Vascular disease - Revision history

Michael: /* Medial calcific sclerosis */ split out

2016-03-07T03:39:26Z

Medial calcific sclerosis: split out

← Older revision		Revision as of 03:39, 7 March 2016
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	==Medial calcific sclerosis==		==Medial calcific sclerosis==
	*[[AKA]] ''Moenckeberg medial calcific sclerosis'', ''calcific medial sclerosis of Monckeberg'', and ''Monckeberg's arteriosclerosis''.		[[AKA]] ''Moenckeberg medial calcific sclerosis'', ''calcific medial sclerosis of Monckeberg'', and ''Monckeberg's arteriosclerosis''.
	~~===General===~~		{{Main\|Medial calcific sclerosis}}
	*Usually of no clinical consequence.

	~~===Microscopic===~~
	~~Features:<ref name=Ref_Klatt7>~~{{~~Ref Klatt~~\|~~7}}</ref>~~
	*Medial ~~calcification (purple irregular stuff on [[H&E stain\|H&E]] -- calcium phosphate).~~

	~~Note:~~
	*Lumen unaffected.

	~~====Images====~~
	~~<gallery>~~
	~~Image:Calcificatio_atherosclerotica.jpg \| MCS. (WC)~~
	~~</gallery>~~
	~~www:~~
	*[http://library.med.utah.edu/WebPath/COW/COW086.html Moenckeberg medial calcific sclerosis ~~(med.utah.edu)].~~

	~~===Sign out===~~
	~~<pre>~~
	~~RIGHT LEG, BELOW KNEE AMPUTATION:~~
	~~- MINIMAL-TO-MILD LARGE VESSEL ATHEROSCLEROSIS, SEE COMMENT.~~
	~~- MEDIAL CALCIFIC SCLEROSIS.~~
	~~- SKIN WITH DERMAL FIBROSIS.~~

	~~COMMENT:~~
	~~The sections may not be representative of disease in the distal vascular bed.~~
	~~</pre>~~

	==Hyperplastic arteriolosclerosis==		==Hyperplastic arteriolosclerosis==

Michael: /* Cystic medial degeneration */ split out

2014-05-16T16:55:13Z

Cystic medial degeneration: split out

← Older revision		Revision as of 16:55, 16 May 2014
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	==Cystic medial degeneration==		==Cystic medial degeneration==
	*[[AKA]] ''cystic medial necrosis''.<ref>URL: [http://emedicine.medscape.com/article/756835-overview http://emedicine.medscape.com/article/756835-overview]. Accessed on: 12 August 2010.</ref>		*[[AKA]] ''cystic medial necrosis''.<ref>URL: [http://emedicine.medscape.com/article/756835-overview http://emedicine.medscape.com/article/756835-overview]. Accessed on: 12 August 2010.</ref>
	~~===General===~~		{{Main\|Cystic medial degeneration}}
	*Nonspecific finding - may be seen in a number of conditions.

	~~Note about ''cystic medial necrosis'':~~
	*Often ''not'' cystic and ''not'' necrotic.

	~~===Microscopic===~~
	~~Features:<ref>URL: [http://emedicine.medscape.com/article/756835-overview http://emedicine.medscape.com/article/756835-overview]. Accessed on: 12 August 2010.</ref><ref name=pmid17620463>~~{{cite journal \|author=Ha HI, Seo JB, Lee SH, ''et al.'' \|title=Imaging of Marfan syndrome: multisystemic manifestations \|journal=Radiographics \|volume=27 \|issue=4 \|pages=989–1004 \|year=2007 \|pmid=17620463 \|doi=10.1148/rg.274065171 \|url=http://radiographics.rsna.org/content/27/4/989.full}}</ref>
	*Basophilic ground substance in the media (seen on Movat's [[stain]]).
	*Disruption of the elastic lamina (seen on elastic trichrome stain).
	*+/-Focal necrosis.

	~~====Images====~~
	~~<gallery>~~
	~~Image:Cystic_medial_degeneration_-_low_mag.jpg~~ \| Cystic medial degeneration ~~- low mag. (WC/Nephron)~~
	~~Image:Cystic_medial_degeneration_-_high_mag.jpg \| Cystic medial degeneration - high mag. (WC/Nephron)~~
	~~Image:Cystic_medial_degeneration_-_movat_-_low_mag.jpg \| Cystic medial degeneration - movat - low mag. (WC/Nephron)~~
	~~Image:Cystic_medial_degeneration_-_movat_-_intermed_mag.jpg \| Cystic medial degeneration - movat - intermed. mag. (WC/Nephron)~~
	~~</gallery>~~
	~~www:~~
	*[http://radiographics.rsna.org/content/27/4/989.full Marfan's syndrome (radiographics.rsna.org)].

	~~===Stains===~~
	*Elastin stains (e.g. [[elastic trichrome stain]]) - disruption of the elastic lamina.
	*[[Movat's stain]] - basophilic ground substance in the media.

	==Medial calcific sclerosis==		==Medial calcific sclerosis==

Michael: /* Aortic dissection */ split out

2014-05-13T13:06:57Z

Aortic dissection: split out

← Older revision		Revision as of 13:06, 13 May 2014
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	==Aortic dissection==		==Aortic dissection==
	*Abbreviated ''AoD''.		*Abbreviated ''AoD''.
	~~===General===~~		{{Main\|Aortic dissection}}
	~~Risk factors:~~
	*[[Hypertension]].<ref name=pmid21968475>{{~~Cite journal~~ \| ~~last1 = Braverman \| first1 = AC. \| title =~~ Aortic dissection: prompt diagnosis and emergency treatment are critical. \| journal = Cleve Clin J Med \| volume = 78 \| issue = 10 \| pages = 685-96 \| month = Oct \| year = 2011 \| doi = 10.3949/ccjm.78a.11053 \| PMID = 21968475 \| URL = http://www.ccjm.org/content/78/10/685.long }}~~</ref>~~
	*[[Atherosclerosis]].<ref name=pmid21173794>{{Cite journal \| last1 = LeMaire \| first1 = SA. \| last2 = Russell \| first2 = L. \| title = Epidemiology of thoracic aortic dissection. \| journal = Nat Rev Cardiol \| volume = 8 \| issue = 2 \| pages = 103-13 \| month = Feb \| year = 2011 \| doi = 10.1038/nrcardio.2010.187 \| PMID = 21173794 }}</ref>
	**[[Smoking]].
	*Cardiac surgery - rare, well-known complication.<ref name=pmid22345184>{{Cite journal \| last1 = Leontyev \| first1 = S. \| last2 = Borger \| first2 = MA. \| last3 = Legare \| first3 = JF. \| last4 = Merk \| first4 = D. \| last5 = Hahn \| first5 = J. \| last6 = Seeburger \| first6 = J. \| last7 = Lehmann \| first7 = S. \| last8 = Mohr \| first8 = FW. \| title = Iatrogenic type A aortic dissection during cardiac procedures: early and late outcome in 48 patients. \| journal = Eur J Cardiothorac Surg \| volume = 41 \| issue = 3 \| pages = 641-6 \| month = Mar \| year = 2012 \| doi = 10.1093/ejcts/ezr070 \| PMID = 22345184 }}</ref>
	**In one large registry, approximately 15% of acute dissections are associated with prior cardiac surgery.<ref name=pmid24030404>{{cite journal \|author=Teman NR, Peterson MD, Russo MJ, ''et al.'' \|title=Outcomes of patients presenting with acute type A aortic dissection in the setting of prior cardiac surgery: an analysis from the International Registry of Acute Aortic Dissection \|journal=Circulation \|volume=128 \|issue=11 Suppl 1 \|pages=S180–5 \|year=2013 \|month=September \|pmid=24030404 \|doi=10.1161/CIRCULATIONAHA.112.000342 \|url=}}</ref>

	~~Note:~~
	*Diabetes uncommon in thoracic aortic dissection.<ref name=pmid21173794/>

	~~May be separated into two groups:<ref>URL: [http://path.upmc.edu/cases/case84/dx.html http://path.upmc.edu/cases/case84/dx.html]. Accessed on: 13 May 2014.</ref>~~
	~~#Hypertension + atherosclerosis, typically 40-60 years old.~~
	~~#Connective tissue disorders - "young".~~

	~~====Associations====~~
	Heritable:<ref name=pmid16253833>{{cite journal \|author=Gleason TG \|title=Heritable disorders predisposing to aortic dissection \|journal=Semin. Thorac. Cardiovasc. Surg. \|volume=17 \|issue=3 \|pages=274-81 \|year=2005 \|pmid=16253833 \|doi=10.1053/j.semtcvs.2005.06.001 \|url=}}</ref>
	*[[Marfan's syndrome]].
	*Loeys-Dietz syndrome - a Marfan-like syndrome<ref name=pmid16928994>{{cite journal \|author=Loeys BL, Schwarze U, Holm T, ''et al'' \|title=Aneurysm syndromes caused by mutations in the TGF-beta receptor \|journal=N. Engl. J. Med. \|volume=355 \|issue=8 \|pages=788-98 \|year=2006 \|month=August \|pmid=16928994 \|doi=10.1056/NEJMoa055695 \|url=http://content.nejm.org/cgi/content/full/355/8/788}}</ref>
	*[[Ehlers-Danlos syndrome]].
	*[[Bicuspid aortic valve]].<ref name=pmid21173794/>

	~~Others:~~
	*Tertiary [[syphilis]].<ref name=pmid20864080>{{Cite journal \| last1 = Cruz \| first1 = RP. \| last2 = Marrone \| first2 = LC. \| last3 = Marrone \| first3 = AC. \| title = Chronic syphilitic aortic aneurysm complicated with chronic aortic dissection. \| journal = Am J Surg \| volume = 200 \| issue = 5 \| pages = e64-6 \| month = Nov \| year = 2010 \| doi = 10.1016/j.amjsurg.2010.02.017 \| PMID = 20864080 }}</ref>
	*[[Turner syndrome]].<ref name=pmid21731587>{{Cite journal \| last1 = Carlson \| first1 = M. \| last2 = Silberbach \| first2 = M. \| title = Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the literature. \| journal = BMJ Case Rep \| volume = 2009 \| issue = \| pages = bcr0620091998 \| month = \| year = 2009 \| doi = 10.1136/bcr.06.2009.1998 \| PMID = 21731587 }}</ref>

	~~====Classification====~~
	~~Two classification exist:~~
	*''DeBakey''.
	*''Stanford''.

	Stanford dissection classification:<ref name=pmid9362838>{{cite journal \|author=Finkelmeier BA \|title=Dissection of the aorta: a clinical update \|journal=J Vasc Nurs \|volume=15 \|issue=3 \|pages=88-93 \|year=1997 \|month=September \|pmid=9362838 \|doi= \|url=}}</ref>
	*Type A - aortic root to the left subclavian artery.
	**Considered a surgical emergency.
	*Type B - distal to (left) subclavian artery.
	**Generally, treated conservatively.

	~~===Gross===~~
	*Entry intimal tear +/- exit intimal tear.
	**Blood between layers of the vessel wall.

	~~====Images====~~
	~~<gallery>~~
	~~Image:AoDiss_Patho.jpg \| Aortic dissection. (WC)~~
	~~</gallery>~~

	~~www:~~
	*[http://library.med.utah.edu/WebPath/CVHTML/CV031.html Aortic dissection (utah.edu)].
	*[http://www.brown.edu/Courses/Digital_Path/systemic_path/cardio/ad-gross.html Aortic dissection (brown.edu)].

	~~===Microscopic===~~
	~~Features:~~
	*Defect in the tunica media (muscle layer).
	*"Abundant" fresh blood in the adventitia.
	*+/-Changes of [[cystic medial degeneration]] - a specific histopathologic cause of aortic dissection.

	~~DDx:~~
	*[[Cystic medial degeneration]].

	~~====Images====~~
	~~<gallery>~~
	~~Image:Aortic dissection (1) Victoria blue-HE.jpg \| Aortic dissection. Victoria blue-H&E. (WC/KGH)~~
	~~</gallery>~~

	~~www:~~
	*[http://path.upmc.edu/cases/case84.html Aortic dissection - autopsy (upmc.edu)].
	*[http://library.med.utah.edu/WebPath/CVHTML/CV029.html Aortic dissection (utah.edu)].

	==Cystic medial degeneration==		==Cystic medial degeneration==

Michael: /* Microscopic */

2014-05-13T12:50:21Z

Microscopic

← Older revision		Revision as of 12:50, 13 May 2014
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	*Defect in the tunica media (muscle layer).		*Defect in the tunica media (muscle layer).
	*"Abundant" fresh blood in the adventitia.		*"Abundant" fresh blood in the adventitia.
	*+/-Changes of ''[[cystic medial degeneration]]''.		*+/-Changes of [[cystic medial degeneration]] - a specific histopathologic cause of aortic dissection.

			DDx:
			*[[Cystic medial degeneration]].

	====Images====		====Images====

Michael: /* Aortic dissection */

2014-05-13T12:48:55Z

Aortic dissection

← Older revision		Revision as of 12:48, 13 May 2014
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	Note:		Note:
	*Diabetes uncommon in ~~AoD~~.<ref name=pmid21173794/>		*Diabetes uncommon in thoracic aortic dissection.<ref name=pmid21173794/>

	~~Clinically~~ two groups:		May be separated into two groups:<ref>URL: [http://path.upmc.edu/cases/case84/dx.html http://path.upmc.edu/cases/case84/dx.html]. Accessed on: 13 May 2014.</ref>
	#Hypertension + atherosclerosis, typically 40-60 years old.		#Hypertension + atherosclerosis, typically 40-60 years old.
	#Connective tissue disorders - "young".		#Connective tissue disorders - "young".

Michael: /* General */

2014-05-13T12:46:30Z

General

← Older revision		Revision as of 12:46, 13 May 2014
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	**[[Smoking]].		**[[Smoking]].
	*Cardiac surgery - rare, well-known complication.<ref name=pmid22345184>{{Cite journal \| last1 = Leontyev \| first1 = S. \| last2 = Borger \| first2 = MA. \| last3 = Legare \| first3 = JF. \| last4 = Merk \| first4 = D. \| last5 = Hahn \| first5 = J. \| last6 = Seeburger \| first6 = J. \| last7 = Lehmann \| first7 = S. \| last8 = Mohr \| first8 = FW. \| title = Iatrogenic type A aortic dissection during cardiac procedures: early and late outcome in 48 patients. \| journal = Eur J Cardiothorac Surg \| volume = 41 \| issue = 3 \| pages = 641-6 \| month = Mar \| year = 2012 \| doi = 10.1093/ejcts/ezr070 \| PMID = 22345184 }}</ref>		*Cardiac surgery - rare, well-known complication.<ref name=pmid22345184>{{Cite journal \| last1 = Leontyev \| first1 = S. \| last2 = Borger \| first2 = MA. \| last3 = Legare \| first3 = JF. \| last4 = Merk \| first4 = D. \| last5 = Hahn \| first5 = J. \| last6 = Seeburger \| first6 = J. \| last7 = Lehmann \| first7 = S. \| last8 = Mohr \| first8 = FW. \| title = Iatrogenic type A aortic dissection during cardiac procedures: early and late outcome in 48 patients. \| journal = Eur J Cardiothorac Surg \| volume = 41 \| issue = 3 \| pages = 641-6 \| month = Mar \| year = 2012 \| doi = 10.1093/ejcts/ezr070 \| PMID = 22345184 }}</ref>
			**In one large registry, approximately 15% of acute dissections are associated with prior cardiac surgery.<ref name=pmid24030404>{{cite journal \|author=Teman NR, Peterson MD, Russo MJ, ''et al.'' \|title=Outcomes of patients presenting with acute type A aortic dissection in the setting of prior cardiac surgery: an analysis from the International Registry of Acute Aortic Dissection \|journal=Circulation \|volume=128 \|issue=11 Suppl 1 \|pages=S180–5 \|year=2013 \|month=September \|pmid=24030404 \|doi=10.1161/CIRCULATIONAHA.112.000342 \|url=}}</ref>

	Note:		Note:
	*Diabetes uncommon in AoD.<ref name=pmid21173794/>		*Diabetes uncommon in AoD.<ref name=pmid21173794/>

			Clinically two groups:
			#Hypertension + atherosclerosis, typically 40-60 years old.
			#Connective tissue disorders - "young".

	====Associations====		====Associations====

Michael: /* Aortic dissection */

2014-05-13T12:38:25Z

Aortic dissection

← Older revision		Revision as of 12:38, 13 May 2014
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	===Microscopic===		===Microscopic===
	:~~See:~~ ''[[cystic medial degeneration]]''.		Features:
			*Defect in the tunica media (muscle layer).
			*"Abundant" fresh blood in the adventitia.
			*+/-Changes of ''[[cystic medial degeneration]]''.

	====Images====		====Images====
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	www:		www:
	*[http://path.upmc.edu/cases/case84.html Aortic dissection - autopsy (upmc.edu)].		*[http://path.upmc.edu/cases/case84.html Aortic dissection - autopsy (upmc.edu)].
			*[http://library.med.utah.edu/WebPath/CVHTML/CV029.html Aortic dissection (utah.edu)].

	==Cystic medial degeneration==		==Cystic medial degeneration==

Michael: /* Normal blood vessels */

2014-02-16T03:36:16Z

Normal blood vessels

← Older revision		Revision as of 03:36, 16 February 2014
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	==Normal blood vessels==		==Normal blood vessels==
	Comparing arteries and veins:<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/vascular/vascular.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/vascular/vascular.htm]. Accessed on: 13 January 2011.</ref>		Comparing arteries and veins:<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/vascular/vascular.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/vascular/vascular.htm]. Accessed on: 13 January 2011.</ref>
			<center>
	{\| class="wikitable sortable"		{\| class="wikitable sortable"
	! Feature		! Feature
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	\| thin		\| thin
	\|}		\|}
			</center>
			[[Image:2102 Comparison of Artery and Vein.jpg\|thumb\|400px\|center\|Artery and vein. (WC)]]

	==Great vessels==		==Great vessels==

Michael: /* Cholesterol embolism */ split-out

2013-12-29T21:09:33Z

Cholesterol embolism: split-out

← Older revision		Revision as of 21:09, 29 December 2013
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	==Cholesterol embolism==		==Cholesterol embolism==
	*Abbreviated ''CE''.		*Abbreviated ''CE''.
			{{Main\|Cholesterol embolism}}

	~~===General===~~
	*Strong association with [[atherosclerosis]] - found in ~3% of individuals in an [[autopsy]] series of 267 older individuals (mean age ~65 years).<ref name=pmid19970827>{{cite journal \| author=Flory CM \| title=Arterial occlusions produced by emboli from eroded aortic atheromatous plaques \| journal=Am J Pathol \| year= 1945 \| volume=21 \| pages=549–565 \| pmid=19970827 \| issue=3 \| pmc=1934118}}</ref>
	*Significant CEs are often iatrogenic.
	**Known complication of coronary catherization (incidence ~ 1%).<ref name=pmid12875753>{{cite journal \|author=Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A \|title=The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study \|journal=J. Am. Coll. Cardiol. \|volume=42 \|issue=2 \|pages=211–6 \|year=2003 \|month=July \|pmid=12875753 \|doi=10.1016/S0735-1097(03)00579-5 \| url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703005795}}</ref>
	**May complicate any vascular surgery, CABG.

	~~===Microscopic===~~
	~~Features:<ref name=Ref_Sternberg5_1735-6>{{Ref Sternberg5\|1735-6}}</ref>~~
	*Intravascular cholesterol clefts (biconvex white spaces) - '''key feature'''.
	**Typically ~ 100-500 micrometers (long axis) x 50-100 micrometers (short axis). (?)
	*+/-Macrophages and giant cells.
	*+/-Eosinophils.

	~~Note:~~
	*May be associated with ischemic changes and [[necrosis]].
	*Usually in the context of severe atherosclerosis.

	~~Note (trivia):~~
	*Cholesterol crystals dissolve with routine processing (paraffin embedding); this is why one talks of "cholesterol clefts".

	~~====Images====~~
	~~<gallery>~~
	~~Image:Cholesterol_embolus_-_intermed_mag.jpg \| Cholesterol embolus - intermed. mag. (WC)~~
	~~Image:Cholesterol_embolus_-_high_mag.jpg \| Cholesterol embolus - high mag. (WC)~~
	~~</gallery>~~
	==Coarctation of the aorta==		==Coarctation of the aorta==
	*[[AKA]] ''aortic coarctation''.		*[[AKA]] ''aortic coarctation''.

Michael: /* Sign out */ tweak

2013-09-13T18:57:52Z

Sign out: tweak

← Older revision		Revision as of 18:57, 13 September 2013
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	COMMENT:		COMMENT:
	The sections may not be representative of the distal vascular bed.		The sections may not be representative of disease in the distal vascular bed.
	</pre>		</pre>