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Anatomical pathology > LUNG DISEASES OF VASCULAR ORIGIN > Flashcards

LUNG DISEASES OF VASCULAR ORIGIN Flashcards

1
Q

Pulmonary circulation

Dual blood supply

A

oBronchial arteries

oPulmonary arteries

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2
Q

Virchow’s triad

A
  • Damage to vessel walls e.g. arteritis
  • Obstruction e.g. thrombus
  • Variations in intravascular pressure
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3
Q

THROMBOSIS( abnormalities of blood flow)

A

The commonest cause of turbulence is an ulcerated atherosclerotic
plaque
Causes of stasis include:
• Aneurysms
• Myocardial infarcts
• Mitral stenosis and atrial fibrillation
• Sickle cell disease (luminal obstruction)

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4
Q

Abnormalities of blood constituents/ hypercoagulability

Genetic (Primary) Hypercoagulable states

A
  • Protein C deficiency
  • Protein S deficiency
  • Anti-thrombin 3 deficiency
  • Mutations in factor 5 gene
  • Prothrombin gene mutations
  • Increased levels of factors
  • VIII, IX, XI or fibrinogen
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
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5
Q

Abnormalities of blood vessel wall

A

causes of damage include:
• Ulcerated atheromatous plaques
• Traumatic injury
• Inflammatory vascular injury

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6
Q

Types Of Emboli

A
  • Thrombo-embolism
  • Amniotic fluid emboli
  • Body tissue emboli
  • Fat and bone marrow emboli
  • Air emboli
  • Tumour emboli
  • Foreign body emboli
  • Parasitic emboli
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7
Q

Pulmonary Embolus

A 
• Sites of thrombus formation:
o Leg veins: 95%
o Pelvic veins
o Intracranial venous sinuses
• Most common site for thrombo-emboli is the pulmonary circulation -
pulmonary embolism
• 60-80% pulmonary TE are silent

With time they organize and are incorporated into the wall
• Sudden death, cor pulmonale or CVS collapse occurs if >60% of
vasculature occluded
• Rarely a leg vein thrombus may enter the arterial side of the
circulation if an arterio-venous shunt is present

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8
Q

Pulmonary Thromboembolism

A

• Originate from deep pelvic or calf vein
• Paradoxical emboli
• Left to right blood flow
o VSD
o ASD
• Size & location of embolus – clinical presentation
o Saddle embolus – sudden death
o One main pulmonary artery occlusion – sudden death
o Occlusion of lobar or segmental artery – +/- distal lung infarction
o Multiple small emboli – pulmonary arterial hypertension

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9
Q

Amniotic fluid emboli

A

Associated with difficult labour or caesarean section

• Presentation:
-Sudden severe dyspnoea
-Cyanosis
-Shock- Diffuse alveolar damage
-Neurologic impairment
• Headache
• Seizures
• Coma
  • DIC
  • Histologic findings in pulmonary artery branches
  • Squamous epithelial cells
  • Lanugo hair
  • Fat
  • Meconium
  • Mucin
  • Complications
  • Diffuse alveolar damage – hyaline membranes
  • Fibrin thrombi in vascular beds
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10
Q

Body tissue emboli

A
  • Associated with trauma or lacerations of the brain & liver

* Severe hepatic necrosis

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11
Q

Fat and bone marrow emboli

A
  • Risk factors
  • Trauma
  • Fractures
  • Vigorous cardiopulmonary rescuscitation
  • Bone marrow infarction due to sickle-cell disease or steroid therapy
  • Fat embolism syndrome
  • Pulmonary insufficiency
  • Neurologic symptoms
  • Anaemia
  • Thrombocytopaenia
  • Diffuse petechial rash
Fat globules
• Marrow elements
• Haematopoietic elements
• Fat stains – oil red O and Sudan 
black
• Frozen section
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12
Q

parasitic embolism

A
  • Various parasites migrate through the lungs
  • Dirofilaria immitis
  • Filarial parasites (e.g. Wuchereria)
  • Strongyloides
  • Ascaris
  • Schistosom
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13
Q

Tumour embolism

A
  • Embolic carcinomatosis

* Mechanism for tumour metastasis

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14
Q

Foreign body emboli

A
  • Intravenous entry of various fragments
  • Cotton
  • Talc
  • Plastic catheters and tubing
  • Microscopy
  • Foreign material
  • Foreign body giant cell reaction
  • Vessel wall destruction
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15
Q

Air embolism

A
  • Risk factors
  • Surgery
  • Coronary bypass
  • Laparoscopic surgery
  • Trauma with laceration of veins
  • Intravenous injection
  • Ventilation therapy
  • Therapeutic insufflation of fallopian tubes
  • Hyperbaric decompression
  • Obstruction to blood flow – pulmonary oedema and death
• Frothy blood in pulmonary vessels
• Dilation of right heart and 
contracted left heart
• Empty circular spaces within a 
column of blood
• Atelectasis, emphysematous 
change and haemosiderin laden 
histiocytes
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16
Q

Pulmonary infarction

A
  • Dual blood supply
  • Infarction uncommon
  • Pre-existing cardiac or pulmonary disease
  • Low flow state
  • Pulmonary artery occlusions
  • Haemorrhagic
  • Wedge shaped
  • Pleural based infarcts
  • Vasculitis infarcts
  • Round
  • Thrombosed blood vessel centrally located
17
Q

Pulmonary embolism and infarction

Pulmonary infarction

A
  • Commonly affect lower lobes
  • Multiple lesions are commonly seen
  • Typically extend to periphery of the lung, forming a wedge
Haemorrhagic
• Early stages: raised redblue
• Within 2 days: Paler then 
red-brown
• Later: gray white

Haemorrhagic area: ischaemic necrosis of alveolar walls, bronchioles
and vessels
• Neutrophilic infiltrate if infected

18
Q

Pulmonary hyperinfection

A

definition: Mean pulmonary artery pressure greater than or
equal to 25mmHg at rest
• Classified into 5 groups according to the WHO

. Pulmonary arterial hypertension
2. Pulmonary hypertension secondary to left-heart failure
3. Pulmonary hypertension stemming from lung parenchymal disease or
hypoxaemia
4. Chronic thromboembolic pulmonary hypertension
5. Pulmonary hypertension of multifactorial basis

19
Q

Pulmonary arterial hypertension

A

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

20
Q

Pulmonary hypertension secondary to left-heart

failure( EXAMPLE)

A

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

21
Q

Pulmonary hypertension stemming from lung

parenchymal disease or hypoxaemia( EXAMPLE)

A

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 hypoxaemi

22
Q

Chronic thromboembolic pulmonary hypertension

Example

A

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

23
Q

pulmonary Hypertension

Morphology

A 
All forms associated with:
• Medial hypertrophy of muscular 
and elastic arteries
• Pulmonary arterial 
atherosclerosis
• Right ventricular hypertrophy
24
Q

Diffuse pulmonary haemorrhage

syndromes

A

• Goodpasture syndrome
• Idiopathic pulmonary
haemosiderosis
• Polyangiitis with granulomatosis

25
Q

Goodpasture syndrome

A

• 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
• Results in : rapidly progressive glomerulonephritis
necrotizing haemorrhagic interstitial pneumonitis
Clinical
• Respiratory: haemoptysis, focal pulmonary consolidation
• Common cause of death is uraemia
• Treatment: immunosuppression

26
Q

Idiopathic pulmonary haemosiderosis

A

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

27
Q

Polyangiitis with granulomatosis

A 
• Previously Wegener granulomatosis
• Autoimmune involving upper respiratory tract and/ or lungs
• Presentation: haemoptysis
Important diagnostic features
• Capillaritis
• Scattered poorly formed granulomas

Anatomical pathology (13 decks)

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