Vascular Pathology Flashcards by Kristin Randa

Arterial wall structure

intima (innermost - endothelial on a basement membrane)
Media - smooth muscle
Adventita - CT

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Large vessel vaculitis involve what?

Aorta and it’s branches

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Temporal (Giant cell artertis)

> 50, carotid
females
granulomatous

HA - temporal
Visual disturbances (ophthalmic)
Jaw claudication
Flu like symptoms (joint/muscle pain) - aka polymyalgia rheumatica

ERS elevated

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Biopsy of Temporal arteritis

inflammed vessel wall w/ giant cells & intimal fibrosis

Granulomatous vasculitis - firbosis narrows lumen and increases distance between intima and media

Lesions are segmental

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Takayasu Arteritis

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Large vessel vasculitis

Temporal arteritis

Takayasu arteritis

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Medium vessel vasculitis

involve muscular arteries that supply organs

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Polyarteritis nodosa

Necrotizing vasculitis - young adult
Spares Lungs
Involves most organs

HTN - renal a
Abd pain w/ melena (mesenteric a)
Neurologic disturbances
Skin lesions
**Associated with serum HBsAg** - HB surface antigen

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What does the vessel look like in Polyarteritis nodosa?

Lesions in varying stage - “string of pearls” from fibriniod necrosis

alternating aneurysm and fibrosis

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Tx of Polyarteritis nodosa

Corticosteroids and cyclophosphamide

Fatal if not treated!

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Kawasaki Dz

Asian children

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TX of Kawasaki DZ

ASA & IVIG

ASA blocks COX - so no TXA2 - preventing thombosis

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Buerger DZ

SMOKING!
Necrotizing vasculitis involving digits
Ulceration, gangrene - autoamputation of fingers/toes
Raynaud often present

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Small vessel vasculitis

Arterioles, capillaries, venules

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Wegener granulomatosis

Necrotizing granulomatous vasculitis
Nasopharynx, lungs, kidney

“wecener” - Man with C going through him - nose, lungs, kidney
c-ANCA
Key tx: cyclophosphamide

Sinusitis, nasopharyngeal ulceration
Hemoptysis w/ bilateral nodular lung infiltrates
Hematuria d/t RPGN

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Microscopic polyangiitis

Necrotizing vasculitis - multiple organs - espc lung/kidney
No nasopharyngeal/granulomas
p-ANCA

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Microscopic polyangiitis tx

corticosteroids and cyclophosphamide

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Churg Strauss Syndrome

Necrotizing granulomatous vasculitis w/ eosinophils
Multiple organs - espc lungs/heart
Asthma & peripheral eosinophilia
p-ANCA

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HSP - Henoch Schonlein Purpura

Vasculitis d/t IgA immune complex deposition
Most common vasculitis in children

Palpaple purpura on buttocks/legs
GI pain/bleeding
Hematuria (IgA nephropathy - IgA in mesagnium)
After URI (develop IgA)

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HSP - Henoch Schonlein Purpura Tx

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Steroids

Common cause of secondary HTN:

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renal artery stenosis - decreases blood flow to glomerulus - JGA secretes renin … ATII contracts arteriolar SM increase TPR and promotes adrenal release of aldosterone

2 causes renal artery stenosis
Men
Women

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Old men: atherosclerosis

Young women: fibromuscular dysplasia - irregular thickening of BV wall

Malignant HTN

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> 180/120
May arise from pre-existing benign HTN or de novo

Acute end organ damage: acute renal failure, HA, papilledema

Three patterns of arteriosclerosis

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Atherosclerosis (Intima thickening - medium/large vessels)
Arteriolosclerosis - small vessels - hyaline/hyperplastic
Monckenberg medial sclerosis - media of muscular (medium sized arteries - calcification)

Atherosclerosis

Intimal plaque - most on necrotic lipid core with fibromuscular core Commonly calcified

Atherosclerosis pathogenesis

Damage to endotheiium allows lipids to leak into intima Lipids oxidized and consumed by macrophages (foam cells) Inflammation/healing = deposition of ECM and proliferation of SM

Common complications of atherosclerosis: impaired blood flow & ischemia

Peripheral vascular DZ Angina (coronary artery) Ischemic bowel Dz (mesenteric a)

Common complications of atherosclerosis: plaque rupture with thombosis

MI | Stroke (MCA)

Common complications of atherosclerosis: plaque rupture with emobolization

atherosclerotic emboli | - characterized by cholesterol clefts

Common complications of atherosclerosis: weakening of vessel wall

Aneurysm | Wall becomes weak/atrophic - so allows ballooning of wall

Arteriolosclerosis

Narrowing of small arterioles | Hyaline and Hyperplastic types

Arteriolosclerosis: hyaline

Protein leak into vessel wall - vacular thicking Pink Hyaline on microscopy 1. Benign HTN 2. Diabetics (nonenzyme glycosylation) End organ ischemia 1. glomerular scarring 2. progresses to CRF

Arteriolosclerosis: hyperplastic

thickening of vessel wall by hyperplasia of SM "onion skin" reduce lumen 1. Malignant hypertension Results in end organ ischemia May lead to fibrinoid necrosis of vessel wall Acute renal failure w/ flea bitten appearance

Monckenberg Medial Calcific Sclerosis

Calcification of media Non-obstructive Incidental finding Doesn't alter lumenal caliber

Aortic dissection

intimal tear w/ dissection of blood thru media and aortic wall

Aortic dissection requires 2 things

Lots of stress - proximal 10 cm of the aorta (right off the heart) Pre-existing weakness of media - HTN Also associated with CT defects

Proximal 10 cm of aorta - very thick - so O2 diffusion not sufficient - what supplies adventita

Vaso vasorum HTN - hyaline arteriolosclerosis - decreasing blood flow to the adventita - so atrophy SM allowing weaking of media so dissection can occur

Major complication of aortic dissection

Pericardial tamponade

Aneurysm:

balloon like dilation of blood vessel wall 1. thorax 2. abdomen Only way to get one: need weakness in aortic wall

Thoracic aneurysm

Tertiary syphilis | Tree bark appearance of aorta - endarteritis of vaso vasorum

Complication of Thoracic aneurysm

dilation of aortic valve root w/ insufficiency - results in aortic insufficiency Compression of mediastinal structures Thrombosis/embolism

Abdominal aortic aneurysm

Below renal arteries but above aortic bifurcation Male smokers >60 w/ HTN Weakness d/t atherosclerosis Atrophy of wall leading to weakness d/t lack of O2 diffusion blocked by atherosclerosis

Presentation of AAA

pulsatile abd mass | Grows with time

Major comlication of AAA

rupture >5 cm | Triad: Hypotension, pulsatile abd mass, flank pain

Hemangioma

Benign tumor of BV Often regresses during childhood Skin/liver

Angiosarcoma

Malignant proliferation of endothelial cells (line BV), highly aggressive Liver angiosarcoma associated with PVC, arsenic, throrotrast

Kaposi sarcoma

HHV-8 Low grade malignant proliferation of endothelial cells Purple patches, plaques, nodules on skin

Kaposi sarcoma seen in

1. Older eastern european males 2. AIDS 3. transplant recipients

Vascular Pathology Flashcards

(48 cards)