Lec 21 Pathology of Vascular Disease Flashcards
What are risk factors for pulm embolism?
- hypercoagulable
- oral contraceptives
- pregnancy
- immobilization
What are symptoms of small infarct?
usually minimal
major SOB; also tachycardia, pain, fever, cough, hemoptysis
What are two mech by which large emboli can cause sudden death?
- lodging in major branch of pulm artery or at bifurcation –> electromech dissociation with rhythm but not pulse
- acute cor pulmonale [dilated R heart] due to local increase resistance to flow, pulm HTN, R heart failure
What do you see grossly in smaller emboli? massive emboli?
smaller = wedge shaped hemorrhagic infarct
larger = may have no parenchymal changes
WHat is definition of pulm HTN?
pulm artery pressure > 25 mmHg
What usually causes pulm htn?
- structural disease causing increased pulm blood flow or pressure
- increased pulm vascular resistance
- increased left heart resistance
Who gets pulmonary arterial hypertension?
- rare disease
- mostly young women
idiopathic or due to collagen vascular disease, drugs, etc
What classic finding in pulmonary arterial htn?
plexiform lesions
What is classic clinical picture of pulmonary arterialhtn?
young women w/ progressive SOB, angina, syncope, possibly suddent death
What is prognosis of PAH?
death usually w/in a few years
What is grade I PAH?
muscularization and medial hypertrophy of pulm arteries
What is grade II PAH?
intimatl hyperplasia causing attenuation of vascular lumen
What is grade III PAH?
subintimal fibrosis w/ onion-ring appearance
have reduplication of internal elastic membrane; arteries + arterioles look like pipes
What is grade 4/5 PAH?
dilation and plexiform lesions; have dilation of small pulm arteries
What is grade 6 PAH?
uncommon acute necrotizing arteritis w/ fibrinoid necrosis and acute inflammation of vessel wall
similar to polyarteritis nodosa
What is a plexiform lesion?
characteristic of advanced pulm htn; seen in small arteries
looks like glomerulus have lots of different lumens
Who gets wegeners / PGA?
wide range; mean 50 yo
What is classic triad of involvement wegener’s/PGA?
- sinus
- lung
- renal
What do you see in wegeners/PGA?
- small vessel involvement
- multiple lung nodules usually
- C-ANCA
What do you see on histology in wegener’s/PGA?
- parenchyma necrosis = irregular areas of necrosis w/ lots of neutrophils (“dirty necrosis” b/c it looks blue)
- necrotic area surrounded by scattered giant cells and histiocytes
- no well formed granulomas
vasculitis not requirement for diagnosis!
What is triad of churg-strauss?
- asthma
- eosinophilia
- vasculitis
Who gets churg-straus?
equal genders; mean age 50
What parts of body typically involved in churg strauss?
neuropathy, cardiac, lung, sinonasal
don’t usually have renal
WHat do you see in churg strauss?
- lung radiographs w/ multifocal infiltrates that may change over time; looks patchy
asthmatic bronchitis, eosinophilic pneumonia, stellate granulomas, vasculitis
What type of granulomas do you see in churg straus?
histiocytes/giant cells surrounding central necrotic zone w/ eosinophils
What do you see in microscopic polyangiitis [MPA]?
pauci-immune vasculitis restricted to arterioles, venules, capillaries
What are systemic manifestations of microscopic polyangiitis?
- glomerulonephritis !!!!
- fever
- myalgia, arthralgia
- weight loss
- ENT symptoms
What type of anca in microscopic polyangitis?
P-ANCA
What type of anca in churg strauss?
P anca
What do you see on biopsy in microscopic polyangiitis?
diffuse alveolar hemorrhage w/ neutrophilic capillaritis
no granulomas, giant cells, eosinophils
What are some things that cause diffuse alveolar hemorrhage w/ capillaritis?
- microscopic polyangiitis
- lupus
- wegeners [rare]
- goodpasture’s
- drug rxn
- infection
What is major clinical finding in diffuse alveolar hemorrhage?
signficant hemoptysis
