Vascular Flashcards
Berry aneurysm congenital defect of the
tunica intima and tunica media are congenitally absent allowing an outpocketing of the tunica adventitia
Average age of berry aneurysm
20-40
Berry aneurysm location
Circle of Willis
Arteriovenous fistulas congenital defect
abnormal communications between arterial and venous blood vessels
Arteriovenous fistulas may be secondary to
to infection, trauma, blood vessel rupture or previous surgical intervention.
Arteriovenous fistulas may contribute to
right-sided congestive heart failure by increasing venous return to the heart
Temporal Arteritis definition
granulomatous inflammation and breakdown if the internal elastic membrane of branches of carotid artery
Temporal Arteritis Treatment
corticosteroids
Takayasu Arteritis definition
granulomatous inflammation of aortic arch, young asian female
Takayasu Arteritis symptoms
ocular disturbances, weak/absent pulses in UE
Polyarteritis Nodosa
young, adult males w/ nodular inflammation of vessels
Polyarteritis Nodosa affects which organs
all organs except the LUNG
Polyarteritis Nodosa acute pathology
fibrinoid necrosis w/ neutrophils, eosinophils, monocytes
Polyarteritis Nodosa healing lesion pathology
fibroblastic proliferation w/ macrophages and plasma cells
Kawasaki Disease symptoms
fever, conjunctivitis, erythematous rash of palms and soles, enlarged cervical lymph nodes
Complication of Kawasaki Disease
coronary aneurysm
Kawasaki Disease patient population
young asian children/infants
Buerger Disease patient population
male, heavy smokers,
Buerger Disease Symptoms
gangrene, pain mostly in fingers and toes, Raynaud Phenomenon
Treatment for Kawasaki Disease
ASA
Treatment for Buerger Disease
smoking cessation
Wegener Granulomatosis definition
necrotizing granulomatosis of the nasopharynx, lung, kidney
Wegener Granulomatosis Symptoms
chronic sinusitis, nasopharynx ulcerations, hemoptysis, pneumonitis, necrotizing glomerulitis
Test for Wegener Granulomatosis
C-ANCA
Wegener Granulomatosis patient pop
male, 50+
Microscopic Polyangitis definition
arterioles, venules, capillaries of the skin, mucus membranes, lung, heart, GIT, kidney, etc
Test for Microscopic Polyangitis
P-ANCA
Churg-Strauss Syndrome is associated w/
asthma and eosinophilia
Test for Churg-Strauss Syndrome
P-ANCA
Infectious vasculitis
direct extension of organism into wall or hematogenous embolization
vaso vasora
found in the tunica adventitia
Atherosclerosis commonly occurs in the
abdominal aorta, coronary arteries, elastic arteries, muscular arteries and cerebral arteries
atherosclerotic plaque is composed what cells
smooth muscle cells, macrophages and leukocytes
atherosclerotic plaque is composed what CT
collagen, elastic fibers, proteoglycans
Simple atheromatous plaque is composed of
composed of a fibrous cap and central lipid core
The fibrous cap is composed of
macrophages, foam cells, lymphocytes, collagen, elastin, and proteoglycans
The inner core is a necrotic center composed of
lipid, cholesterol, cellular debris, foam cells, and calcium
Simple atheromatous plaques occur b/w
tunica intima and tunica media
Complicated atheromatous plaque is associated w/
Either: 1.) calcification 2) surface ulceration 3) thrombosis 4) hemorrhage into the plaque causing hematoma. 5) aneurysmal dilation
fatty streaks
earliest sign of atherosclerotic plaque
Fatty streaks are characterized by
proliferation of smooth muscle with intracytoplasmic lipid accumulation
fatty streaks tend to occur as
intimal cushion pads occurring at the bifurcation of arteries
intimal cushion pads HOWEVER are
smooth muscle cells with collagen however, they usually lack lipid
atheroma formation is initiated by
damage to endothelium lining arterial blood vessels
Damage causes
adherence of platelets and monocytes, attraction of SM cells and collagen production, w/ monocyte/macrophage phagocytosis of lipids deposited in the injury site
Monckeberg
ring-like calcifications of the tunica media arranged in a concentric fashion throughout the length of an artery - give rise to bone
Monckeberg sites most commonly affected
femoral, tibial, radial, ulnar, and arterial supplies of the genital tracts in both sexes
Arteriolosclerosis
thickening of arterial walls due to HTN
Hyaline arteriolosclerosis occurs in
hypertensive and diabetics
Hyaline arteriolosclerosis appears as
accumulation of pink homogenous hyaline material within the blood vessel wall -> narrowing of intima
Benign nephrosclerosis and/or ischemic necrosis and gangrene in the lower extremities of diabetics is due to
Hyaline arteriolosclerosis
Hyperplastic arteriolosclerosis
malignant hypertensive
Hyperplastic arteriolosclerosis characteristic finding
onionskin layering due to an increase of smooth muscle cells within the tunica media
Hyperplastic arteriolosclerosis most commonly affects
abdominal and thoracic viscera are very commonly affected
headache, temporal tenderness, visual loss or facial pain.
Temporal arteritis
Polyarteritis Nodosa most commonly affects
arterial bifurcations
Polyarteritis Nodosa Sx
fever of unknown origin, weight loss, hematuria, albuminuria, renal failure, hypertension, abdominal pain, melena myalgia and neuritis
acute form of Polyarteritis Nodosa
fibrinoid necrosis of the blood vessel wall with infiltrates of neutrophils, eosinophils and monocytes
Healing form of Polyarteritis Nodosa
fibroblastic proliferation with an infiltrate of macrophages and plasma cells
Healed form of Polyarteritis Nodosa
fibrotic thickening of the blood vessel wall with a loss of the internal elastic membrane.
Churg-Strauss Syndrome
allergic granulomatosis of Polyarteritis Nodosa
Churg-Strauss Syndrome key findings
bronchial asthma, marked eosinophilia
Wegener granulomatosis
necrotizing granulomas, upper airway and lungs, glomerulitis
Wegener granulomatosis occurs at age
50+
Treatment of Wegener granulomatosis
if not fatal in 5 mo
Buerger Disease patients
heavy smokers under the age of 35
Buerger Disease Sx
Raynaud phenomenon, instep claudication, pain with gangrene
mycotic aneurysm
weakening of the vessel wall due to infectious vasculitis
Raynaud Disease definition
intense vasospasm of small arteries and arterioles of
Raynaud Disease pathology
no identifiable changes in the arterial walls except in the late form in which there may be intimal proliferation
Raynaud phenomenon definition
arterial insufficiency from a direct underlying cause
Underlying causes of Raynaud phenomenon
SLE, scleroderma, atherosclerosis, Buerger
The most common cause of aortic aneurysms is
atherosclerosis
Aneurysm pathogenesis
cystic medial necrosis with degeneration of the tunica media and subsequent weakening of the wall
Atherosclerotic aneurysms pt pop
hypertensive males, abdominal aorta, may rupture
Complications of Atherosclerotic aneurysms
mural thrombi/emboli, rupture into peritoneum
Syphilitic (luetic) aneurysms common site
ascending thoracic aorta and arch
Syphilitic (luetic) aneurysms characteristic shape
fusiform
Syphilitic (luetic) aneurysms appearance of vessel
endothelium undergoes “tree-barking”, caused by linear destruction and inflammation of the tunica intima
Syphilitic (luetic) aneurysms pathology
lymphocytes and plasma cells, medial necrosis and destruction
Aortic Dissection
tear of the tunica intima into the tunica media with separation and dissection along the tunica media
Aortic Dissection fate
spontaneously reenter the aortic lumen or may end as a blind pouch
Aortic Dissection pathology
cystic medial necrosis with fragmentation of the elastic membrane
Aortic Dissection Type A1
begins in the ascending aorta and extends over the arch and down along the entire descending aorta
Aortic Dissection Type A2
begins at and involves only ascending aorta
Aortic Dissection Type B
distal to the aortic arch and involves the entire descending aorta
Venous varicosities are caused by
destruction of venous valves with subsequent venous insufficiency
Venous varicosities Sx
progression of marked dilation and tortuosity of veins
Venous varicosities pt pop
genetic predisposition, non-mobile upright occupations
Venous varicosities of the Lower extremities
superficial veins, dilated tortuousities, prone to thrombi
Venous varicosities - Hemorrhoids caused by
increased abdominal pressure (obesity, tumor, scarring secondary to previous surgery or trauma, pregnancy)
Venous varicosities - Esophageal varices
lower plexus of the esophagus, cirrhosis, chronic alcoholics and prone to rupture
Venous varicosities - Varicocele
pampiniform plexus of the spermatic cord, “bag of worms”
Phlebothrombosis and Thrombophlebitis
inflammation with thrombosis - inflammatory processes of the veins associated with the formation of venous thrombi
Causes for Phlebothrombosis
cardiac failure, neoplasia, pregnancy, obesity, post operative state, infection, prolonged bed rest or immobilization and hypercoagulable states
Trousseau sign
paraneoplastic syndrome of malignany is migratory thrombophlebitis
Phlebothrombosis locations
DVT, periprostatic venous plexus, large veins of the skull
first manifestation of Phlebothrombosis may be
PE
Lymphangitis causes
bacterial - group A beta hemolytic streptococci
Lymphangitis pathogenesis
dilated and filled with acute inflammatory exudate -> break through causing cellulitis and abscess
Clinically lymphangitis is diagnosed by
development of streaks along extremities spreading towards the trunk from the distal area proximally
The most common causes of lymph edema include
- metastasis + obstruction in the lymphatic vessels 2) surgery 3) radiation 4) filariasis 5) post inflammatory thrombosis with scarring of lymphatic channels.
chylous ascites, chylothorax or chylopericardium
Lymph edema in the abdominal and thoracic cavities
Capillary hemangioma
small, benign, neoplasm of capillaries in the skin, mucus membrane, viscera
strawberry hemangioma
large capillary hemangioma on the skin of infants
strawberry hemangioma fate
usually fade at approximately 3 years of, regress by 5
Cavernous hemangiomas
small, benign, neoplasm of dilated vascular spaces of the head and neck, mucus membranes, viscera, brain
von Hippel-Lindau
condition in which cavernous hemangiomas occur in the cerebellum or brain stem and eye grounds, pancreas, liver, etc
Granuloma Pyogenicum
polypoid form of hemangioma, with surface inflammation and ulceration or the skin, gingiva, and oral mucosa
Granuloma Pyogenicum pathology
distinct collarette at base w/ granulation-looking stroma
33% of Granuloma Pyogenicum are due to
trauma
granuloma gravidarum
tumor on the gingiva and spontaneously regresses after delivery
Glomus Tumor definition
benign, painful tumor of the nerve receptor sensitive to temperature variation and regulating arterial flow
Glomus Tumor commonly found
distal extremities, especially beneath the nails
Pathology of Glomus Tumor
Vascular channels split by CT Aggregated nests of gloms cells
Vascular Ectasias
Nevus flammeus, Spider telangiectasis, Hereditary hemorrhagic telangiectasia
Hemangioendothelioma
endothelial cells growing in vascular lumina
Hemangioendothelioma is intermediate b/w
hemangioma and angiosarcoma
Hemangioendothelioma is most common in the
skin but also the spleen and liver
Hemangioendothelioma pathology
spindle shaped cells with occasional mitotic figures and pleomorphism
Angiosarcoma
anaplastic endothelial cells with frequent mitotic figures
Angiosarcoma is most common in the
skin, breast, soft tissue and liver
Angiosarcoma symptoms
small red well-demarcated masses -> bulky and fleshy with central areas of hemorrhage and poorly defined borders
Hepativ variants of Angiosarcoma involve exposure to
arsenic, Thorotrast and PVC
Hemangiopericytoma
lower extremities and retroperitoneum, these rare tumors arise from pericytes
Hemangiopericytoma pahtology
spindle-shaped cells
Hemangiopericytoma risk of metastatsis
50% may metastasize to the lungs, bone and liver.
Classic Kaposi Sarcoma pt pop
older men of Eastern European and Mediterranean,
Classic Kaposi Sarcoma Sx
multiple purple red skin plaques or nodules usually arising on the lower extremities and spreading proximally
African Kaposi Sarcoma pt pop
children and younger men
African Kaposi Sarcoma accounts for 10% of
All tumors in Africa, regional lymph node involvement
Transplant Associated Kaposi pt pop
transplant recipients + immunosuppressants
Transplant Associated Kaposi Sx
localized or metastasized, regresses w/ discontinuation of immunosuppressants
AIDS-associated Kaposi pt pop
33% of all AIDS pts
AIDS-associated Kaposi Sx
wide dissemination, skin, membranes, viscera and typically develop another malignancy
Appearance of all kaposi lesions
red to blue coalescing plaques and nodules composed of spindle cells around angulated blood filled vascular spaces with occasional mitoses
Lymphangioma
benign, subcutaneous tissues of the head, neck and axilla
Lymphangioma pathology
identical to capillary hemangioma but absence of blood from the vascular spaces
Lymphangiosarcoma
malignant, after prolonged lymph obstruction w/ lymphedema
Lymphangiosarcoma is most common in
mastectomy pt
Lymphangiosarcoma Sx
small subcutaneous nodules, which later coalesce to form a large mass
