Vascular Pathology Flashcards
What is vasculitis?
Inflammation of the blood vessel wall.
What are the layers of the arterial wall?
Endothelial intima smooth muscle media
What are common clinical features of vasculitis?
Nonspecific inflammatory symptoms (fever fatigue
How is vasculitis classified by vessel size?
Large-vessel (aorta and major branches) medium-vessel (muscular arteries to organs)
What is temporal (giant cell) arteritis?
Granulomatous vasculitis involving branches of the carotid artery common in older adults
What are key symptoms of temporal arteritis?
Headache (temporal artery) visual disturbances (ophthalmic artery)
How is temporal arteritis diagnosed and treated?
Diagnosis requires a biopsy with giant cells and intimal fibrosis; treatment is corticosteroids to prevent blindness.
What is Takayasu arteritis?
Granulomatous vasculitis involving the aortic arch at branch points often in young Asian females.
What are the main clinical features of Takayasu arteritis?
Visual and neurologic symptoms weak or absent pulse in the upper extremity (“pulseless disease”)
How is Takayasu arteritis treated? .
Corticosteroids
What is polyarteritis nodosa?
Necrotizing vasculitis involving multiple organs except the lungs common in young adults.
What are key symptoms of polyarteritis nodosa?
Hypertension (renal artery) abdominal pain with melena (mesenteric artery)
What does polyarteritis nodosa look like on imaging?
“String-of-pearls” appearance due to varying stages of lesions with transmural inflammation and fibrinoid necrosis.
How is polyarteritis nodosa treated?
Corticosteroids and cyclophosphamide; fatal if untreated.
What is Kawasaki disease?
An acute vasculitis affecting children especially Asian children under 4 years old.
What are clinical features of Kawasaki disease?
conjunctivitis Fever
What are the main complications of Kawasaki disease?
Coronary artery thrombosis (risk of MI) and aneurysm with rupture.
How is Kawasaki disease treated?
Aspirin and IVIG; it is self-limited.
What is Buerger disease?
A necrotizing vasculitis affecting the digits often associated with smoking.
What are symptoms of Buerger disease?
Ulceration gangrene
How is Buerger disease treated?
Smoking cessation.
What is Wegener granulomatosis?
Necrotizing granulomatous vasculitis affecting the nasopharynx lungs
What are symptoms of Wegener granulomatosis?
Sinusitis or nasopharyngeal ulcers hemoptysis with lung nodules
What lab marker is associated with Wegener granulomatosis?
Serum c-ANCA which correlates with disease activity.
How is Wegener granulomatosis diagnosed and treated?
Biopsy shows necrotizing granulomas; treatment is cyclophosphamide and steroids though relapses are common.
What is microscopic polyangiitis?
Necrotizing vasculitis similar to Wegener’s but without nasopharyngeal involvement or granulomas.
What lab marker is associated with microscopic polyangiitis?
Serum p-ANCA which correlates with disease activity.
How is microscopic polyangiitis treated?
Corticosteroids and cyclophosphamide; relapses are common.
What is Churg-Strauss syndrome?
Necrotizing granulomatous vasculitis with eosinophils affecting multiple organs
What are key features of Churg-Strauss syndrome?
Asthma peripheral eosinophilia
What is Henoch-Schönlein purpura?
IgA-mediated vasculitis the most common vasculitis in children.
What are symptoms of Henoch-Schönlein purpura?
Palpable purpura on buttocks/legs GI pain/bleeding
How is Henoch-Schönlein purpura treated?
Usually self-limited; steroids if severe.
What is hypertension?
Increased blood pressure which can affect the systemic or pulmonary circulation.
How is systemic hypertension (HTN) defined?
Pressure ≥ 140/90 mm Hg; normal is <120/80 mm Hg.
How is HTN classified based on etiology?
Primary (unknown cause 95%) and secondary (identifiable cause
What are the risk factors for primary hypertension?
Age race (higher in African Americans)
What is a common cause of secondary hypertension?
Renal artery stenosis known as renovascular hypertension.
How does renal artery stenosis lead to HTN?
Stenosis reduces glomerular blood flow activating the JGA to secrete renin
What causes renal artery stenosis?
Atherosclerosis (in elderly males) and fibromuscular dysplasia (in young females).
What is fibromuscular dysplasia?
A developmental defect causing irregular thickening of large- and medium-sized arteries especially the renal artery.
How else can HTN be classified?
Benign (most cases slow damage) and malignant (severe HTN > 200/120 mm Hg).
What are signs of malignant hypertension?
Acute end-organ damage including acute renal failure
What is arteriosclerosis?
Hardening of the arteries due to thickening of the vessel wall.
What are the three types of arteriosclerosis?
Atherosclerosis arteriolosclerosis
What is atherosclerosis?
Intimal plaque formation in large- and medium-sized arteries often with a necrotic core and fibromuscular cap.
What are common sites of atherosclerosis?
Abdominal aorta coronary artery
What are modifiable risk factors for atherosclerosis?
Hypertension high LDL cholesterol
What are non-modifiable risk factors for atherosclerosis?
Age gender (higher in males and postmenopausal females)
What initiates the formation of atherosclerosis?
Endothelial damage allowing lipids to enter the intima.
What forms foam cells in atherosclerosis?
Macrophages consume oxidized lipids becoming foam cells.
What are the stages of atherosclerosis development?
Starts as fatty streaks (lipid-laden macrophages) progressing to atherosclerotic plaque.
What are complications of atherosclerosis?
Stenosis plaque rupture with thrombosis
What does stenosis of medium-sized vessels cause?
Impaired blood flow leading to peripheral vascular disease angina
What is the consequence of plaque rupture with thrombosis?
Thrombosis can cause myocardial infarction (MI) in coronary arteries or stroke in cerebral arteries.
What does plaque rupture with embolization cause?
Atherosclerotic emboli often containing cholesterol crystals.
What happens when atherosclerosis weakens the vessel wall?
Can lead to aneurysm formation such as abdominal aortic aneurysm.
What is arteriolosclerosis?
Narrowing of small arterioles divided into hyaline and hyperplastic types.
What causes hyaline arteriolosclerosis?
Protein leakage into the vessel wall often due to benign HTN or diabetes.
What is hyperplastic arteriolosclerosis?
Thickening of vessel walls due to smooth muscle hyperplasia giving an “onion-skin” appearance
What is Monckeberg medial calcific sclerosis?
Calcification of the media in muscular arteries which is non-obstructive and clinically insignificant.
What is aortic dissection?
Intimal tear with blood dissecting through the aortic media typically in the proximal aorta.
What causes aortic dissection?
Most commonly HTN; also connective tissue disorders like Marfan syndrome or Ehlers-Danlos syndrome.
What are symptoms and complications of aortic dissection?
Sharp tearing chest pain radiating to the back; complications include pericardial tamponade
What is thoracic aneurysm and its classic cause?
Dilation of the thoracic aorta often due to tertiary syphilis
What are complications of thoracic aneurysm?
Aortic valve insufficiency compression of nearby structures
What is abdominal aortic aneurysm and its classic cause?
Dilation of the abdominal aorta often due to atherosclerosis
What is a major complication of abdominal aortic aneurysm?
Rupture particularly when >5 cm
What is hemangioma?
A benign tumor of blood vessels commonly seen at birth
What is angiosarcoma?
A highly aggressive malignant proliferation of endothelial cells commonly in skin
What exposures are associated with liver angiosarcoma?
Polyvinyl chloride arsenic
What is Kaposi sarcoma?
A low-grade malignant proliferation of endothelial cells associated with HHV-8 infection.
What are the types of Kaposi sarcoma?
Older Eastern European males (localized) AIDS patients (disseminated)
