Blood vessels Flashcards
Inflammation of blood vessel wall (unknown etiology)
Vasculitis
Large vessel vasculitis
Involves the aorta and it’s mahout branches
Most common form of vasculitis in older adults (>50) usually affects females
Affects branches of the common carotid
ESR>100
Inflamed vessel wall with giant cells and intimal fibrosis (granulomatous inflammation)
Temporal (giant cell) arteries
Treatment: corticosteroids due to high risk of blindness
Granulomatous vasculitis presents in adults <50 years usually young Asian females
Mainly affects aortic arch at branch points
Weak upper extremity pulse (pulseless disease)
ESR elevated
Takayasu arteritis
Treatment: corticosteroids
Medium vessel vasculitis
Involves muscular arteries that supply organs
- Immune complex associated vasculitis (drug HSR or after an infection)
- Presents with fibrinoid necrosis and involves all organs EXCEPT THE LUNG
- presents in young adults
- Associated with SERUM HBsAg
- Transmittal fibrinoid necrosis followed by massive fibrosis present as nodules (string of pearls)
Polyarteritis nodosa
Treatment: corticosteroids or cyclophosphamide (otherwise fatal)
- Associated with ANTIENDOTHELIAL CELL antibodies
- young children 4 years old or younger
- coronary artery involvement (risk of MI)
- aneurysm and rupture due to weakening
- erythematous rash on palms and soles
Kawasaki disease
Treatment is aspirin AND IVIG
- Vasculitis that is highly associated with smoking
- Necrotising vasculitis involving digits
- presents with ulcers, gangrene and auto amputation of fingers and toes.
- Raynaud phenomena is present
Buerger disease
OR
thromboangitis Obliterans
Small vessel vasculitis
•Involves arteriolar, capillaries and venules
- Necrotising granulomatous vasculitis
- involves nasopharynx lungs and kidneys
- presents in Middle Aged makes
- C-ANCA levels correlate with the disease
- On biopsy large necrotising granulomatous with adjacent necrotising vasculitis
WEGNER or WECNER (C involvement)
Treatment : cyclophosphamide
C-ANCA
PR3-ANCA
P-ANCA
MPO-ANCA
Necrotising vasculitis that involves - kidney - lungs •no nasopharyngeal and granulomatous involvement •P-ANCA involvement
Microscopic polyangitis
Treatment: Cyclophosphamide
- Necrotising granulomatous vasculitis with eosinophils
- involves heart and lungs
- patient often has a asthma and peripheral eosinophilia
- P-ANCA involvement
Chris-Strauss Syndrome
Focal, irregular thickening of the walls of medium and large muscular arteries. Segments of the vessel wall are focally thickened by combination of irregular medial and intimal hyperplasia and fibrosis, causing luminal stenosis
Fibromuscular dysplasia
Literally means hardening of the arteries, term reflecting arterial wall thickening and loss of elasticity, affecting small arteries and arterioles.
Arteriolosclerosis:
Characterized by calcific deposits in media of muscular arteries, typical in persons older than 50 yrs old. The radiographically visible, palpable calcifications do not encroach on the vessel lumen, and are not clinically significant.
Mockenberg medial calcific sclerosis
Characterized by intimal lesions called atheromas that protrude into vascular lumina
Atherosclerosis
Composed of lipid-filled foam cells but are not significantly raised and thus do not cause any disturbance in blood flow. Can appear as early as 1 year, and present in virtually all children older than 10 years old.
Fatty streaks
This vascular lesion consists of a homogenous pink hyaline thickening of the walls of arterioles with loss of underlying structural detail and with narrowing of the lumen. A major morphologic characteristic in benign nephrosclerosis
Hyaline arteriolosclerosis
Characteristic of malignant hypertension, associated with “onion-skin” concentric, laminated, thickening of the walls of arterioles with luminal narrowing. These laminations consist of smooth muscle cells and thickened duplicated basement membrane
Hyperplastic arteriolosclerosis
Aneurysm which involves all three layers of the arterial wall, or the attenuated wall of the heart.
True aneurysm
A breach in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space
False aneurysm
Arises when blood enters the wall of an artery, as a hematoma dissecting between its layers. Often, but not always aneurysmal in origin
Arterial dissection
Aneurysms which involve diffuse, circumferential dilation of a long vascular segment, varies in diameter and length, and can involve extensive portions of the aortic arch, abdominal aorta,and iliacs.
Fusiform aneurysms
Infection of a major artery that causes weakness to its wall
Mycotic aneurysm
This disease can more commonly affects men >50 years old. Lesion usually positioned below the renal arteries and above the aortic bifurcation. Can be saccular or fusiform.
Abdominal aortic aneurysm (AAA)
Syphilitic aortitis Small blood vessels and vasa vasorum show luminal narrowing and obliteration (obliterative endarteritis), scarring of the vessel wall and a dense surrounding rim of lymphocytes and plasma cells that may extend into the media. Characteristic of
the tertiary stage of syphilis.
Most common point of origin of an aortic dissection.
Ascending aorta, 10 cms from the aortic valve
affected blood vessels develop nodular intimal thickening, granulomatous inflammation within the inner media centered on the internal elastic membrane, and fragmentation of the internal elastic lamina. Typically involves temporal and ophthalmic arteries.
Giant - cell/Temporal arteritis In this disease
Granulomatous inflammation usually occuring in patients younger than 50 years old. Classically involves the aortic arch, with intimal hyperplasia and irregular thickening of the vessel wall. Origin of great vessels are obliterated causing weakness of peripheral pulses. Age is the diff
Takayasu arteritis
A systemic vasculitis causing transmural necrotizing inflammation of small to medium sized vessels, with mixed infiltvrate of neutrophils, eosinophils, and mononuclear cells, frequently accompanied by fibrinoid necrosis.Typically involves renal arteries but spares pulmonary vessels
Polyarteritis Nodosa (PAN)
Arteritis associated with mucocutaneous lymph node syndrome, which usually occurs in children. Coronary arteries can be involved with aneurysm formation or thrombosis. Fibrinoid necrosis usually less prominent
Kawasaki disease
Fate of an atherosclerotic plaque due to increased pressure or ischemic atrophy of the underlying media, with loss of elastic tissue, leading to weakness of the vessel wall.
Aneurysm formation
Granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small vessels, including cresencteric glomerulonephritis. Associated with c-ANCA.
Wegener granulomatosis
A necrotizing vasculitis that generally affects capillaries, arterioles and venules, with few or no immune deposits. Necrotizing glomerulonephritis and pulmonary capillaritis are common. Associated with p-ANCA
Microscopic polyangiitis
Hyalinized glomeruli
Chronic Glomerulonephritis
An important cause of end-stage renal disease presenting as chronic renal failure. Kidneys are symmetrically contracted, surfaces are red-brown and diffusely granular. Glomeruli are obliterated with marked interstitial fibrosis
Chronic glomerulonephriti
Eosinophil-rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small vessels. Associated with asthma and blood eosinophilia. Associated with p-ANCA.
Churg-Strauss syndrome
Reflects an exaggeration of central and local vasomotor responses to cold or emotion. Structural changes in the arterial walls are absent except late in course when intimal thickening can appear.
Primary Raynaud phenomenon
Reflects vascular insufficiency of the extremities in the context of arterial disease caused by other entities including SLE, Buerger disease, or atherosclerosis.
Secondary Raynaud phenomenon
Abnormally dilated, tortous veins produced by prolonged increase in intraluminal pressure and loss of vessel wall support. Veins show wall thinning at the points of maximal dilation with smooth muscle hypertrophy and intimal fibrosis. Focal thrombosis and venous valve deformities are common.
Varicose veins
These are bright red to blue lesions, that vary from a few millimeters tomseveral centimeters in diameter. Unencapsulated aggregates of closely packed, thin-walled capillaries, usually blood-filled and lined by flattened endothelium. Vessels are separated by scant connective tissue stroma.
Capillary hemangiomas
Appears as red-blue, soft, spongy masses 1-2 cm in diameter, which can affect large subcutaneous areas of the face, extremities, and othe body regions. Mass is sharply defined but not encapsulated, composed of large, cavernous, blood-filled spaces.
Cavernous hemangioma
This form of capillar hemangioma is a rapidly growing peduncular red nodule on the skin, gingival, or oral mucosa, bleeds easily and is often ulcerated.
Pyogenic granuloma
These are round, slightly elevated, red-blue firm nodules, less than 1 cm diameter that can resemble a minute focus of hemorrhage UNDER THE NAIL. Histologically, these are aggregates, nests, and masses of tumor cells intimately associated with branching vascular channels.
Glomus tumor (Glomangioma
A specialized arteriovenous structure involved in thermoregulation
Glomus
This lesion is the ordinary “birthmark” and is the most common form of ectasia. Characteristically a flat lesion on the head or neck, ranging in color from light pink to deep purple.
Nevus flammeus
This non-neoplastic vascular lesion grossly resembles a spider. There is radial, often pulsatile array of dilated subcutaneous arteries or arterioles about a central core, that blanches when pressure is applied to its center.
Spider telangiectasia
An opportunistic infection in immunocompromised persons that manifest as vascular proliferations involving skin, bone, brain and other organs. Characterized grossly by red papules and nodules, or rounded subcutaneous masses. Histologically, there is capillary proliferation with prominent epitheloid EC’s showing nuclear atypia and mitoses. Lesions contain stromal neutrophils, nuclear dust nd purplish granular material.
Bacillary angiomatosis
These are malignant endothelial neoplasms, with varying histology from plump, anaplastic but recognizable endothelial cells producing vascular channels to widely undifferentiated tumors having solid, spindle cell appearance and producing nondefinite blood vessels.
Angiosarcoma
Hypertension
> 140/90 mmhg
Primary hypertension
95% of cases with unknown etiology
Secondary hypertension
5% of cases with identifiable cause
Increase in plasma renin and activation of RAAS system, angiotensin 2 directly contracting the arteriolar smooth muscles -> INCREASEE TPR and stimulate aldosterone release
Unilateral
Renal artery stenosis
Causes of renal artery stenosis
Atherosclerosis (elder males) Fibromuscular dysplasia (young females)
Mild to moderate elevation in blood pressure, clinically silent and damages vessels and organs over time
Benign hypertension
- Severe elevation in blood pressure >200/120
- may arise from preexisting benign hypertension or de novo
- present with end organ damage like acute renal failure, headache and papillae Eden’s (fibrinoid necrosis)
Malignant hypertension
Thickening due to protein deposition in small vessels
Arteriosclerosis
Arteriosclerosis caused by malignant hypertension “onion skin” thickening accompanied by fibrinoid deposits and vessel wall necrosis -necrotising arteriolitis which classically causes ARF with flea bitten appearance and pinpoint hemorrhages
Hyperplastic arteriosclerosis
Thickening of intima in medium to large vessels
Atherosclerosis
Intimal plaque that consists of W necrotic lipid core consisting of cholesterol and cover fibromascular cap
Affects abdominal aorta, coronary popliteal and internal carotid arteries
Atherosclerosis
Damage to endothelium leads to cholesterol penetrating through the opening of the intima then the cholesterol gets oxidised and taken up by macrophages forming the initial lesion called
Fatty streaks
Hello fatty streaks running along blood vessels
Fatty streaks
Inflammation and healing ensue on the fatty streaks and increases the deposition of fat witching the intima leading to thickening of the intima forming ….
atheroma/plaque - so called atherosclerosis
Atherosclerosis in the popliteal artery causes
Peripheral vascular diseases
Atherosclerosis in coronary artery causes
Angina
Atherosclerosis of mesenteric artery causes
Ischemic bowel disease
Atherosclerotic emboli characterised by cholesterol clefts is caused by
Plaque rupture with embolization
Plaque rupture with thrombosis causes
MI - coronary artery
Stroke- middle cerebral artery
And is due to the exposure of the necrotic debris and the activation of the coagulation cascade
Calcification of media
monckeberg medial sclerosis
Intimal tear with dissection of blood through the media of aortic wall
Aortic dissection
Which type of aortic dissection is an emergency and requires surgery most commonly involves the ascending aorta with or without descending
Type A aortic dissection
Which type of aortic dissection is managed by controlling Blood pressure and happens beyond subclavian artery
TYPE B AORTIC DISSECTION
Aortic dissection requires 2 things which are
TON of stress
Preexisting weakness of the media
What can cause pre existing weakness of the media?
Hypertension- due to hylanization of Vaso vesoram
Inherited defects of connective tissue like Marfan syndrome and ehlers- danlos syndrome
Has all 3 vessel layers and no rupture
True aneurysm
Doesn’t have all 3 vessel layer and has small ruptures
False aneurysm
Tertiary sephilils with tree bark appearance of aorta
Throacic aneurysm
•dilatation of aortic valve root causing aortic insufficiency
•compression of mediastinal structures
Thrombosis and embolism due to non laminar flow through the vessel and activation of coagulation cascade
Aortic aneurysm
Ballon like dilatation below the renal arteries and above the bifurcation of the aorta which is primarily caused by atherosclerosis and is classically seen in male smokers over 60years with hypertension
•it presents as a pulsatile abdominal mass
AAA - ABDOMINAL AORTIC ANEURYSM
Major complications occur with its bigger than 5cm in diameter and rupture presents w/a triad of hypotension pulsatile abdominal mass and flank pain
Benign tumour composed of blood vessels that is commonly present at birth often regress during childhood mostly involves skin and liver
Hemangioma
Malignant proliferation of endothelial cells which is highly aggressive and most commonly affected sites include skin breast and liver
Angio sarcoma
Liver angio sarcoma is associated with exposure to PVC, arsenic and thorotrash
Low grade malignant proliferation of endothelial cells that doesn’t blanch presents as purple patches plaques or modules on skin may involve visceral organs
Classically seen in aids and transplant recipients and older Eastern European’s
Kaposi sarcoma
Local dilation of a structure
Vascular ectasia
Permanent dilation of preexisting vessels
Telangiectasia
Most common form of vascular ectasia, light pink to deep purple flat lesion on head or neck with dilated vessels also called (birthmark)
Nevus flammus
Special form of Nevus flammeus that tend to grow during childhood and thicken the surface but don’t fade with time
Port wine stain
Non neoplastic vascular lesions resembling spider these lesions manifest as radial pulsatile dilated subcutaneous arteries that blanch with pressure and mostly associated with hyperestrogneic states
(Pregnant women or cirrhosis)
Spider telangiectasis
Autosomal dominant disorder caused by mutations in genes coding for TGF-B signalling pathway in endothelial cells the lesions can spontaneously rupture causing epistaxis GI bleeding and hematuria
Hereditary hemorrhagic telangiectasia
Most common type of hemangiomas, occurs in skin, SC tissue, mucus membranes of oral cavity, lips, liver, spleen and kidneys
Capillary hemangiomas
Extremely common on newborn skin (1 in 200 births) can be multiple and can regress it is also called strawberry hemangiomas
Juvenile hemangiomas
This form of hemangiomas are capillary hemangiomas manifesting as pedunclated lesions
Resembles granulation tissue, they bleed easily and are often ulcerated
Pyogenic granuloma
This form of hemangiomas is composed of large dilated vascular channels it also is composed of capillary hemangiomas but more infiltrative involving deep structures more frequently and they don’t spontaneously regress
Cavernous Hemangioma
Benign lymphatic counter part of hemangiomas
Lymphangioma
Which type of lymphangioma is
- 1-2 cm
- Occur in head neck and axilla
- is slightly elevated or pedunculated
Simple lymphangioma
Which type of lymphangioma is
- up to 15 CM
- on neck or axilla of a child
- usually common in Turner syndrome
Cystic hygromas
