Blood Vessels

Pathology
Congenital Anomalies

Arteriosclerosis

HTN

Vasculitides ( inflammations)

Aneurysms & Dissections

Veins & Lymphatics

Tumors

 Vasculitides = Inflammation of Blood Vessels

Present with Non-Specific/ systemic/Vague complaints Fever, Myalgia, Artharlgia, Malaise, etc.,

Pathogenic Mechanisms
Immune MCC 1. Immune complex = Hypersensitivity (to Drugs), Following Viral Infections (PAN & HBV) 2. ANCA Positive (Anti Neutrophil Cytoplasmic Antibody) C- ANCA (Ab

Against Proteinase -3) = Wagener's

P- ANCA ( Ab against MPO) = mPAN, Chaurg Straus 3. Anti Endothelial Cell = SLE, Kawasakis Infectious Less Common, Direct Trauma is the cause, can be Bacterial or fungal

 Vasculitides = Types Based on

1. Giant Cell ( Temporal ) Arteritis

Size of Vessels involved Site of involvement Characteristic Features

Systemic Vasculitis Sites = Temporal ( Head ache & Facial Pain), Vertebral,
Ophthalmic ( Blindness), Aorta ( Aneurysm) Age, Sex & Ethnicity = >50 yrs., M=F, Nordic people Clinical = Facial Pain & Headache, Diplopia & Blindness (most dangerous, Sudden, permanent) Pathology / Morphology = Granulomas in vessel walls, Giant cells, Segmental involvement Diagnosis = Biopsy is important Treatment = Steroids save vision

1. Giant Cell ( Temporal ) Arteritis

Fragmented IEL

Systemic Vasculitis Sites = Temporal ( Head ache & Facial Pain), Vertebral, Ophthalmic (
Blindness), Aorta ( Aneurysm) Age, Sex & Ethnicity = >50 yrs., M=F, Nordic people

Clinical = Facial Pain & Headache, Diplopia & Blindness (most dangerous, Sudden, permanent) Pathology / Morphology = Granulomas in vessel walls, Giant cells,
Segmental involvement, Fragmentation of Internal Elastic Lamina (IEL) Diagnosis = Biopsy is important Treatment = Steroids save vision

2. Takayasu ( Pulse less ) Arteritis

Systemic Vasculitis = of Medium and large size vessels Sites = Aorta ( Aneurysm), Temporal ( Head ache & Facial Pain), Vertebral, Age, Sex & Ethnicity = <40 yrs., F>M, Japanese, HLA (A24, B52, DR2) Clinical = Pulses Weak & Low BP in Hands ( Just opposite to Coarction of Pathology / Morphology = Granulomas in vessel walls, Giant cells, Fibrosis
and Lymphocytic infiltration Diagnosis = Biopsy Treatment = Steroids Complications = MI, Aortic Regurgitation Aorta) Ophthalmic ( Blindness),

3. Poly Arteritis Nodosa (PAN)

Systemic Vasculitis = of Small & Medium size vessels Sites = Kidneys (not the Glomerular capillaries), Heart, Liver, and GIT (NOT
LUNGS)

Age, Sex & Ethnicity = Young Adults, M>F , no special risk groups Clinical = Ulcers, Infarcts, Hemorrhages, HBsAg Positive Clinical course = Relapses & Remissions Pathology / Morphology = acute (inflammation, Fibrinoid Necrosis, Thrombosis), Chronic (modularity, Fibrosis ) Diagnosis = Biopsy is important, No ANCA Positive Treatment = corticosteroids and Cyclophosphamide Complications = MCC of death Renal Failure, CNS lesions

PAN Small & Medium size Vessels Different stages of disease in same or different vessels HBsAg Positive ANCA Negative Capillaries (Pulmonary, Glomerular) not involved,

Large infarcts seen Bad prognosis

4. mPAN( micro) Smallest vessels( Arterioles, capillaries, Venules) Same stage of disease in all vessels Negative P-ANCA Positive Involved (Necrotizing Glomerulonephritis, Hemoptysis) No Large infarcts Better Prognosis

Microscopic polyangiitis (microscopic polyarteritis (m PAN), Hypersensitivity or Leukocytoclastic Vasculitis)

5. Kawasaki Disease
Muco Cutaneous Lymph node syndrome

Systemic Vasculitis = of Small & Medium size vessels Sites = coronary, cutaneous vessels Age, Sex & Ethnicity = Very young (<4yrs. Age), North America, Japan Clinical = Fever, Muco (conjunctival, oral erythema, erosions), cutaneous

(erythema of palms, soles, & Skin rash), Lymph node syndrome ( cervical) Clinical course = spontaneous Remissions in most of them Treatment = aspirin, Immunoglobulins Complications = coronary aneurysms

6. Churg Strauss Syndrome

Transient Pul. Infiltrates Eosinophilic Necrosis

Skin Rash

Systemic Vasculitis = of Medium and large size vessels Sites = Pulmonary, Coronary, Cutaneous, Age= 40- 50 yrs. Clinical = Allergic Rhinitis, Bronchial Asthma, Eosinophilia, skin rash Pathology / Morphology = Eosinophilic Granulomas in vessel walls,

Necrosis, Eosinophilic infiltration of organs Diagnosis = Biopsy Treatment = Steroids Complications = Myocarditis, Coronary Vasculitis

7. Wegeners Granulomatosis

Systemic Vasculitis = of small & Medium size vessels Sites = Pulmonary, renal, nasal & Para nasal, Age= 40yrs., M>F, Clinical = Pneumonitis & Nodular Pul. Infiltrates (MC), Ch. Sinusitis,
Glomerulonephritis, Nasal ulcers Pathology / Morphology = Granulomatous Necrotizing Vasculitis, Crescentic Glomerulonephritis, Nasal Granulomas Diagnosis = Biopsy, C-ANCA positive, Triad (Vasculitis, Respiratory, Renal) Treatment = Cyclophosphamide Complications = RPGN, Pulmonary and upper airway obstruction

8. Thromboangiitis Obliterans
( Buergers disease)

Limited Vasculitis Sites = Tibial & Radial arteries Age= <35yrs., M>F, Smokers, Asians Clinical = intermittent claudication, rest pain ( neural involvement),
ulcerations of Toes, Fingers

Pathology / Morphology = Granulomatous inflammation, Thrombi with

central micro abscess (Pus) Diagnosis = Biopsy, Treatment = Avoidance of smoking, Surgery, Prostaglandin analogues Complications =ulcers, gangrene, infection need of amputation