Difference between revisions of "Vascular disease"
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*Considered "complex" if any of the following are present:<ref name= | *Considered "complex" if any of the following are present:<ref name=Ref_Klatt4>{{Ref Klatt|4}}</ref> | ||
**Calcifications. | **Calcifications. | ||
**Thrombosis. | **Thrombosis. | ||
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===Microscopic=== | ===Microscopic=== | ||
Features:<ref name= | Features:<ref name=Ref_Klatt7>{{Ref Klatt|7}}</ref> | ||
*Onion-skin appearance of intima & media due to: | *Onion-skin appearance of intima & media due to: | ||
**Intimal hyperplasia. | **Intimal hyperplasia. | ||
Revision as of 02:06, 14 November 2010
The article covers vascular disease. Vasculitides are covered in a separate article called vasculitides.
Great vessels
When things go wrong here, you see a cardiac surgeon.
Atherosclerosis
General
- Cardiac atherosclerosis -> myocardial infarction, coronary thrombosis.
- Peripheral atherosclerosis -> peripheral vascular disease -> amputations.
- Carotid atherosclerosis -> thrombotic stroke.
Clinical risk factors:
- Age.
- Blood pressure - modifiable (antihypertensives).
- Cholesterol - modifiable (statins, diet).
- Diabetes mellitus - modifiable (hypoglycemic medications, diet, lifestyle).
- Smoking - modifiable (cessation).
- Family history.
Microscopic
Features:
- Intimal hyperplasia.
- Lipid deposition.
- Foam macrophages within intima & media.
- Cholesterol clefts
- Luminal narrowing.
Image: RCA with atherosclerosis (WC).
Notes:
- Considered "complex" if any of the following are present:[1]
- Calcifications.
- Thrombosis.
- Haemorrhage.
Aortic dissection
Associations
Heritable:[2]
- Marfan's syndrome.
- Loeys-Dietz syndrome.[3]
- Marfan-like syndrome.
- Ehlers-Danlos syndrome.
- Bicuspid aortic valve.
Others:
- Tertiary syphilis.
Cystic medial degeneration
General
Microscopic
- Basophilic ground substance in the media (seen on Movat's stain).
- Disruption of the elastic lamina (seen on elastic trichrome stain).
- +/-Focal necrosis.
Images: Marfan's syndrome (radiographics.rsna.org).
Medial calcific sclerosis
- AKA Moenckeberg medial calcific sclerosis, calcific medial sclerosis of Monckeberg, and Monckeberg's arteriosclerosis.
General
- Usually of no clinical consequence.
Microscopic
Features:[7]
- Medial calcification (purple irregular stuff -- calcium phosphate).
Note:
- Lumen unaffected.
Images:
Hyperplastic arteriolosclerosis
General
- Hyperplasia = proliferation of cells.
- Associated with malignant hypertension.
Microscopic
Features:[8]
- Onion-skin appearance of intima & media due to:
- Intimal hyperplasia.
- Smooth muscle hyperplasia.
Image: Hyperplastic arteriolosclerosis (utah.edu).
See also
References
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 4. ISBN 978-1416002741.
- ↑ Gleason TG (2005). "Heritable disorders predisposing to aortic dissection". Semin. Thorac. Cardiovasc. Surg. 17 (3): 274-81. doi:10.1053/j.semtcvs.2005.06.001. PMID 16253833.
- ↑ Loeys BL, Schwarze U, Holm T, et al (August 2006). "Aneurysm syndromes caused by mutations in the TGF-beta receptor". N. Engl. J. Med. 355 (8): 788-98. doi:10.1056/NEJMoa055695. PMID 16928994. http://content.nejm.org/cgi/content/full/355/8/788.
- ↑ URL: http://emedicine.medscape.com/article/756835-overview. Accessed on: 12 August 2010.
- ↑ URL: http://emedicine.medscape.com/article/756835-overview. Accessed on: 12 August 2010.
- ↑ Ha HI, Seo JB, Lee SH, et al. (2007). "Imaging of Marfan syndrome: multisystemic manifestations". Radiographics 27 (4): 989–1004. doi:10.1148/rg.274065171. PMID 17620463. http://radiographics.rsna.org/content/27/4/989.full.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 7. ISBN 978-1416002741.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 7. ISBN 978-1416002741.