Arteriosclerosis, Vascular Tumors, And Aneurysms

Front 1

Define: Arteriosclerosis -

Back 1

small artery disease with luminal narrowing (affects unnamed arteries and arterioles, especially affects kidneys - disruption of RAAS -> HTN)

Front 2

Examples of Arteriosclerosis -

Back 2

Monckeberg's medial calcific sclerosis
Intimal fibrosis (aka hypertensive arteriosclerosis)
Hyaline arteriolar sclerosis
Hyperplastic arteriolar sclerosis

Front 3

Monckeberg's medial calcific sclerosis -

Back 3

calcification of media of medium sized arteries

NO LUMINAL NARROWING
No shrinking
No significant wall weakening

Normally seen in elderly, not a dz

Front 4

Intimal fibrosis aka hypertensive arteriosclerosis -

Back 4

Slow build up of fibrous tissue in intima without lipid deposition

Assoc with aging, but accelerated in HTN

Front 5

Hyaline arteriolar sclerosis -

Back 5

Slow build up on extracellular basement membrane material

Assoc with DM, HTN, and post radiation

Front 6

Hyperplastic arteriolar sclerosis -

Back 6

Onion skin proliferation of smooth muscles - narrowing of vessel lumen

Can result in necrotizing arteriolitis and fibrinoid necrosis of arteries

Assoc with malignant HTN

Front 7

Aneurysms -

Back 7

abnormal dilation of vessels, usually arteries

Front 8

Different examples of aneurysms -

Back 8

Congenital "berry" aneurysm
Syphilitic aneurysm
Abdominal aortic aneurysm
Aortic dissection

Front 9

congenital berry aneurysm affects what vessels -

Back 9

cerebral arteries at Circle of Willis branch points (lack elastic lamina and SM)

Front 10

Mechanism for congenital berry aneurysm -

Back 10

HTN

Front 11

Disease association for Congenital berry aneurysm -

Back 11

PCKD - as PKCD pts have HTN

Front 12

Clinical presentation for congenital berry aneurysm -

Back 12

SAH, worst headache of life
Neurologic deficits, coma

quick death if bleeding not controlled, may cause stroke from post-rupture vascular spasm

Front 13

Syphilitic aneurysm affects -

Back 13

ascending aorta - dilation of aorta and aortic valve ring.

Front 14

Assoc of syphilitic aneurysm with -

Back 14

tertiary syphilis -> endarteritis obliterans (obliteration of vaso vasorum)

Front 15

Clinical presentation of syphilitic aneurysm -

Back 15

aortic regurgitation
cough/rough voice (recurrent laryngeal nerve affected)

Front 16

Pathologic presentation of syphilitic aneurysm -

Back 16

Tree bark appearance - ascending aorta

plasma cells histologically

Front 17

Abdominal aortic aneurysm affects -

Back 17

distal to renal arteries (aorta lacks vasa vasorum below the renal arteries)

Front 18

MCC of abdominal aortic aneurysm -

Back 18

atherosclerotic weakening of wall

Front 19

Clinical presentation of Abdominal aortic aneurysm -

Back 19

Triad of -
1. sudden flank pain
2. hypotension
3. palpable pulsatile mass

Front 20

Risk assoc with AAA -

Back 20

life-threatening hemorrhage into retroperitoneum
Much more likely to rupture if >5cm dilated

Front 21

Aortic dissection -

Back 21

false aneurysm -

blood has broken through the endothelium and found a weak plane in the aortic wall

Front 22

Cystic medionecrosis of Erdheim -

Back 22

blood has broken through the endothelium and found a weak plane in the aortic wall.

It extends through this plane, ripping the aorta into layers.

No necrosis or cysts

Decreased elastin and less organized fibers

excess mucoid ‘ground substance’

These weakened aortic walls can be easily ‘peeled apart’

Front 23

Who is at higher risk for Aortic dissection?

Back 23

Hypertension and Pregnancy
Marfans, Ehler Danlos - both result in elastic tissue defect

Front 24

Clinical presentation of Aortic dissection -

Back 24

Acute retrosternal tearing pain, radiating to the back
Aortic regurgitation - aortic valve ring dilation
Widened mediastinum and Double Barrel (2 lumens) aorta seen on imaging

Front 25

Complications of Aortic dissection

Back 25

• Backward extension with rupture into pericardium causing tamponade.

• Blockage of coronary arteries or other arterial branches, such as the subclavian( loss of pulse in upper ext) and spinal arteries.

• Patients have bad chest pain, often ‘tearing’ in quality.

Immediate surgery can be life-saving.

Front 26

Varicose veins -

Back 26

Self-perpetuating, dilated, tortuous veins

Front 27

Mechanism of varicose veins -

Back 27

loss of competency of valves in veins of legs -> pooling

Front 28

Risk factors for varicose veins -

Back 28

Pregnancy
Obesity
Prolonged standing - much worst than walking (walking reduces pressure on foot valves)

Front 29

Complications of varicose veins -

Back 29

secondary stasis changes in skin including pigmentation (stasis dermatitis)
Can even cause ulcers

Front 30

Churg-strauss syndrome -

Back 30

small vessel vasculitis of skin, lungs, heart

Assoc with allergic rhinitis and asthma
assoc with p-ANCA

Front 31

Hemangioma and it's types -

Back 31

Benign vascular tumor
Increased density of vessels microscopically with granulation tissue grossly

Strawberry: congenital, regress
Cherry: adult type, don't regress

Front 32

Kaposi's sarcoma:

Back 32

often seen as a raised-red purple discoloration
Flat lesion-> plaque->Nodule->Ulceration

Assoc with HHV8, seen in AIDS and elderly men of Mediterranen descent

Front 33

Angiosarcoma:

Back 33

very aggressive vascular malignancy seen as a brown-red growth
Endothelial cells bulge into lumens
Immunostain for Factor VIII, CD31/34

Assoc with radiation treatment for breast cancer after 6-8 yrs

Front 34

Lymphangiosarcoma:

Back 34

seen after axillary dissection for breast cancer

Front 35

Liver angiosarcoma:

Back 35

seen in patients exposed to vinyl chloride and arsenic