Aneurysms and Dissections

Question 1

Berry aneurysms result from

Answer 1

congenital weakness of the arterial wall, usually found around the Circle of Willis

Question 2

Berry aneurysms typically occur in who?

Answer 2

young people - heralded by a basilar headache

Question 3

Where do aortic aneurysms most commonly occur

Answer 3

in the abdominal aorta between the renal arteries and the iliac bifurcation

Question 4

Most common cause of aortic aneurysms

Answer 4

severe atherosclerosis, often with associated hypertension

Question 5

Mycotic abdominal aneurysm

Answer 5

atherosclerotic aneurysms that have been infected by circulating organisms (Salmonella gastroenteritis)

Question 6

Complications of aortic aneurysms

Answer 6

rupture, thrombosis and embolism

Question 7

Syphilitic (leutic) involvement of the aortic arch leads to

Answer 7

aneurysm

Question 8

Syphilitic lesions of the aortic arch consist of

Answer 8

obliterative endarteritis with infiltration of lymphocytes and plasma cells

Question 9

Resulting ischemic injury of the media with syphilitic lesions of the aortic arch result in

Answer 9

dilation of the aortic arch, with contraction of fibrous scars and wrinkling of the intima known as tree-barking

Question 10

Enlargement of the aortic root leads to

Answer 10

aortic valve insufficiency and the resulting hypertrophy of the heart is known as cor bovinum

Question 11

Dissections occur when

Answer 11

when an intima tear leads to collection of blood within the vessel wall

Question 12

Dissections most commonly occur in who

Answer 12

men aged 40 to 60 with hypertension

Question 13

Most common cause of death with a dissection

Answer 13

dissection into the abdomen, thorax, or pericardium

Question 14

Describe the pain from an aortic dissection

Answer 14

intense, tearing, and can be confused with myocardial infarction

Question 15

Key to prevention and treatment of an aortic dissection

Answer 15

control of hypertension

Question 16

Other important causes of aneurysms and dissections

Answer 16

genetic connective tissue disease: Marfans and Ehlers-Danlos

Question 17

Berry aneurysms are sometimes associated with

Answer 17

polycystic kidneys and Ehlers Danlos

Question 18

Most common spots for a berry aneurysm

Answer 18

Circle of Willis > anterior communicating artery > MCA > junction of carotid and posterior communicating artery

Question 19

Describe the progression of a berry aneurysm rupture

Answer 19

arterial wall bulges through the muscular wall of the artery, causes subarachnoid hemorrhage

Question 20

How does a berry aneurysm rupture present

Answer 20

with acute, severe headache and transient loss of consciousness; associated with reactive cerebral vasospasm

Question 21

Arteriovenous fistula

Answer 21

anomalous connection between artery and vein; may be congenital or secondary to trauma, inflammation

Question 22

What can arteriovenous fistulas cause

Answer 22

significant left to right shunts, overloading the right side of the heart and causing right heart failure

Question 23

Monckeberg’s arteriosclerosis

Answer 23

focal calcification of the media: affects small to medium sized arteries; basophilic, amorphous medial deposition in media; no associated inflammation

Question 24

Types of aneurysms

Answer 24

Berry; abdominal; dissecting; leutic; mycotic

Question 25

True aneurysm

Answer 25

bounded by generally complete but attenuated arterial wall components

Question 26

False aneurysm (pseudoaneurysm)

Answer 26

extravascular hematoma that communicates with the intravasular space; usually results from intimal tear

Question 27

Classic saccular aneurysm

Answer 27

berry aneurysm

Question 28

Classic fusiform or cylindrical aneurysm

Answer 28

atherosclerotic/cystic medial necrosis/syphilitic

Question 29

Abdominal aneurysms can give rise to

Answer 29

1. rupture into peritoneal cavity/retroperitoneal tissue
2. impingement on adjacent structure
3. occlusion of a vessel
4. embolism
5. creation of abdominal mass (simulates tumor)

Question 30

Thoracic aneurysms can give rise to

Answer 30

1. encroachment on mediastinal strucutres
2. respiratory difficulties
3. difficulty swallowing
4. persistent cough (laryngeal nerve)
5. pain (erosion of bone)
6. cardiac disease
7. rupture of aneurysm

Question 31

Dissecting (false aneurysm associated with intimal tear) usually affects

Answer 31

ascending and proximal aorta with intimal tear within 10 cm of aortic valves

Question 32

Dissecting (false aneurysms) associated with

Answer 32

hypertension; systemic or localized abnormality of connective tissue such as Marfans, Ehlers-Danlos

Question 33

Most common cause of death with a dissection

Answer 33

rupture into body cavity

hemopericardium most common

Question 34

Degenerative changes in the media associated with an aortic dissection

Answer 34

elastic tissue fragmentation and disruption; focal separation of elastic and fibromuscular elements; small cleft-like or cystic spaces with amorphous material; no inflammation

Question 35

Classic symptoms of an aortic dissection

Answer 35

sudden onset of excruciating pain, usually beginning in the anterior chest, radiating to the back and moving downwards as the dissection progresses; often confused with acute myocardial infarction

Question 36

Describe the aneurysms produced by atherosclerosis

Answer 36

generally causes cylindrical aneurysms which may rupture

Question 37

Atherosclerotic aneurysms often positioned where

Answer 37

below the renal arteries and above the bifurcation of the aorta; may affect origins of the renal, superior and inferior mesenteric arteries

Question 38

Atherosclerotic aneurysms often associated with

Answer 38

dilatations of the iliac arteries

Question 39

Cystic medial necrosis

Answer 39

characteristic changes include elastic tissue fragmentation and disruption, focal separation of elastic and fibromuscular elements, small cleft-like or cystic spaces with amorphous material; NO INFLAMMATION

Question 40

Cystic medial necrosis is characteristic of

Answer 40

Marfan’s and other collagen disease (Ehlers-Danlos)

Question 41

Marfan’s

Answer 41

autosomal dominant disease of connective tissue fibrillin; skeletal, cardiovascular, and ocular manifestations; dilatation and dissection of aortic root; mitral valve prolapse

Question 42

Syphilis (Leutic aneurysms)

Answer 42

associated with tertiary syphilis; always confined to thoracic aorta (arch)

Question 43

Cor Bovinum

Answer 43

greatly enlarged heart secondary to aortic valve insufficiency

Question 44

Characteristics of leutic aneurysms

Answer 44

inflammation of adventitia; obliterative endarteritis of the basa vasorum with infiltrate of lymphocytes and plasma cells; secondary ischemic injury of aortic media with patchy loss of medial elastic fibers and muscle cells; inflammatory scarring of the media; treebarking of the aorta

Question 45

Treebarking of the aortic intima results from

Answer 45

segmental wrinkling due to scar contraction

Question 46

Mycotic aneurysm

Answer 46

infection by organisms lodged in aortic wall

Question 47

Mycotic aneurysms particularly associated with

Answer 47

Salmonella gastroenteritis