Aneurysms and Dissections Flashcards
Three types of congenital lesions…
Anomalous vessels
Berry aneurysms
AV fistula
Coarction of the Aorta
Cause of Berry aneurysms…
Usually sporadic
Sometimes associated with polycystic kidneys
Ehlers Danlos
Where do Berry aneurysms
Most common around Circle of Willis
esp. in ACA
Effect of berry aneurysm rupture…
Subarachnoid Hemorrhage
What tends to cause berry aneurysm rupture
Acute increase in arterial pressure (Weight Lifting)
How do berry aneurysms present?
Acute, severe headache
Transient loss of consciousness
Assoc. w/ reactive cerebral vasospasm.
Causes of AV fistula
Congenital
Secondary to taruma, inflammation
Problem with AV fistula?
Can cause significant L to R shunts, overloading the R heart and causing R Heart Failure
What happens in Monckeberg’s arteriosclerosis
Calcification of the media
Seen on Xray
Difference between a true and pseudoaneurysm
True – complete, but attenuated wall components
Pseudo – Extravascular hematoma that communicates with intravascular space. Usually an intimal tear.
Where would you expect to see a saccular aneurysm?
Berry
Why would you expect to find fusiform or cylindrical aneurysm?
Atherosclerotic/Cystic Medial Necrosis/Syphilitic
Whats the problem with AAA? (5)
- Rupture
- Impingement of adjacent structure
- Occlusion of a vessel form pressure or thrombus
- Embolism from atheroma
- Creation of ab mass that simulates a tumor
Whats the problem with Thoracic Aneurysms?
- Encroachment on mediastinum
- Respiratory difficulties
- Difficulty Swallowing
- Persistent Cough
- Pain from bone erosion
- Rupture
What is a dissecting aneurysm?
A false aneurysm associated with an intimal tear
Most common cause of death from dissecting aneurysm?
Hemopericardium
Where do dissecting intramural hematomas form?
Between middle and outer third of the media
Why is medial cystic degeneration an inaccurate term?
No necrosis present
Characteristic changes in medial cystic necrosis (or degeneration)
Elastic Tissue Fragmentation and Disruption
Focal Separation of Elastic and Fibromuscular Elements
Small cleft-like/cystic spaces with AMORPHOUS material
NO INFLAMMATION
Atherosclerosis typically causes _____ aneurysms?
Cylindrical
Cystic medial necrosis is characteristic of…
Marfans and Ehlers-Danlos
Marfans is a disease of…
Connective Tissue (Fibrillin)
Syphilis can lead to ____ aneurysms
Leutic aneurysms of the aortic arch
Common cardiac effects seen with tertiary syphilis involvement
- Aortic Valve Insufficiency
2. Occlusion/Narrowing of Coronary Ostia
What is Cor Bovinum
Greatly enlarged heart secondary to aortic valve insufficiency
Damage characteristic of tertiary syphilis?
Destruction of adventitia, obliterative arteritis of vasa vasorum with lymphoplasmacytic infiltrate. Causes 2dary ischemic injury to AORTIC MEDIA with patchy loss of MEDIAL ELASTIC FIBERS AND MUSCLE CELLS.
Tissue morphology associated with tertiary syphilis
Treebarking of the aortic intima
Caused by segmental wrinkling due to scar contraction
Mycotic infection of the aorta is particularly assoicated with…
Salmonella gastroenteritis
