What is the most common vasculature to be invaded by a malignancy for hematogenous spread?
Veins and lymphatics If in the head, however, veins bc there are no lymphatics in the cranium.
Fibromuscular dysplasia typically involves what arteries?
Fibromuscular dysplasia (FMD) typically involves renal and carotid arteries. Renal arterial stenosis activates the renin-angiotensin system, leading to hypertension. On angiography, FMD appears as a “string of beads” caused by focal medial hyperplasia with thickened fibromuscular ridges adjacent to less involved areas of the arterial wall. This is a surgically correctible cause for hypertension.
Necrotizing vasculitis occurs in pulmonary vasculature in association with:
Necrotizing vasculitis occurs in pulmonary vasculature in association with anti–neutrophil cytoplasmic autoantibody (ANCA)–associated granulomatous vasculitis.
Symmetrically smaller than normal kidneys can be caused by:
diabetes mellitus; systemic hypertension (hyaline arteriosclerosis) Hyaline arteriolosclerosis is seen with long-standing essential hypertension of moderate severity. These lesions give rise to benign nephrosclerosis. The affected kidneys become symmetrically shrunken and granular because of progressive loss of renal parenchyma and consequent fine scarring.
A 45-year-old man has had poorly controlled hypertension ranging from 150/90 mm Hg to 160/95 mm Hg for the past 11 years. Over the past 3 months, his blood pressure has increased to 250/125 mm Hg. On physical examination, his temperature is 36.9° C. His lungs are clear on auscultation, and his heart rate is regular. There is no abdominal pain on palpation. A chest radiograph shows a prominent border on the left side of the heart. Laboratory studies show that his serum creatinine level has increased during this time from 1.7 mg/dL to 3.8 mg/dL. What vascular lesions is most likely to be found in this patient’s kidneys?
Necrotizing arteriolitis Malignant hypertension can suddenly complicate and be superimposed on less severe, benign essential hypertension. The arterioles undergo concentric thickening and luminal narrowing with malignant hypertension, called hyperplastic arteriolosclerosis, and fibrinoid necrosis is a prominent feature.
What is Mockeberg arteriosclerosis?
a benign process that is a form of arteriosclerosis, often with no serious sequelae. The distal extremities, pelvis, thyroid, and breast regions are the most common locations.
An experiment studies early atheroma development. Lipid streaks on arterial walls are examined microscopically and biochemically to determine their cellular and chemical constituents and the factors promoting their formation. Early lesions show increased attachment of monocytes to endothelium. The monocytes migrate subendothelially and become macrophages; these macrophages transform themselves into foam cells. What substance is most likely to be responsible for the transformation of macrophages?
Oxidized LDL –can be taken up by a special “scavenger” pathway in macrophages; it also promotes monocyte chemotaxis and adherence. Macrophages taking up the lipid become foam cells that begin to form the fatty streak. Smoking, diabetes mellitus, and hypertension all promote free radical formation, and free radicals increase degradation of LDL to its oxidized form. About one third of LDL is degraded to the oxidized form; a higher LDL level increases the amount of oxidized LDL available for uptake into macrophages.
_______ are present early in the pathogenesis of atherosclerotic lesions and are believed to activate monocytes, endothelial cells, and smooth muscle cells by secreting cytokines.
T-cells T cells are present early in the pathogenesis of atherosclerotic lesions and are believed to activate monocytes, endothelial cells, and smooth muscle cells by secreting cytokines. T cells adhere to VCAM-1 on activated endothelial cells and migrate into the vessel wall. These T cells, activated by some unknown mechanism, secrete various proinflammatory molecules that recruit and activate monocytes and smooth muscle cells and perpetuate chronic inflammation of the vessel wall.
Syphilis (positive VDRL test result) produces endarteritis obliterans of the:
Syphilis (positive VDRL test result) produces endarteritis obliterans of the aortic vasa vasorum, which weakens the wall and predisposes to aortic aneurysm formation.
Classic polyarteritis nodosa (PAN) can produce small microaneurysms in small arteries, most often where?
Classic polyarteritis nodosa (PAN) can produce small microaneurysms in small arteries, most often renal and mesenteric. –segmental involvement of medium-sized arteries with aneurysmal dilation in the renal and mesenteric vascular beds (e.g., abdominal pain, melena). PAN can affect many organs at different times. Although the cause of PAN is unknown, about 30% of patients have hepatitis B surface antigen that presumably forms immune complexes that damage vascular walls. In contrast to microscopic polyangiitis, PAN has less of an association with anti–neutrophil cytoplasmic autoantibody (ANCA).
__________ is a rare condition in which muscular arteries become occluded in the lower extremities in smokers.
Thromboangiitis obliterans (Buerger disease) is a rare condition in which muscular arteries become occluded in the lower extremities in smokers.
Marfan syndrome is a risk for aortic dissection starting in what area of the aorta?
Marfan syndrome is a risk for aortic dissection starting in a dilated ascending aorta.
_________ is seen mainly in children and involves the aorta (particularly the arch) and branches such as the coronary and renal arteries, causing granulomatous inflammation, aneurysm formation, and dissection.
Takayasu arteritis is seen mainly in children and involves the aorta (particularly the arch) and branches such as the coronary and renal arteries, causing granulomatous inflammation, aneurysm formation, and dissection. Takayasu arteritis leads to “pulseless disease,” because of involvement of the aorta (particularly the arch) and branches such as coronary, carotid, and renal arteries, which results in granulomatous inflammation, aneurysm formation, and dissection. Fibrosis is a late finding, and the pulmonary arteries also can be involved.
A 3-year-old child from Osaka, Japan, has developed a fever and a rash and swelling of her hands and feet over the past 2 days. On physical examination, her temperature is 37.8° C. There is a desquamative skin rash, oral erythema, erythema of the palms and soles, edema of the hands and feet, and cervical lymphadenopathy. The child improves after a course of intravenous immunoglobulin therapy. What is most likely to be a complication of this child’s disease if it is untreated?
Mucocutaneous lymph node syndrome, or Kawasaki disease, involves large, medium-sized, and small arteries. Cardiovascular complications occur in 20% of cases and include thrombosis, ectasia, and aneurysm formation of coronary arteries.
A 50-year-old man has had a chronic cough for the past 18 months. Physical examination shows nasopharyngeal ulcers, and the lungs have diffuse crackles bilaterally on auscultation. Laboratory studies include a serum urea nitrogen level of 75 mg/dL and a creatinine concentration of 6.7 mg/dL. Urinalysis shows 50 RBCs per high-power field and RBC casts. His serologic titer for C-ANCA (proteinase 3) is elevated. A chest radiograph shows multiple, small, bilateral pulmonary nodules. A transbronchial lung biopsy specimen shows a necrotizing inflammatory process involving the small peripheral pulmonary arteries and arterioles. What is the most likely diagnosis?
GPA, Granulomatosis with polyangiitis Anti–neutrophil cytoplasmic autoantibody (ANCA)–associated vasculitis (granulomatosis with polyangiitis) is a form of hypersensitivity reaction to an unknown antigen characterized by necrotizing granulomatous inflammation that typically involves small to medium-sized vessels, although many organ sites may be affected. Pulmonary and renal involvement can be life-threatening. C-ANCAs (antibodies mainly directed against neutrophil proteinase 3) are found in more than 90% of cases.
Fibromuscular dysplasia is a hyperplastic medial disorder, usually involving renal and carotid arteries; on angiography, it appears as what?
Fibromuscular dysplasia is a hyperplastic medial disorder, usually involving renal and carotid arteries; on angiography, it appears as a “string of beads” caused by thickened fibromuscular ridges adjacent to less involved areas of the arterial wall.
A 50-year-old man with muscle pain and fever for a month now notes darker colored urine for the past 2 weeks. On physical examination he has palpable purpuric lesions of his skin. Urinalysis shows hematuria and proteinuria. Serum laboratory findings include a mixed cryoglobulinemia with a polyclonal increase in IgG, as well as a high titer of anti–neutrophil cytoplasmic autoantibodies, mainly antimyeloperoxidase (MPO-ANCA, or P-ANCA). A skin biopsy is performed. What pathologic finding is most likely to be observed in this biopsy?
Medial fibrinoid necrosis Microscopic polyangiitis involves small vessels, typically capillaries. Kidneys and lungs are commonly involved, but many organs can be affected. There may be an underlying immune disease, chronic infection, or drug reaction.
An 8-year-old child has had abdominal pain and dark urine for 10 days. Physical examination shows blotchy purple skin lesions on the trunk and extremities. Urinalysis shows hematuria and proteinuria. Serologic test results are negative for MPO-ANCA (P-ANCA) and PR3-ANCA (C-ANCA). A skin biopsy specimen shows necrotizing vasculitis of small dermal vessels. A renal biopsy specimen shows immune complex deposition in glomeruli, with some IgA-rich immune complexes. What is the most likely diagnosis?
In children, Henoch-Schönlein purpura is the multisystemic counterpart of the IgA nephropathy seen in adults. The immune complexes formed with IgA produce the vasculitis that affects mainly arterioles, capillaries, and venules in skin, gastrointestinal tract, and kidney.
Bacillary angiomatosis produces a focal vascular proliferation, typically on the skin, of an immunocompromised person infected with:
Bacillary angiomatosis produces a focal vascular proliferation, typically on the skin, of an immunocompromised person infected with Bartonella spp.
A 50-year-old man cuts his right index finger on a sharp metal shard while cleaning debris out of the gate in an irrigation canal. The cut stops bleeding within 3 minutes, but 6 hours later he notes increasing pain in the right arm and goes to his physician. On physical examination, his temperature is 38° C. Red streaks extend from the right hand to the upper arm, and the arm is swollen and tender when palpated. Multiple tender lumps are noted in the right axilla. A blood culture grows group A β-hemolytic streptococcus. What process is occurring in this patient’s right arm?
Lymphangitis The red streaks represent lymphatic channels through which the acute infection is draining to axillary lymph nodes, and these nodes drain to the right lymphatic duct and into the right subclavian vein (lymphatics from the lower body and left upper body drain to the thoracic duct).
A 46-year-old man has noted increasing abdominal enlargement over the past 15 months. Physical examination shows multiple skin lesions on the upper chest that have central pulsatile cores and measure, from core to periphery, 0.5 to 1.5 cm. Pressing on a core causes a radially arranged array of subcutaneous arterioles to blanch. Laboratory studies show serum glucose of 112 mg/dL, creatinine of 1.1 mg/dL, total protein of 5.8 g/dL, and albumin of 3.4 g/dL. What underlying diseases is most likely to be present in this patient?
Micronodular cirrhosis Spider telangiectasias are a feature of micronodular cirrhosis, typically as a consequence of chronic alcohol abuse. They are thought to be caused by hyperestrogenism (estrogen excess) that results from hepatic damage with reduced clearance of circulating steroids.
A 67-year-old woman with glucose intolerance, hypertension, central obesity, and hyperlipidemia has increasing dyspnea from worsening congestive heart failure. Echocardiography shows a left ventricular ejection fraction of 25%. Percutaneous transluminal coronary angioplasty is performed with placement of a left anterior descending arterial stent containing paclitaxel. What long-term complications in her coronary artery is most likely to be prevented by paclitaxel?
Proliferative restenosis She has metabolic syndrome, a risk for coronary atherosclerosis. Following angioplasty, there is often intimal thickening that causes restenosis. The wire stent holds the lumen open and the paclitaxel limits smooth muscle hyperplasia
A 73-year-old woman with hyperhomocystinemia has noted poor circulation in her left leg for the past 2 years. On examination her dorsalis pedis and posterior tibial pulses are barely palpable. CT angiography shows 90% stenosis of the left iliac artery. What procedure would be most effective in treating this woman?
Endovascular stent Endovascular stent placement can be done without major surgery, because the graft can be deployed percutaneously.
Name the diagnosis: HTN, hypernatremia and hypokalemia due to aldosterone secretion; Severe HA, weakness and dizziness
Conn syndrome Adrenal cortical adenoma
Name the diagnosis: recent acute Hep B infection; ANCA (+); Proteinuria; Fever, muscle pain, weight loss; Lesions on legs - reddish-blue; Elevated ESR
Polyarteritis nodosa small to medium arteries fibrinoid necrosis = eosinophilic mass that stains for fibrin
Name the diagnosis: Exquisitely painful red, raised lesion; Benign; Branching vascular channels in connective tissue stroma and aggregates of specialized ____ cells
Cystic medial necrosis is associated with what?
Dissecting aortic aneurysm
Name the diagnosis: Known autoimmune disease (ie Sjogren’s); immune complex deposition in dermal venules causing a purpuric skin rash
Name the diagnosis: Kids; Skin rash; Mucosal inflammation; Lymphadenopathy; Aneurysm formation on coronary arteries and HF re rare complications
Kawasaki disease aka mucocutaneous lymph node syndrome
Name the diagnosis: Kids; IgA deposits in walls of small blood vessels; purpuric skin lesions; glomerulonephritis