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Difference between revisions of "Rheumatic heart disease"
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'''Rheumatic heart disease''', abbreviated '''RHD''', is a relatively uncommon [[heart valve]] pathology that follows ''rheumatic fever''. | |||
==General== | |||
*Classically leads to mitral valve stenosis. | |||
**Rheumatic fever accounts for 99% of mitral stenosis.<ref name=Ref_PBoD594>{{Ref PBoD|594}}</ref> | |||
***Caused by ''Streptococcus pyogenes''.<ref name=pmid18306530>{{Cite journal | last1 = Chopra | first1 = P. | last2 = Gulwani | first2 = H. | title = Pathology and pathogenesis of rheumatic heart disease. | journal = Indian J Pathol Microbiol | volume = 50 | issue = 4 | pages = 685-97 | month = Oct | year = 2007 | doi = | PMID = 18306530 }}</ref> | |||
*Disease less frequent today - as streptococcal pharynigits is treated with antibiotics. | |||
==Gross== | |||
*"Fish-mouth appearance". | |||
**Slit-like morphology; elliptical cross-sectional flow area (mitral valve) has an abnormally small semi-minor axis<ref>URL: [http://en.wikipedia.org/wiki/Ellipse http://en.wikipedia.org/wiki/Ellipse]. Accessed on: 13 November 2010.</ref> axis due to valve thickening. | |||
**Image: [http://www.principia-eng.com/services/construction/IMG_3098.jpg Fish-mouth appearance - pipe (principia-eng.com)]. | |||
*Significant valvular thickening. | |||
*Thickening and shortening of the cordae tendinae. | |||
DDx: | |||
*Thickening of the cordae tendinae due to micronodular [[cirrhosis]].<ref name=Ref_AoGP25>{{Ref AoGP|25}}</ref> | |||
===Images=== | |||
<gallery> | |||
Image:Rheumatic_heart_disease,_gross_pathology_20G0013_lores.jpg | RHD - showing valvular thickening and thickening of the cordae tendinae. (WC) | |||
Image:Aortic_stenosis_rheumatic,_gross_pathology_20G0014_lores.jpg | RHD - showing valvular thickening - aortic valve. (WC) | |||
</gallery> | |||
==Microscopic== | |||
Features:<ref name=Ref_PBoD593>{{Ref PBoD|593}}</ref> | |||
*Caterpillar cells ([[AKA]] Anitschkow cells) | |||
**Abundant eosinophilic cytoplasm. | |||
**Moderately-poorly defined cell border. | |||
**Well-defined central ovoid nucleus with a prominent wavy ribbon-like chromatin -- looks vaguely like a caterpillar with some imagination. | |||
**Pathognomonic for rheumatic fever. | |||
*Aschoff bodies - usually in the heart itself: | |||
**Jumbled collagen, eosinophilic. | |||
**Surrounded by lymphocytes (T cells) +/- plasma cells. | |||
Notes: | |||
*Anitschkow cells are thought to be histocytes and Aschoff bodies are thought to be [[granuloma]]s.<ref name=pmid3070554>{{Cite journal | last1 = Love | first1 = GL. | last2 = Restrepo | first2 = C. | title = Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin. | journal = Mod Pathol | volume = 1 | issue = 4 | pages = 256-61 | month = Jul | year = 1988 | doi = | PMID = 3070554 }}</ref> | |||
**This is disputed.<ref name=pmid10399163>{{Cite journal | last1 = Stehbens | first1 = WE. | last2 = Zuccollo | first2 = JM. | title = Anitschkow myocytes or cardiac histiocytes in human hearts. | journal = Pathology | volume = 31 | issue = 2 | pages = 98-101 | month = May | year = 1999 | doi = | PMID = 10399163 }}</ref> | |||
===Images=== | |||
<gallery> | |||
Image:Rheumatic_heart_disease_-_intermed_mag.jpg | RHD - intermed. mag. (WC/Nephron) | |||
Image:Rheumatic_heart_disease_-_3_-_high_mag.jpg | RHD - high mag. (WC/Nephron) | |||
Image:Rheumatic_heart_disease_-_3b_-_very_high_mag.jpg | RHD - very high mag. (WC/Nephron) | |||
Image:Aschoff_Body_in_Rheumatic_Myocarditis.jpg | Aschoff body (WC/Uthman) | |||
Image:Anitschkow_Myocytes_in_an_Aschoff_Body,_Rheumatic_Myocarditis.jpg | Anitschkow myocytes (WC/Uthman) | |||
</gallery> | |||
===IHC=== | |||
Features (Aschoff bodies & Anitschkow cells):<ref name=pmid3070554>{{Cite journal | last1 = Love | first1 = GL. | last2 = Restrepo | first2 = C. | title = Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin. | journal = Mod Pathol | volume = 1 | issue = 4 | pages = 256-61 | month = Jul | year = 1988 | doi = | PMID = 3070554 }}</ref> | |||
*S100 -ve. | |||
*Muscle specific actin -ve. | |||
*Desmin -ve. | |||
*NF -ve. | |||
*Vimentin +ve. | |||
*CD45 +ve (weak). | |||
==See also== | |||
*[[Heart valves]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Cardiovascular pathology]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||