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
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
