gefter, MD,
Michael A. Grippi, MD, Pablo G. Sanchez, MD, Drew A. Torigian, MD, and Alexander C. Wright, PhD (all from the University of Pennsylvania).

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Fishmans Pulmonary
Diseases and Disorders

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Notice
Medicine is an ever-changing science. As new research and clinical experience broaden
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error or changes in medical sciences, neither the authors nor the publisher nor any other
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in connection with new or infrequently used drugs.

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Fishmans Pulmonary
Diseases and Disorders
Fifth Edition
Editor-in-Chief
Michael A. Grippi, MD
Vice Chairman, Department of Medicine
Pulmonary, Allergy, and Critical Care Division
Perelman School of Medicine at the University of Pennsylvania
Chief Medical Officer, GSPP Specialty Hospital
Philadelphia, Pennsylvania

Editors
Jack A. Elias, MD
Dean of Medicine and Biologic Sciences
Frank L. Day Professor of Biology
Professor of Medicine
Professor of Molecular Microbiology and Immunology
Professor of Molecular Biology, Cell Biology, and Biochemistry
Brown University
Warren Alpert School of Medicine
Providence, Rhode Island

Jay A. Fishman, MD
Professor of Medicine
Harvard Medical School
Director, Transplant Infectious Disease and
Compromised Host Program
Massachusetts General Hospital
Associate Director, MGH Transplantation Center
Boston, Massachusetts

Robert M. Kotloff, MD
Chairman, Department of Pulmonary Medicine
Respiratory Institute
Cleveland Clinic
Cleveland, Ohio

Allan I. Pack, MBChB, PhD

John Miclot Professor of Medicine
Chief, Division of Sleep Medicine/Department of Medicine
Director, Center for Sleep and Circadian Neurobiology
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

Robert M. Senior, MD
Professor of Medicine
Professor of Cell Biology & Physiology
Washington University School of Medicine
St. Louis, Missouri

Video Editor
Mark D. Siegel, MD
Professor of Medicine
Department of Internal Medicine
Yale School of Medicine
New Haven, Connecticut

New YorkChicagoSan FranciscoAthensLondonMadridMexico City

MilanNew DelhiSingaporeSydneyToronto

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Copyright 2015 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be
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ISBN: 978-1-25-958912-6
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Alfred P. Fishman, MD, 19182010

Alfred P. Fishman, MD, was a husband, father, scientist, clinician, author, and consummate editor. The breadth and depth of his intellectual
curiosity were great, and his contributions to pulmonary medicine and science of real consequence. He was an exacting task master who set
a high bar for all of us, as well as for himself; his commitment to excellence was steadfast. The editors of the fifth edition dedicate this work
to Dr. Fishmanthe man, the mentor, and the driving force behind the origins of Pulmonary Diseases and Disorders.
To Barbara, Kristen, Amy, Emily, Sawyer, Levi, and Kieran
Michael A. Grippi, MD
To Sandy, Lauren, Alma, and Gabby
Jack A. Elias, MD
To Gayle, Aaron, and Brian
Jay A. Fishman, MD
To Debbie, Eric, Brian, and Ethan; and to the memory of Jean and Leon Kotloff
Robert M. Kotloff, MD
To Fran, Alison, Angela, Andrew, and Allan Jr.
Allan I. Pack, MBChB, PhD
To Martha, Jocelyn, Rebecca, Devra, and David
Robert M. Senior, MD

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