Lung Disease Of Vascular Origin

Question 1

Pulmonary circulation

Answer 1

Dual blood supply: bronchial arteries and pulmonary arteries

Question 2

Virchow’s triad

Answer 2

Endothelial injury
Abnormal blood flow
Hypercoagulable states

Question 3

Thrombus

Abnormalities to blood flow common cause

Answer 3

Ulcerated atherosclerotic plaque

Question 4

Thrombus

Abnormalities to blood flow causes of stasis

Answer 4

Aneurysms, myocardial infarcts, mitral stenosis and atrial fibrillation, sickle cell disease (luminal obstruction)

Question 5

Thrombus

Abnormalities of the blood vessel wall/ endothelial injury causes

Answer 5

Ulcerated atheromatous plaques, traumatic injury, inflammator vascular

Question 6

Thrombus
( abnormalities of blood constituents/ hypercoagulability)
Genetic(primary) hypercoagulable state

Answer 6

Protein c deficiency, protein s deficiency, anti-thrimbin 3 deficiency, mutations in factor 5 gene, prothrombin gene mutations, increased level of factors 8,9!11

Question 7

Thrombus
( abnormalities of blood constituents/ hypercoagulability)
Acquired (secondary) hypercoagulable state

Answer 7

Prolonged bed rest/ immobilization, Myocardial infarction, Cancer, Anti-phospholipid
antibody syndrome, Disseminated intravascular coagulopathy (DIC), Heparin-induced
thrombocytopenia, Prosthetic valves, Hyperoestrogenic states, Combined oral
contraceptive use (COC), Smoking (increased lipids), Nephrotic syndrome,
Hyperoestrogenic states (pregnancy and postpartum)

Question 8

types of emboli

Answer 8

1. Thrombo-embolism
2. Amniotic fluid emboli
3. Body tissue emboli
4. Fat and bone marrow emboli
5. Air emboli
6. Tumour emboli
7. Foreign body emboli
8. Parasitic emboli

Question 9

thromb0-embolism/pulmonary embolus (site of formation, size and location and dertemine clinical presentation

Answer 9

site of formation:Leg veins: 95%
Pelvic veins
Intracranial venous sinuses

Saddle embolus – sudden death
One main pulmonary artery occlusion – sudden death
Occlusion of lobar or segmental artery – +/- distal lung infarction
Multiple small emboli – pulmonary arterial hypertension

Question 10

amniotic fluid emboli associated with

Answer 10

labour or caesarean section

Question 11

amniotic fluid emboli presentation

Answer 11

1. Sudden severe dyspneoa
2. Cyanosis
3. Shock – diffuse alveolar damage
4. Neurologic impairment
   a. Headache
   b. Seizures
   c. Coma
5. DIC

Question 12

amniotic fluid emboli histologic findings

Answer 12

1. Squamous epithelial cells
2. Lanugo hair
3. Fat
4. Meconium
5. Mucin

Question 13

amniotic fluid emboli complications

Answer 13

1. Diffuse alveolar damage – hyaline membranes

2. Fibrin thrombi in vascular beds

Question 14

body tissue emboli

Answer 14

Associated with trauma or lacerations of the brain and liver

Severe hepatic necrosis

Question 15

fat and bone marrow emboli risk factors

Answer 15

a. Trauma
a. Fractures
b. Vigorous cardiopulmonary resuscitation
c. Bone marrow infarction due to sickle-cell disease or steroid therapy

Question 16

fat and bone marrow emboli syndrome

Answer 16

1. Pulmonary insufficiency
2. Neurologic symptoms
3. Anaemia
4. Thrombocytopenia

Question 17

fat and bone marrow emboli microscopic findings

Answer 17

1. Fat globules
2. Marrow elements
3. Haematopoietic elements
4. Fat stains – oil red O and Sudan black
5. Frozen sectio

Question 18

parasitic embolism

Answer 18

Various parasites migrate through the lungs

1. Dirofilaria immitis
2. Filarial parasites (e.g. Wuchereria)
3. Strongyloides
4. Ascaris
5. Schistosoma

Question 19

tumour embolism

Answer 19

Embolic carcinomatosis

Mechanism for tumour metastasi

Question 20

foreign body emboli iv entry of which fregments

Answer 20

1. Cotton
2. Talc
3. Plastic catheters and tubing

Question 21

foreign body emboli microscopy

Answer 21

1. Foreign material
2. Foreign body giant cell reaction
3. Vessel wall destruction

Question 22

air embolism risk factors

Answer 22

1. Surgery
   a. Coronary bypass
   b. Laparoscopic surgery
2. Trauma with laceration of veins
3. Intravenous injection
4. Ventilation therapy
5. Therapeutic insufflation of fallopian tubes
6. Hyperbaric decompression

Question 23

air embolism obstruction to blood flow

Answer 23

pulmonary oedema and death

Question 24

Infarction uncommon

Answer 24

Pre-existing cardiac or pulmonary disease

o Low flow state

Question 25

Pulmonary artery occlusions

Answer 25

 Haemorrhagic,  Wedge shaped,  Pleural based infarct

Question 26

Vasculitis infarcts

Answer 26

Round |  Thrombosed blood vessel centrally located

Question 27

PULMONARY HYPERTENSION

Answer 27

Mean pulmonary artery pressure greater than or | equal to 25mmHg at rest

Question 28

Pulmonary arterial hypertension

Answer 28

Examples:  Autoimmune diseases -Systemic sclerosis involving pulmonary vasculature and/ or interstitium  Idiopathic/primary pulmonary arterial hypertension -Mutations in BMPR2 locus result in pulmonary vascular thickening and occlusion

Question 29

Pulmonary hypertension secondary to left-heart failur

Answer 29

Example:  Antecedent congenital or acquired heart disease -Mitral stenosis causes an increase in left atrial pressure that is eventually transmitted to the arterial side of the pulmonary vasculature

Question 30

Pulmonary hypertension stemming from lung parenchymal disease or hypoxaemia

Answer 30

Examples: • Chronic obstructive or interstitial lung diseases -Mechanism: disease results in obliteration of alveolar capillaries thus increasing pulmonary resistance to blood flow • Obstructive sleep apnea -Obesity and hypoxaemia

Question 31

Chronic thromboembolic pulmonary hypertension

Answer 31

Example: • Recurrent thromboemboli -Mechanism: reduces functional area of pulmonary vascular bed

Question 32

Morphology of pulmonary hypertension | All forms associated with:

Answer 32

Medial hypertrophy of muscular and elastic arteries • Pulmonary arterial atherosclerosis • Right ventricular hypertrophy

Question 33

DIFFUSE PULMONARY HAEMORRHAGE SYNDROMES

Answer 33

Goodpasture syndrome • Idiopathic pulmonary haemosiderosis • Polyangiitis with granulomatosis

Question 34

Goodpasture syndrome

Answer 34

Uncommon • Seen predominantly in teens or 20s and active smokers • Autoimmune disease involving the kidney and lung • Caused by circulating antibodies against collagen IV • Trigger that initiates the production of antibodies is still unknown • Antibodies initiate inflammatory destruction to basement membranes in the renal glomeruli and pulmonary alveoli

Question 35

Goodpasture syndrome clinical

Answer 35

Respiratory: haemoptysis, focal pulmonary consolidation • Common cause of death is uraemia • Treatment: immunosuppression

Question 36

Idiopathic pulmonary haemosiderosis

Answer 36

``` Rare • Pathogenesis is unknown • Commonly seen in young children • Adult cases have been reported • Presentation: productive cough, haemoptysis, anaemia associated with diffuse pulmonary infiltration ```

Question 37

Polyangiitis with granulomatosi

Answer 37

Previously Wegener granulomatosis • Autoimmune involving upper respiratory tract and/ or lungs • Presentation: haemoptysis