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Pulm > Lec 21 Pathology of Vascular Disease > Flashcards

Lec 21 Pathology of Vascular Disease Flashcards

1
Q

What are risk factors for pulm embolism?

A
  • hypercoagulable
  • oral contraceptives
  • pregnancy
  • immobilization
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2
Q

What are symptoms of small infarct?

A

usually minimal

major SOB; also tachycardia, pain, fever, cough, hemoptysis

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3
Q

What are two mech by which large emboli can cause sudden death?

A
  • 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
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4
Q

What do you see grossly in smaller emboli? massive emboli?

A

smaller = wedge shaped hemorrhagic infarct

larger = may have no parenchymal changes

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5
Q

WHat is definition of pulm HTN?

A

pulm artery pressure > 25 mmHg

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6
Q

What usually causes pulm htn?

A
  • structural disease causing increased pulm blood flow or pressure
  • increased pulm vascular resistance
  • increased left heart resistance
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7
Q

Who gets pulmonary arterial hypertension?

A
  • rare disease
  • mostly young women

idiopathic or due to collagen vascular disease, drugs, etc

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8
Q

What classic finding in pulmonary arterial htn?

A

plexiform lesions

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9
Q

What is classic clinical picture of pulmonary arterialhtn?

A

young women w/ progressive SOB, angina, syncope, possibly suddent death

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10
Q

What is prognosis of PAH?

A

death usually w/in a few years

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11
Q

What is grade I PAH?

A

muscularization and medial hypertrophy of pulm arteries

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12
Q

What is grade II PAH?

A

intimatl hyperplasia causing attenuation of vascular lumen

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13
Q

What is grade III PAH?

A

subintimal fibrosis w/ onion-ring appearance

have reduplication of internal elastic membrane; arteries + arterioles look like pipes

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14
Q

What is grade 4/5 PAH?

A

dilation and plexiform lesions; have dilation of small pulm arteries

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15
Q

What is grade 6 PAH?

A

uncommon acute necrotizing arteritis w/ fibrinoid necrosis and acute inflammation of vessel wall

similar to polyarteritis nodosa

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16
Q

What is a plexiform lesion?

A

characteristic of advanced pulm htn; seen in small arteries

looks like glomerulus have lots of different lumens

17
Q

Who gets wegeners / PGA?

A

wide range; mean 50 yo

18
Q

What is classic triad of involvement wegener’s/PGA?

A
  • sinus
  • lung
  • renal
19
Q

What do you see in wegeners/PGA?

A
  • small vessel involvement
  • multiple lung nodules usually
  • C-ANCA
20
Q

What do you see on histology in wegener’s/PGA?

A
  • 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!

21
Q

What is triad of churg-strauss?

A
  • asthma
  • eosinophilia
  • vasculitis
22
Q

Who gets churg-straus?

A

equal genders; mean age 50

23
Q

What parts of body typically involved in churg strauss?

A

neuropathy, cardiac, lung, sinonasal

don’t usually have renal

24
Q

WHat do you see in churg strauss?

A
  • lung radiographs w/ multifocal infiltrates that may change over time; looks patchy

asthmatic bronchitis, eosinophilic pneumonia, stellate granulomas, vasculitis

25
Q

What type of granulomas do you see in churg straus?

A

histiocytes/giant cells surrounding central necrotic zone w/ eosinophils

26
Q

What do you see in microscopic polyangiitis [MPA]?

A

pauci-immune vasculitis restricted to arterioles, venules, capillaries

27
Q

What are systemic manifestations of microscopic polyangiitis?

A
  • glomerulonephritis !!!!
  • fever
  • myalgia, arthralgia
  • weight loss
  • ENT symptoms
28
Q

What type of anca in microscopic polyangitis?

A

P-ANCA

29
Q

What type of anca in churg strauss?

A

P anca

30
Q

What do you see on biopsy in microscopic polyangiitis?

A

diffuse alveolar hemorrhage w/ neutrophilic capillaritis

no granulomas, giant cells, eosinophils

31
Q

What are some things that cause diffuse alveolar hemorrhage w/ capillaritis?

A
  • microscopic polyangiitis
  • lupus
  • wegeners [rare]
  • goodpasture’s
  • drug rxn
  • infection
32
Q

What is major clinical finding in diffuse alveolar hemorrhage?

A

signficant hemoptysis

Pulm (24 decks)

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