Chapter 7

Question 1

what is seen histologically with giant cell arteritis

Answer 1

giant cells and intimal fibrosis

Question 2

what is seen histologically with takyasu arteritis

Answer 2

Granulomatous vasculitis

Question 3

what is seen histologically with polyarteritis nodosa

Answer 3

Lesions of varying stages are present. Early lesion consists of transmural inflammation with fibrinoid necrosis (Fig. 7.3); eventually heals with fibrosis, producing a ‘string-of-pearls’ appearance on imaging

Question 4

what is seen histologically with buergers disease

Answer 4

Necrotizing vasculitis involving digits

Question 5

wegners histology

Answer 5

Biopsy reveals large necrotizing granulomas with adjacent necrotizing vasculitis

Question 6

how are microscopic polyangitiis and wegners different?

Answer 6

Microscopic Polyangiitis
1. Necrotizing vasculitis involving multiple organs, especially lung and kidney
2. Presentation is similar to Wegener granulomatosis, but nasopharyngeal
involvement and granulomas are absent.
3. Serum p-ANCA levels correlate with disease activity.
4. Treatment is corticosteroids and cyclophosphamide; relapses are common.

Question 7

what are the highlights of churg-strauss?

Answer 7

Churg-Strauss Syndrome
1. Necrotizing granulomatous inflammation with eosinophils involving multiple
organs, especially lungs and heart
2. Asthma and peripheral eosinophilia are often present.
3. Serum p-ANCA levels correlate with disease activity.

Question 8

all of the small vessel vasculitis have…

Answer 8

necrotizing issues
except HSP
and MP doesn’t have the granulomas

Question 9

what are the highlights of HSP?

Answer 9

Henoch-Schonlein Purpura
1. Vasculitis due to IgA immune complex deposition; most common vasculitis in
children
2. Presents with palpable purpura on buttocks and legs, GI pain and bleeding, and
hematuria (IgA nephropathy); usually occurs following an upper respiratory
tract infection
3. Disease is self-limited, but may recur; treated with steroids, if severe

Question 10

The large vessel vasculitis…

Answer 10

are not associated with the word “necrotizing”

Question 11

hyaline vs. hyperplastic arteriolosclerosis

Answer 11

Hyaline arteriolosclerosis is caused by proteins leaking into the vessel wall, producing vascular thickening; proteins are seen as pink hyaline on microscopy; consequence of long-standing benign hypertension or diabetes

Hyperplastic arteriolosclerosis involves thickening of vessel wall by hyperplasia of smooth muscle (‘onion-skin’ appearance).

Consequence of malignant hypertension

Results in reduced vessel caliber with end-organ ischemia
May lead to fibrinoid necrosis of the vessel wall with hemorrhage; classically causes acute renal failure with a characteristic ‘flea-bitten’ appearance

Question 12

why is HTN the #1 risk factor in aortic dissection?

Answer 12

Hypertension results in hyaline arteriosclerosis of the vasa vasorum; decreased
flow causes atrophy of the media.

Question 13

what is the big risk factor for AAA?

Answer 13

Primarily due to atherosclerosis; classically seen in male smokers> 60 years old with hypertension

Atherosclerosis increases the diffusion barrier to the media, resulting in atrophy and weakness of the vessel wall.
Presents as a pulsatile abdominal mass that grows with time