Blood Vessels Flashcards by Jamaira Belmes

54/F, known hypertensive w/ rising BUN and creatinine. Impression - hypertensive nephrosclerosis.
Renal Biopsy: HOMOGENOUS, pink, hyaline material on the walls of ARTERIOLES w/ NARROWING of the lumen.

Vascular pathology seen

Hyaline Arteriolosclerosis

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55/M, presented w/ SUDDEN ONSET OF OLIGURIA and BP 220/110 mmHg. Patient eventually died.
Autopsy: “ONION SKIN”, concentric, laminated thickening of the walls of arterioles w/ luminal narrowing and necrotizing arteriolitis

Hyperplastic Arteriolosclerosis

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67/M known hypertensive and diabetic, presented w/ exertional retrosternal chest heaviness lasting for 5 mins, relieved by rest and sublingual nitroglycerin.
Angiography revealed 75% stenosis of the LAD.

Diagnosis and pathologic consequence of atherosclerosis

Chronic Stable Angina Pectoris

Atherosclerotic stenosis

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67/M known hypertensive and diabetic, presented w/ retrosternal chest heaviness lasting for 30 mins at rest, NOT relieved by sublingual nitroglycerin.
ECG - ST segment elevation leads II, III, avF

Autopsy: LARGE INTRAPLAQUE HEMORRHAGE that OCCLUDED THE WHOLE VESSEL

Diagnosis and pathologic consequence of atherosclerosis

Inferior wall STEMI

Acute Plaque Change (Hemorrhage)

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34/F known case of ADPKD presented w/ SEVERE HEADACHE and EVENTUAL COLLAPSE.

Antemortem plain CT scan: ENHANCEMENT of sulci
Autopsy: multiple saccular dilatations along the vessels of COW with ruptured one on the ACA-ACoA junction

Subarachnoid Hemorrhage (SAH) secondary to Ruptured Intracranial Berry Aneurysm

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55/M, known HPN w/ previous CXR and plain abdominal films only showing ATHEROMATOUS AORTA presented w/ PULSATING ABDOMINAL MASS.

Autopsy: fusiform dilation of the abdominal aorta with a point of rupture

Ruptured Abdominal Aortic Aneurysm

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34/M, 6’5 w/ LONG FINGERS presented w/ chronic nonproductive cough.
PE: 120/10.
Patient suddenly went hypotensive, w/ muffled heart sounds and neck vein distention.

Autopsy: 200 cc of blood in the pericardial cavity w/ fusiform dilation of the abdominal aorta w/ a point of rupture.

Ruptured Thoracic Aortic Aneurysm

Marfan syndrome

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34/M, 6’5 w/ LONG FINGERS presented w/ chronic nonproductive cough.
Presented w/ sudden onset of exquisite chest pain, tearing in character, radiating to the back w/ sudden cardiovascular collapse and death.

Autopsy: Secondary lumen in the thoracic aorta w/ point of tear noted proximal to the formation of secondary lumen

Aortic Dissection

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65/F, known case of polymyalgia rheumatica presented w/ severe headache and diplopia associated w/ fever and fatigue.
PE: tenderness over the course of superficial temporal artery
Biopsy: intimal thickening of the artery, granulomatous inflammation of the internal elastic lamina w/ infiltrate of T cells and macrophages

Diagnosis

Giant Cell Arteritis (Large Arteries)

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38/F, with fatigue, weight loss and fever and REDUCED BLOOD PRESSURE, WEAK PULSES IN THE CAROTIDS and UPPER EXTREMITIES, OCULAR DISTURBANCES and NEUROLOGIC DEFECTS.

Biopsy: intimal thickening of the artery, granulomatous inflammation of the internal elastic lamina w/ infiltrate of T cells and macrophages

Diagnosis

Takayasu Arteritis (Large Arteries)

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56/M, known case of CHRONIC HEPA B, presented w/ RAPIDLY ACCELERATING HPN, ABDOMINAL PAIN, BLOODY STOOL and MYALGIA and eventually expired.

Biopsy: segmental TRANSMURAL necrotizing inflammation w/ EXTENSIVE fibrinoid necrosis and temporal heterogeneity lesions

Polyarteritis Nodosa (PAN)

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4/F, presented w/ FEVER and MACULOPAPULAR RASH on trunk and extremities associated w/ CONJUNCTIVAL ERYTHEMA and CERVICAL LYMPH NODE ENLARGEMENT.

Biopsy: segmental TRANSMURAL necrotizing inflammation w/ LESS fibrinoid necrosis

Kawasaki Disease

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45/M, presented w/ HEMOPTYSIS and HEMATURIA
Serology: p-ANCA/MPO-ANCA (+)

Biopsy: vasculitis pattern similar to PAN but lesions are of the same stage and with FRAGMENTED PMNs in post-capillary venules (leukocytoclasia)

Microscopic Polyangiitis

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34/F, known case of BRONCHIAL ASTHMA
CBC: 62% eosinophils, (-) blasts
Serology: p-ANCA/MPO-ANCA (+)

Biopsy: Granulomatous inflammation involving the respiratory tract and necrotizing vasculitis

Churg-Strauss Syndrome

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54/M, (+) hemoptysis and hematuria w/ increasing BUN and creatinine
Serology: c-ANCA (PR3-ANCA) (+)

Biopsy: necrotizing granulomas of the respiratory tract, necrotizing vasculitis and CRESCENTIC GLOMERULONEPHRITIS
(-) findings on immunofluorescence

Granulomatosis w/ Polyangiitis (Wegener Granulomatosis)

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30/M, smoker w/ INTERMITTENT CLAUDICATION with right leg

Biopsy: segmental thrombosing acute and chronic vasculitis w/ microabscesses

Thromboangiitis obliterans (Buerger disease)

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45/M, CHRONIC ALCOHOLIC, known case of LIVER CIRRHOSIS
multiple, radial, pulsatile arrays of dilated submucosal arteries that blanch in pressure

Spider telangiectasia

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4/M, with SEIZURES, MENTAL RETARDATION and HEMIPLEGIA

PE: port wine stain on the left

CT scan: extraaxial hyperdense lesion on the left parietal convexity

Biopsy: dilated venous vessels

Sturge Weber Syndrome

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4/F with PINKISH, EXOPHYTIC lesion on the LIP since birth

Biopsy: small, endothelial-lined spaces filled w/ RBCs

Capillary Hemangiomas

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4/F with PINKISH, EXOPHYTIC lesion on the LIP AFTER history of TRAUMA

Biopsy: small, endothelial-lined spaces filled w/ RBCs
granulating acute and chronic inflammation

Pyogenic Granuloma

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43/F w/ LIVER MASS

Biopsy: Dilated vascular spaces filled w/ blood

Cavernous Hemangioma

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15/F, SHORT STATURE and AMENORRHEA presented w/ a MASS on the NECK (10 cm in widest dimension)

Biopsy: dilated endothelial lined space WITHOUT RBCs

Cavernous Lymphangioma; Turner Syndrome

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29/M, known case of HIV, developed PUPRLE PLAQUES on bilateral lower extremities

Biopsy: dermal accumulation of jagged vascular channels lined and surrounded by plump spindle cells

Kaposi Sarcoma

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46/M, exposed to VINYL CHLORIDE presented w/ a LIVER MASS

Biopsy: sheets of spindle cells w/ occasional vessel formation

Immunohistochemistry: CD31, vWF (+)

Hepatic Angiosarcoma

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Vascular resistance is determined at the level of the

ARTERIOLES

Homogenous, pink hyaline thickening with associated luminal narrowing

Hyaline Arteriolosclerosis Essential HPN DM

Concentric, laminated thickening "onion skin" lesions

Hyperplastic Arteriolosclerosis Malignant HPN

Fibrinoid deposition and vessel wall necrosis (NECROTIZING arteriolitis)

Malignant HPN

Early lesions containing LIPID-FILLED FOAMY MACROPHAGES

Fatty streak small flat yellow macules --> elongated streaks

Fibrous cap + lipid core (+) neovascularization at the periphery

Atheromatous plaque yellow to tan

MC sites of atherosclerosis

LOWER abdominal aorta and ILIAC arteries

Most dangerous consequence of atherosclerosis

Acute Plaque Change

THIN fibrous cap LARGE lipid core INCREASED inflammation

VULNERABLE PLAQUE

Thickened and densely collagenous fibrous cap w/ minimal inflammation and atheromatous core

STABLE PLAQUE

4 PRINCIPAL COMPONENTS OF ATHEROSCLEROTIC PLAQUES

cells – SMCs, macrophages and T lymphocytes ECM – collagen, elastic fibers and proteoglycans intracellular and extracellular lipids calcifications in later stage plaques

Clinical manifestations of ANEURYSMS

(+) mass and mass effect erosion of bone rupture - hemorrhage and cardiovascular collapse

Abdominal aortic aneurysm (AAA) usually arise at the

INFRARENAL AORTA fewer elastic fibers and collagen more fragile vasa vasorum

HPN CT defects - Marfan, Loeys-Dietz syndrome Inflammatory disorders (aortitis)

Thoracic Aortic Aneurysm

40-60, M HPN young w/ CT defects - Marfan

Aortic dissection sudden excruciating anterior chest pain radiating to the back

MC site of aortic dissection

ASCENDING AORTA - w/n 10 cm of the aortic valve

MC site of aortic dissection

ASCENDING AORTA - w/n 10 cm of the aortic valve

MC form of vasculitis among OLDER population (>50) TEMPORAL, OPHTHALMIC headache, pain tenderness along SUPERFICIAL TEMPORAL a diplopia or complete vision loss associated with POLYMYALGIA RHEUMATICA

LARGE Vessel Vasculitis GIANT CELL ARTERITIS (TEMPORAL CELL ARTERITIS)

<50 y/o AORTIC ARCH great vessels pulmonary, coronary, renal ocular disturbances PULSELESS DISEASE - weakening of pulses in the UPPER limbs

LARGE Vessel Vasculitis TAKAYASU ARTERITIS

Morphology of LARGE VESSEL vasculitis

intimal thickening medial granulomatous inflammation w/ elastic lamina fragmentation T cell infiltrate (CD4 > CD8), macrophages, multinucleated giant cells

Associated w/ HEPATITIS B RENAL and VISCERAL VESSELS EXCEPT - pulmonary abdominal pain HPN

MIDDLE Vessel Vasculitis Polyarteritis Nodosa (PAN)

Morphology of MEDIUM VESSEL vasculitis

segmental, transmural necrotizing inflammation FIBRINOID NECROSIS AND LUMINAL THROMBOSIS *PAN - PROMINEN fibrinoid necrosis *KAWASAKI - LESS prominent fibrinoid necrosis temporal heterogeneity of lesions

Important cause of MI in CHILDREN CORONARY ARTERIES fever >5 days conjunctival injection mucosal erythema cervical lymphadenopathy polymorphous exanthem

MIDDLE Vessel Vasculitis Kawasaki Disease

Seen in vasculitis associated with HSP and CT disorders KIDNEY and LUNGS hemoptysis hematuria and proteinuria

SMALL Vessel Vasculitis MICROSCOPIC POLYANGIITIS MPO-ANCA/p-ANCA PAN but temporally homogenous leukocytoclastic vasculitis

Allergic granulomatosis and angiitis Associated w/ asthma, allergic rhinitis and eosinophilia Cutaneous GIT Renal palpable purpura GI bleed FSGS cardiomyopathy

SMALL Vessel Vasculitis CHURG STRAUSS SYNDROME (Eosinophilic Granulomatous with Polyangiitis) MPO-ANCA/p-ANCA PAN + extravascular necrotizing granulomas and eosinophils

PROMINENT PULMONARY INVOLVEMENT necrotizing granuloma necrotizing vasculitis necrotizing glomerulonephritis

SMALL Vessel Vasculitis GRANULOMATOSIS W/ ANGIITIS (WEGENER's GRANULOMATOSIS) PR3-ANCA (c-ANCA) acute necrotizing granulomas of respiratory tract necrotizing or granulomatous vasculitis crescentic G

Highly associated with HEAVY TOBACCO SMOKING small to medium - TIBIAL AND RADIAL Raynaud phenomenon intermittent claudication superficial nodular phlebitis

THROMBOANGIITIS OBLITERANS (BUERGER DISEASE) focal acute and chronic vasculitis thrombosis w/ micro abscesses

Small to medium NEUTROPHILIC VASCULITIS precipitated by HSV and parvovirus recurrent oral aphthous ulcers genital ulcers uveitis PATHERGY TEST

BEHCET SYNDROME HLA-B51 neutrophilic infiltration of vessels

Exaggerated vasoconstriction of arteries and arterioles in response to cold or emotion

Raynaud Phenomenon RED - WHITE - BLUE

Primary Raynaud

NON-progressive SYMMETRIC

Secondary Raynaud

PROGRESSIVE ASYMMETRIC ASSOCIATIONS: SLE, scleroderma, Buerger disease, atherosclerosis

Cancers associated with production of PROTHROMBOGENIC substances that cause the body to be in hypercoagulable state

LUNGS and PANCREATIC cancer

MC vascular ectasia Regress spontaneously

NEVUS FLAMMEUS (birthmark)

MC HIV related malignancy worldwide patch -- plaque -- nodule

Kaposi sarcoma - HHV-8

Benign tumor THIN WALLED capillaries with scan stroma

Hemangioma

Benign tumor UNENCAPSULATED, infiltrative borders Large, cavernous blood filled vascular spaces DEEP structures

Cavernous

VHL - chromosome 3 -- loss of function -- increased HIF-1 -- increased VEGF -- EXCESSIVE VESSEL GROWTH

VON HIPPEL LINDAU DISEASE *AD COMPONENTS: CNS hemangioblastomas cavernous hemangiomas pancreas, kidneys, liver cysts Renal cell ca pheochromocytomas

Benign tumor thin, endothelial lined spaces w/o RBC

Lymphangioma

Blood Vessels Flashcards

(62 cards)