Flashcards in Lec 21 Pathology of Vascular Disease Deck (32):
What are risk factors for pulm embolism?
- oral contraceptives
What are symptoms of small infarct?
major SOB; also tachycardia, pain, fever, cough, hemoptysis
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
What do you see grossly in smaller emboli? massive emboli?
smaller = wedge shaped hemorrhagic infarct
larger = may have no parenchymal changes
WHat is definition of pulm HTN?
pulm artery pressure > 25 mmHg
What usually causes pulm htn?
- structural disease causing increased pulm blood flow or pressure
- increased pulm vascular resistance
- increased left heart resistance
Who gets pulmonary arterial hypertension?
- rare disease
- mostly young women
idiopathic or due to collagen vascular disease, drugs, etc
What classic finding in pulmonary arterial htn?
What is classic clinical picture of pulmonary arterialhtn?
young women w/ progressive SOB, angina, syncope, possibly suddent death
What is prognosis of PAH?
death usually w/in a few years
What is grade I PAH?
muscularization and medial hypertrophy of pulm arteries
What is grade II PAH?
intimatl hyperplasia causing attenuation of vascular lumen
What is grade III PAH?
subintimal fibrosis w/ onion-ring appearance
have reduplication of internal elastic membrane; arteries + arterioles look like pipes
What is grade 4/5 PAH?
dilation and plexiform lesions; have dilation of small pulm arteries
What is grade 6 PAH?
uncommon acute necrotizing arteritis w/ fibrinoid necrosis and acute inflammation of vessel wall
similar to polyarteritis nodosa
What is a plexiform lesion?
characteristic of advanced pulm htn; seen in small arteries
looks like glomerulus have lots of different lumens
Who gets wegeners / PGA?
wide range; mean 50 yo
What is classic triad of involvement wegener's/PGA?
What do you see in wegeners/PGA?
- small vessel involvement
- multiple lung nodules usually
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!
What is triad of churg-strauss?
Who gets churg-straus?
equal genders; mean age 50
What parts of body typically involved in churg strauss?
neuropathy, cardiac, lung, sinonasal
don't usually have renal
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
What type of granulomas do you see in churg straus?
histiocytes/giant cells surrounding central necrotic zone w/ eosinophils
What do you see in microscopic polyangiitis [MPA]?
pauci-immune vasculitis restricted to arterioles, venules, capillaries
What are systemic manifestations of microscopic polyangiitis?
- glomerulonephritis !!!!
- myalgia, arthralgia
- weight loss
- ENT symptoms
What type of anca in microscopic polyangitis?
What type of anca in churg strauss?
What do you see on biopsy in microscopic polyangiitis?
diffuse alveolar hemorrhage w/ neutrophilic capillaritis
no granulomas, giant cells, eosinophils
What are some things that cause diffuse alveolar hemorrhage w/ capillaritis?
- microscopic polyangiitis
- wegeners [rare]
- drug rxn