Aneurysms and Dissections

Question 1

Three types of congenital lesions…

Answer 1

Anomalous vessels
Berry aneurysms
AV fistula
Coarction of the Aorta

Question 2

Cause of Berry aneurysms…

Answer 2

Usually sporadic
Sometimes associated with polycystic kidneys
Ehlers Danlos

Question 3

Where do Berry aneurysms

Answer 3

Most common around Circle of Willis

esp. in ACA

Question 4

Effect of berry aneurysm rupture…

Answer 4

Subarachnoid Hemorrhage

Question 5

What tends to cause berry aneurysm rupture

Answer 5

Acute increase in arterial pressure (Weight Lifting)

Question 6

How do berry aneurysms present?

Answer 6

Acute, severe headache
Transient loss of consciousness
Assoc. w/ reactive cerebral vasospasm.

Question 7

Causes of AV fistula

Answer 7

Congenital

Secondary to taruma, inflammation

Question 8

Problem with AV fistula?

Answer 8

Can cause significant L to R shunts, overloading the R heart and causing R Heart Failure

Question 9

What happens in Monckeberg’s arteriosclerosis

Answer 9

Calcification of the media

Seen on Xray

Question 10

Difference between a true and pseudoaneurysm

Answer 10

True – complete, but attenuated wall components

Pseudo – Extravascular hematoma that communicates with intravascular space. Usually an intimal tear.

Question 11

Where would you expect to see a saccular aneurysm?

Answer 11

Berry

Question 12

Why would you expect to find fusiform or cylindrical aneurysm?

Answer 12

Atherosclerotic/Cystic Medial Necrosis/Syphilitic

Question 13

Whats the problem with AAA? (5)

Answer 13

1. Rupture
2. Impingement of adjacent structure
3. Occlusion of a vessel form pressure or thrombus
4. Embolism from atheroma
5. Creation of ab mass that simulates a tumor

Question 14

Whats the problem with Thoracic Aneurysms?

Answer 14

1. Encroachment on mediastinum
2. Respiratory difficulties
3. Difficulty Swallowing
4. Persistent Cough
5. Pain from bone erosion
6. Rupture

Question 15

What is a dissecting aneurysm?

Answer 15

A false aneurysm associated with an intimal tear

Question 16

Most common cause of death from dissecting aneurysm?

Answer 16

Hemopericardium

Question 17

Where do dissecting intramural hematomas form?

Answer 17

Between middle and outer third of the media

Question 18

Why is medial cystic degeneration an inaccurate term?

Answer 18

No necrosis present

Question 19

Characteristic changes in medial cystic necrosis (or degeneration)

Answer 19

Elastic Tissue Fragmentation and Disruption
Focal Separation of Elastic and Fibromuscular Elements
Small cleft-like/cystic spaces with AMORPHOUS material
NO INFLAMMATION

Question 20

Atherosclerosis typically causes _____ aneurysms?

Answer 20

Cylindrical

Question 21

Cystic medial necrosis is characteristic of…

Answer 21

Marfans and Ehlers-Danlos

Question 22

Marfans is a disease of…

Answer 22

Connective Tissue (Fibrillin)

Question 23

Syphilis can lead to ____ aneurysms

Answer 23

Leutic aneurysms of the aortic arch

Question 24

Common cardiac effects seen with tertiary syphilis involvement

Answer 24

1. Aortic Valve Insufficiency

2. Occlusion/Narrowing of Coronary Ostia

Question 25

What is Cor Bovinum

Answer 25

Greatly enlarged heart secondary to aortic valve insufficiency

Question 26

Damage characteristic of tertiary syphilis?

Answer 26

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.

Question 27

Tissue morphology associated with tertiary syphilis

Answer 27

Treebarking of the aortic intima

Caused by segmental wrinkling due to scar contraction

Question 28

Mycotic infection of the aorta is particularly assoicated with…

Answer 28

Salmonella gastroenteritis