Blood Vessels part 2, UTHSC Fall 2022 D2 Pathology

Blood Vessels part 2, UTHSC Fall 2022 D2 Pathology Giant-Cell (Temporal) Arteritis - The most common form of vaculities among old people in US and Europe - 50 years - A chronic, granulomatous inflammation of large to small-sized arteries - Predominantly in head - Facial pain or headache - Blindness in case of ophthalmic artery involvement - An initial T cell-mediated immune response Giant-Cell (Temporal) Arteritis morphology - Nodular intimal thickening - Reduced the luminal diameter - Medial granulomatous inflammation - Elastic lamina fragmentation Polyarteritis Nodosa (PAD) - A systemic vasculitis of small or medium-sized muscular arteries - Typically involving renal and visceral vessels - No association with ANCAs - 30% associated with chronic hepatitis B - Young adults - Malaise, fever, and weight loss, hypertension (renal involvement), abdominal pain and melena (GI involvement), muscular pain, and peripheral neuritis what are the symptoms of Polyarteritis Nodosa? Malaise, fever, and weight loss, hypertension (renal involvement), abdominal pain and melena (GI involvement), muscular pain, and peripheral neuritis Polyarteritis Nodosa typically involves what vessels? renal and visceral vessels Polyarteritis Nodosa morphology - Segmental transmural necrotizing inflammation → weakening the arterial wall → aneurysm or rupture - Impaired perfusion → ulcerations, infarct - Transmural inflammation → fibrinoid necrosis - Luminal thrombosis Granulomatosis with Polyangitis (Wegener's Granulomatosis) - A necrotizing vasculitis - Limited forms, restricted to respiratory tract - T-cell mediated hypersensitivity reaction - PR3-ANCAs (c-ANCA; c-antoneutrophil cytoplasmic antibodies) in up to 95% of the cases, a useful marker of disease activity what are the symptoms of Granulomatosis with Polyangitis (Wegener's Granulomatosis)? - Acute necrotizing granulomas of the upper or lower respiratory tract or both - Necrotizing or granulomatous vasculitis affecting small to medium-sized vessel - Renal disease (necrotizing glomerulonephritis) Granulomatosis with Polyangitis (Wegener's Granulomatosis) morphology Large necrotizing granulomas. A similar appearance might be seen in tuberculosis or fungal infections Thromboangiitis Obliterans (Buerger Disease) - Segmental, thrombosing, acute and chronic inflammation of medium-sized and small arteries - Tibial and radial arteries - Almost exclusively in heavy smokers, 35 years old what is Thromboangiitis Obliterans (Buerger Disease) almost exclusively seen in? heavy smokers, 35 years old Early manifestations of Thromboangiitis Obliterans (Buerger Disease) - Superficial nodular phlebitis - Cold sensitivity of the Raynaud's type in the hands - Pain in the foot induced by exercise symptoms of Thromboangiitis Obliterans (Buerger Disease) - Severe pain (in contrast to atherosclerosis) even at rest (due to neural involvement) - Chronic ulcerations followed in time by frank gangrene Thromboangiitis Obliterans (Buerger Disease) morphology - The lumen is occluded by a thrombus containing abscesses (arrow), and the vessel wall is infiltrated with leukocytes. - Sharply segmental acute and chronic vasculitis - Luminal thrombosis COVID-19-Associated Vasculitis and Vasculopathy - The vascular endothelium: The cornerstone of organ dysfunction in severe COVID-19 - Endothelial cell inflammation, apoptosis and dysfunction occur in patients with COVID-19 - Vasculitis in COVID-19 - Kawasaki-like disease with accompanying toxic shock syndrome or multi-systemic inflammatory disease has been reported in children with COVID-19 Raynaud's Phenomenon - Results from an exaggerated vasoconstriction of digital arteries and arterioles. - Primary Raynaud phenomenon, in 3-5% of the general population, predilection for young women. - Secondary Raynaud phenomenon, secondary to arterial diseases (SLE, scleroderma, Buerger disease, atherosclerosis), maybe as the first manifestation symptoms of raynaud phenomenon Fingers become white due to lack of blood flow, then blue as vessels dilate to keep blood in tissues, finally red as blood flow returns Varicose Veins - Abnormally dilated, tortuous veins - Causes: prolonged, increased intraluminal pressure and loss of vessel wall support - Superficial veins of the legs - Obesity, pregnancy, and familial tendency, as risk factor - Valves incompetent, stasis, edema, pain, and thrombosis - Embolism rare from these superficial veins