Lec 21 Pathology of Vascular Disease Flashcards Preview

Pulm > Lec 21 Pathology of Vascular Disease > Flashcards

Flashcards in Lec 21 Pathology of Vascular Disease Deck (32):
1

What are risk factors for pulm embolism?

- hypercoagulable
- oral contraceptives
- pregnancy
- immobilization

2

What are symptoms of small infarct?

usually minimal
major SOB; also tachycardia, pain, fever, cough, hemoptysis

3

What are two mech by which large emboli can cause sudden death?

- lodging in major branch of pulm artery or at bifurcation --> electromech dissociation with rhythm but not pulse

- acute cor pulmonale [dilated R heart] due to local increase resistance to flow, pulm HTN, R heart failure

4

What do you see grossly in smaller emboli? massive emboli?

smaller = wedge shaped hemorrhagic infarct

larger = may have no parenchymal changes

5

WHat is definition of pulm HTN?

pulm artery pressure > 25 mmHg

6

What usually causes pulm htn?

- structural disease causing increased pulm blood flow or pressure
- increased pulm vascular resistance
- increased left heart resistance

7

Who gets pulmonary arterial hypertension?

- rare disease
- mostly young women

idiopathic or due to collagen vascular disease, drugs, etc

8

What classic finding in pulmonary arterial htn?

plexiform lesions

9

What is classic clinical picture of pulmonary arterialhtn?

young women w/ progressive SOB, angina, syncope, possibly suddent death

10

What is prognosis of PAH?

death usually w/in a few years

11

What is grade I PAH?

muscularization and medial hypertrophy of pulm arteries

12

What is grade II PAH?

intimatl hyperplasia causing attenuation of vascular lumen

13

What is grade III PAH?

subintimal fibrosis w/ onion-ring appearance

have reduplication of internal elastic membrane; arteries + arterioles look like pipes

14

What is grade 4/5 PAH?

dilation and plexiform lesions; have dilation of small pulm arteries

15

What is grade 6 PAH?

uncommon acute necrotizing arteritis w/ fibrinoid necrosis and acute inflammation of vessel wall

similar to polyarteritis nodosa

16

What is a plexiform lesion?

characteristic of advanced pulm htn; seen in small arteries

looks like glomerulus have lots of different lumens

17

Who gets wegeners / PGA?

wide range; mean 50 yo

18

What is classic triad of involvement wegener's/PGA?

- sinus
- lung
- renal

19

What do you see in wegeners/PGA?

- small vessel involvement
- multiple lung nodules usually
- C-ANCA

20

What do you see on histology in wegener's/PGA?

- parenchyma necrosis = irregular areas of necrosis w/ lots of neutrophils ("dirty necrosis" b/c it looks blue)
- necrotic area surrounded by scattered giant cells and histiocytes
- no well formed granulomas

vasculitis not requirement for diagnosis!

21

What is triad of churg-strauss?

- asthma
- eosinophilia
- vasculitis

22

Who gets churg-straus?

equal genders; mean age 50

23

What parts of body typically involved in churg strauss?

neuropathy, cardiac, lung, sinonasal

don't usually have renal

24

WHat do you see in churg strauss?

- lung radiographs w/ multifocal infiltrates that may change over time; looks patchy

asthmatic bronchitis, eosinophilic pneumonia, stellate granulomas, vasculitis

25

What type of granulomas do you see in churg straus?

histiocytes/giant cells surrounding central necrotic zone w/ eosinophils

26

What do you see in microscopic polyangiitis [MPA]?

pauci-immune vasculitis restricted to arterioles, venules, capillaries

27

What are systemic manifestations of microscopic polyangiitis?

- glomerulonephritis !!!!
- fever
- myalgia, arthralgia
- weight loss
- ENT symptoms

28

What type of anca in microscopic polyangitis?

P-ANCA

29

What type of anca in churg strauss?

P anca

30

What do you see on biopsy in microscopic polyangiitis?

diffuse alveolar hemorrhage w/ neutrophilic capillaritis

no granulomas, giant cells, eosinophils

31

What are some things that cause diffuse alveolar hemorrhage w/ capillaritis?

- microscopic polyangiitis
- lupus
- wegeners [rare]
- goodpasture's
- drug rxn
- infection

32

What is major clinical finding in diffuse alveolar hemorrhage?

signficant hemoptysis