Vascular Pulmonary Disease Flashcards
What are primary and secondary causes of a hypercoagulable state that can result in pulmonary emboli?
Primary: SLE
Secondary: Cancer
How does a patient present with PE in tested and physical exam?
Pulseless electrical activity
EKG shows a rhythm
Main diagnostic tool for PE.
CT angiography
-opacities appear in lung fields due to inflammation and/or hemorrhage
What can appear on CXR indicating PE?
Hampton’s Hump
Type of necrosis that occurs when lung tissue becomes ischemic due to PE.
Coagulative Necrosis
-architecture is maintained
How can you tell if an embolus formed pre or post mortem?
Lines of Zahn
-microscopic characteristic of a clot formed in active blood flow
Cell that always arrives during hemorrhage.
Macrophages
-phagocytose the hemorrhaged RBCs, then the iron from the heme is visible (hemosiderin-laden macrophages)
Major cause of fat emboli
Long Bone Fractures
What is classified as pulmonary HTN?
Mean Pulmonary Artery pressure greater than:
25mmHg at rest
30mmHg with exercise
Two major causes for primary Pulmonary HTN.
- Hereditary
2. Drug Induced: Fen-Phen, cocaine, amphetamines
How does primary Pulmonary HTN appear on X-ray or CT?
RV hypertrophy, increased cardiothoracic ration, dilation of the pulmonary arteries
What are characteristics of reversible damage caused to pulmonary blood vessels in Pulmonary HTN?
Medial Hypertrophy
Intimal Thickening or Proliferation
What are characteristics of irreversible damage caused to pulmonary blood vessels in Pulmonary HTN?
Concentric Laminar Intimal Fibrosis
Fibrinoid Necrosis
Plexiform Lesions (looks like a glomerulus 90 degrees off a vessel)
Where do atheromas commonly form during pulmonary HTN?
Pulmonary arteries and major branches
What congenital defect commonly leads to pulmonary HTN?
ASDs
-increase the pressure on the right side of the heart and increase pressure in the lungs
What is the triad in Goodpasture Syndrome?
Diffuse Pulmonary Hemorrhage
Glomerulonephritis
Anti-glomerular basement membrane Abs
Treatment for Goodpasture Syndrome.
Flushing the plasma to remove the autoimmune Abs
What microscopic findings are seen in the lungs and kindeys in Goodpasture Syndrome?
Lungs
- FOCAL necrosis
- fibrous thickening and hyperplasia of alveolar septa
- linear Ig deposits on basement membrane
Kidneys
- FOCAL crescentic glomerulonephritis
- linear deposits of Ig and complement on basement membranes
What is the difference between Idiopathic Pulmonary Hemosiderosis and Goodpastures or Wegeners?
Children and Teens with intermittent hemoptysis
No circulating Abs or renal involvement
No necrosis
Hemosiderin Laden Macrophages
Possible etiology of Wegener Syndrome
Antineutrophil cytoplasmic antibodies
-directed against neutrophil proteinase 3
What are the microscopic findings seen in the lungs and kidneys in Wegener Syndrome?
Lungs
- necrotizing granulomas
- DIFFUSE arteritis (not focal)
Kidneys
-necrotizing glomerulonephritis
