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30 Cards in this Set
- Front
- Back
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fibromuscular dysplasia
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focal irregular thickening of walls of medium-sized and large muscular artieries - see areas of thickening separated by aneurysm
idiopathic, effects young women most often renal artery -> renovascular hypertension |
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aneurysm
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localized abnormal dilation of a blood vessel or cardiac chamber
caused by a weakness in the wall - usually tunica media (muscular layer) a true aneurysm is bounded by vascular wall components with luminal dilation |
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false aneurysm
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pseudo-aneurysm
breach THROUGH WALL-> EXTRAvascular hematoma |
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dissection
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split within vessel wall due to breach through endothelium - hematoma dissects BETWEEN layers of wall
doesnt necessarily cause a dilation |
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most common cause of arterial aneurysms
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atherosclerosis
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arterial aneurysm etiology and pathogenesis
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due to atherosclerosis, connective tissue disease, or idiopathic
intimal thickening causing ischemia of media -> smooth muscle cell loss/dmg (erdheim medial degeneration) - replacement with ECM inflammation -> MMP production of macrophage -> ECM degredation overall: decrease in wall strength made worse by hypertension which causes artheriolosclerosis of vasa vasorum -> ischemia of OUTER media |
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erdheim medial degeneration morphology
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see elastic tissue fragmentation and separation of elastic and fibromuscular elements with cyst like spaces filed with ECM (GAGs)
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abdominal aortic aneurysm
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smokers > 65
located most often distal to renal arteries most often due to atherosclerosis also can be caused by altered ECM - scurvy, marfan worry about ruptures - especially after > 5cm, high mortaility also...can obstruct branches (renal a.), create emboli, impinge on other structure (duodenum) doesn't get occluded because aorta is big asymptomatic until you see one of these complications - dangerous |
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thoracic aortic aneurysm
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rare compared to AAA
descending is same as AAA - atherosclerosis ascending causes: 1. erdheim medial degeneration 2. atherosclerosis 3. syphilitic aortitis #1 risk factor - hypertension complications: aortic ring dilation -> aortic insufficiency -> CHF rupture, encroachment |
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syphilitic aneurysm
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tertiary syphilis -> plasmacytic vasculitis of vasa vasorum
--> obliterative endarteritis -> ischemic necrosis of aortic media -> loss of elastic recoil -> dilation "tree-barking" subintimal depression |
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aortic dissection
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5-6th decade
hypertension is biggest factor other factors: CT disease, marfans, pregnancy, iatrogenic between middle and outer 1/3 of media blood enters through a tear - most idiopathic, in ascending aorta creation of a false lumen worst complication - rupture through adventitia -> hemorrhage intimal rupture (back into original lumen) -> "double barreled aorta" - not as bad can extend dissection to the valves -> disruption or extend to other vessels -> obstruction (carotids, coronary) |
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aortic dissection classification
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type A - proximal (arch) +/- distal
type B - distal descending |
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aneruyrsm repair
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vascular replacement using dacron or gortex - but can lead to stenosis, occlusion due to thrombosis or neointima
stent graft - less invasive endoluminal approach |
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varicose veins
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most common venous lesion
abnormally dilated, tortuous veins, created by prolonged intraluminal pressure, loss of vascular wall support often in superficial (saphenous veins) of lower extremity increasing age -> prolonged upright position, degenerative veins, loss of CT pregnancy, obesity mostly a cosmetic issue, but can cause stasis -> decrased wound healing -> varicose ulcers |
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T/F primary tumors of large vessels are rare
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True
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benign vascular neoplasms
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hemangioma
lymphangioma glomus tumor |
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bacillary angiomatosis
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nonneoplastic vascular tumor - REACTIVE
Bartonella infection (cat scratch disease) -> vascular proliferation -> red papules/nodules AIDS predisposed |
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Vascular ectasias
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dilation of pre-existing vessles
examples: nevus flammus (port-wine stain) spider telangiectasia hereditary hemorrhagic telangiectasia (osler-weber-rendu disease) |
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nevus flammeus
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port wine stain - dilated dermal vessels
associated with sturge-weber syndrome and other syndromes |
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sturge-weber syndrome
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nevus flammeus
leptomeningeal angiomas mental retardation |
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spider telangiectasia
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effects subcut arterioles and small arteries
often due to increased estrogen - pregnancy, cirrhosis |
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hereditary hemorrhagic telangiectasia (osler-weber-rendu disease)
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auto dom
congenital dilated capillaries, veins in skin and mucous membranes see mucosal bleeding - GI bleeds |
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hemangioma
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most common vascular tumor
most common pediatric neoplasm see well formed vascular channels capillary type - superficial skin/mucous membranes - see pyogenic granuloma - pregnancy cavernous type - see in deep soft tissues |
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lymphangioma
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subcutaneous
capillary type - lymphangioma circumscriptum cavernous - cystic hygroma |
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glomus tumor (glomangioma)
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see in distal digit under the nail - very painful
from glomous body - arteriovenous thermoreceptor important for regulating arterial blood flow |
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karposi sarcoma
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slit like cells
spindle cells intermediate grade vascular neoplasms - minimal anaplasia, local invasion, low metastatic potential |
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hemangioendothelioma
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see plump vacuolated cells
vessels are variable few mitosis intermediate grade vascular neoplasm - minimal anaplasia, local invasion met rate 20-30% |
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angiosarcoma
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malignancy of endothelial cells
hemangiosarcoma - vinyl chloride exposure lymphangiosarcoma - chronic lymphedema highly malignant CD31 is endothelial cell marker 5 year survival 30% |
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hemangiopericytoma
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neoplasm of pericytes
see in soft tissues - retroperitoneum and lower extremities 5 year survival 60-80% |
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CD31
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distinguish angiosarcoma (CD31+) from hemangiopericyoma (CD31-)
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