Vascular Pathology Flashcards
Consequences of hyperplastic arteriolsclerosis
Reduced vessel caliber with end organ ischemia
Fibrinoid necrosis of the vessel wall with hemorrhage
Acute renal failure with a characteristic ‘flea-bitten appearance
When does an abdominal aortic aneurysm classically rupture?
When >5cm in diameter
Why is artherosclerosis not common in pre-menopausal females?
Estrogen is protective
Granulomatous vasculitis that classically involves the aortic arch at branch points
Takayasu Arteritis
What is the classical appearance of the thoracic aneurysm?
“Tree bark” appearance
What is the most common cause of aortic dissection?
Hypertension
*Also associated with inherited defects of connective tissue in younger individuals
Complications of thoracic aneurysm
Dilation of the aortic valve root, resulting aortic valve insufficiency (major)
Compression of mediastinal structures
Thrombosis/embolism
Complications of atherosclerosis
- Impaired blood flow and ischemia:
- Peripheral vascular disease
- Angina
- Ischemic bowel disease
- Plaque rupture with thrombosis results in MI and stroke
- Plaque rupture with embolization results in artherosclerotic emboli
- Weaking of vessel wall results in aneurysm
Necrotizing granulomatous vasculities involving nasopharynx, lungs, and kidneys
Wegener Granulomatosis
What is an angiosarcoma?
Malignant proliferation of endothelial cells; highly agressive
Classic demographic for takayasu arteritis
<50
young asian females
Necrotizing granulomatous inflammation with eosinophils involving multiple organs, especially lungs and heart
Chrug-Strauss Syndrome
What is the pathology by which hypertension leads to aortic dissection?
Hypertension results in hyaline arteriolosclerosis of the vasa vasorum. Decreased flow causes atrophy of the media
How does polyarteritis nodosa present?
Hypertension
Abdominal pain with melena
Neurologic disturbances
Skin lesions
Takayasu Arteritis treatment
Corticosteriods
You have to have greater than _________ stenosis before you see complications.
70%
Low-grade malignant proliferation of endothelial cells
Kaposi Sarcoma
How does takayau arteritis present?
Visual and neurologic symptoms with a weak or absent pulse in the upper extremity
ESR is elevated
How does temporal arteritis present?
Headache (due to temporal artery involvement)
jaw claudication
Visual disturbances (due to opthalmic artery)
Flu-symptoms with joint and muscle pain (polymyaligia rheumatica)
Initimal plaque that obstructs blood flow
Atherosclerosis
__________ hypertension is due to an unknown etiology, while ________ hypertension is due to an identifiable etiolgy.
Primary; secondary
Causes of renal artery stenosis
Artherosclerosis (elderly males)
Fibromuscular dysplasis (young females)
Intimal tear with dissection of blood through media of the aortic wall
Aortic dissection
Pathogenesis of thoracic aneurysm
Endarteritis of the vasa vasurum results in luminal narrowing, decreased flow, and atrophy of the vessel
Classic demographic of abdominal aortic dissection
Male smokers >60 yrs with HTN
In conditions is thoracic aneurysm classically seen?
Tertiary syphillis
How is Wegener Granulomatosis treated?
Cyclophosphamide
Steroids
How does an abdominal aortic aneurysm present?
Pulsatile abdominal mass that grows with time
Which artery is involved in kawasaki disease?
Coronary artery, which leads to risk for thrombosis with MI and aneurysm rupture
Hyperpastic arteriolosclerosis is a consequence of __________.
Malignant hypertension
Modificable risk factors for artherosclerosis
HTN
Hypercholesterolemia (LDL increase, HDL decreases)
Smoking
Diabetes
Which vasculitis is associated with serum HBsAg?
Polyarteritis nodosa
3 pathologic patterns of arteriosclerosis
Atherosclerosis
Arteriolosclerosis
Monckeberg medial calcific sclerosis
Demographic for kawasaki disease
Asian children <4 yrs
Hyaline arteriolosclerosis is the consequence of …
Long standing benign hypertension or diabetes
What is the hematuria seen in Wegener granulomatosis due to?
Rapidly progressive glomerulonephritis
String of pearls
Polyarteritis nodosa
Henoch-Schonlein Purpura is a vasculitis due to ____ immune complex deposition.
Henoch Schonlein Purpura
Complications of aortic dissection
- Pericardial tamponade
- Rupture with fatal hemorrhage
- Obstruction of branching arteries with resultant end-organ ischemia
Pathogenesis of artherosclerosis
- Damage to endothelium allows lipids to leak into the intima
- Lipids are oxidized and then consumed by macrophages via scavenger receptors , resulting in foam cells
- Inflammation and healing leads to deposition of extracellular matrix and proliferation of smooth muscle
What is the cause of the hematuria seen in Henoch-Schonlein Purpura?
IgA nephropathy
What is the characteristic appearance of acute renal failure due to hyperplastic arteriolosclerosis?
Flea-bitten
When does Henoch-Schonlein purpura typically occur?
Following an upper respiratory tract infection
Most common organs impacted by hemangioma
Skin and liver
Where does an abdominal aortic aneurysm usually arise?
Below the renal arteries, but above the aortic bifurcation
How does Henoch-Schonlein Purpura presnt?
Palpable purpura on buttocks and legs
GI pain and bleeding
Hematuria
Ballon-like dilation of the thoracic aorta
Thoracic aneurysm
How does malignant hypertension present?
Acute end-organ damage
Necrotizing vasculitis involving multiple organs
Polyarteritis nodosa
Which arteries are usually affected by artherosclerosis?
Large and medium sized arteries
- Abdominal aorta
- Coronary artery
- Popliteal artery
- Internal carotid artery
______________ arteriolosclerosis involves thickening of vessel wall by hyperplasia of smooth muscle.
Hyperplastic
Histo of polyarteritis nodosa?
Early
- Transmural inflammation with fibrinoid necrosis
Late
- Healing results in fibrosis producing a “string of pearls” apperance on imaging
Pathology by atherosclerosis results in abdominal aortic aneurysm
Athreosclerosis increases the diffusion barrier to the media, resulting in atrophy and weakness of the vessel wall
Necrotizing vasculitis involving the digits?
Buerger Disease
Complications of abdominal aortic aneurysm
Rupture
Compression of local structures
Thrombosis/embolism
Where does an aortic dissection typically occur?
In the proximal 10 cm of the aorta with pre-existing weakness of the media
Which arteries are involved in polyarteritis nodosa?
Renal
Abdominal
How is temporal arteritis treated?
Corticosteroids
*High risk of blindness if not treated
Morphologic stages of atherosclerosis
- begins as fatty streaks (fatty yellow lesions of the intima consisting of lipid-laden macrophages
- Progresses to atherosclerotic plaque
Which organs are spared in polyarteritis nodosa?
Lungs
Why does a negative biopsy not exculde temporal arteritis?
Lesions are segment. Diagnosis requires biopsy of a long segment of vessel.
Characteristic of atherosclerotic emboli
Cholesterol crystals with in the embolus
Liver angiosarcoma is associated with exposure to what substances?
Polyvinyl chloride
Arsenic
Thorortrast
Common sites of angiosarcoma
Skin, breat, and liver
Treatment for Buerger Disease
Smoking cessation
How does a ruptured abdominal aortic aneurysm present?
Hypotension
Pulsatile abdominal mass
Flank pain
Components of intimal plaque seen in atherosclerosis
Consists of a necrotic lipid core (mostly cholesterol) with a fibromuscular cap
*often undergoes dystrophic calcification
Consquences of hylaine arteriolosclerosis
Reduced vessel caliber with end-organ ischemia
Glomerular scarring that slowly progresses to chronic renal failure
What genetics conditions are related to aortic dissection and by what mechanism?
Marfan syndrome and Ehlers-Danlos syndrome classically lead to weakness of the connective tissue in the media (cystic medial necrosis)
How does Wegener Granulomatosis presnt?
- Middle aged male with sinusitis or nasopharyngeal ulceration
- Hemoptysis with bilateral nodular lung inflitrates
- Hematuria
Abdominal aortic aneurysm is primary due to _____________.
Artherosclerosis
How does buerger disease present?
Ulceration
Gangrene
Autoamputation of fingers and toes
Raynaud phenomenon
Microscopic polyangiitis presents similar to wegener granulomatosis. How does it differ?
No nasopharyngeal involvement
Granulomas are absent
p-ANCA
Most common vasculitis in children
Henoch-Schonlein Purpura
What lung condition is often associated with churg-strauss syndrome?
Asthma
How is Henoch-Scholein Purpura treated?
Disease is self-limited, but may recur; treated with steroids, if severe
Common demographic for temporal arteritis
Females
>50
How does renal artery stenosis result in secondary HTN?
- Stenosis decreases blood flow to glomerulus
- Juxtaglomerular apparatus responds by secreting renin, which converts angiotension to angiotension II
- ATII raised blood pressure by contracting smooth musclem increasing total peripheral resistance and promting adrenal release of aldosterone, which increases resorption of sodium in the distal convuluted tubule (expanding plasma volume)
Temporal (giant cell) arteritis is a granulomatous vasculitis that classically involves branches of the _______ artery.
Carotid
How does aortic dissection present?
Presents as sharp, tearing chest pain that radiates to the back
How is polyarteritis nodosa treated?
Cyclophosphamide
Corticosteriods
______________ is a developmental defect of the blood vessel wall, resulting in irregular thickening of large and emdium-sized arteries, especially the renal artery.
Fibromucular dysplasia
How is Kawasaki treated?
Aspirin and IVIG
Calcification of the media of muscular arteries; non obstructive
Monkerberg Medial Calcific Sclerosis
Cause of hyaline arteriolosclerosis
Proteins leaking into the vessel wall, producing vascular thickening
