CVS MODULE EL-Nemr PATHOLOGY
ANEURYSMS
ILOS
Mention the types of aneurysm
Mention the causes of aneurysm
Differentiate beteen true and false aneurysm
Explain the pathogenesis of aneurysm
Describe causes and patholgy of aortic dissection.
List the complications of aneurysm
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CVS MODULE EL-Nemr PATHOLOGY
Definition:
Abnormal bulge or dilatation in the arterial wall.
Types of aneurysm:
A. According to site
Aortic aneurysm.
- Thoracic Aortic Aneurysm
- Abdominal Aortic Aneurysm
Peripheral aneurysm.
Cardiac aneurysm.
Cerebral aneurysm.
B. According to the shape of the dilated segment:
- Saccular. - Fusiform. - Cylindrical.
N.B: Other varites
1. Dissecting aneurysm
2. Berry aneurysm.
3. Arteriovenous aneurysm.
C. According to aneurysm wall:
True aneurysm: The aneurysm is a part of the arterial wall.
False aneurysm:
Lesion is not part of arterial wall,
a) Pulsating hematoma: Simple false aneurysm caused by trauma.
b) Arterio-venous fistula:
1- Aneurysmal varix
2- varicose aneurysm
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CVS MODULE EL-Nemr PATHOLOGY
Causes of vessel wall weakness:
A. Acquired diseases of arterial wall:
1- Atherosclerosis:
Most common cause & important cause.
are responsible for fusiform & saccular aneurysm
affects abdominal aorta
2- Vasculitis as polyarteritis nodosa.
3- Syphilis: nowadays is rare and affect mainly thoracic aorta.
4- Mycotic aneurysm: due to infection (subacute bacterial endocarditis emboli)
B. Congenital:
1- Berry aneurysm of circle of willis:
Potential weakness due to deficiency of media and elastic lamina at sites of
branching especially at base of brain.
2- Developmental anomaly of arteries and veins in some cases AV aneurysm:
C. Inherited disorders of connective tissue metaboilism:
Decreased elastic tissue in the media
Marfans syndrome causes of Dissecting aneurysm
D. Traumatic: false aneurysm
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CVS MODULE EL-Nemr PATHOLOGY
Abdominal Aorta aneurysm (Fusiform aneurysm)
Cause: Due to atheroma
Risl Factors: AS Atherosclerosis
Major risk factors Minor risk factors
راجل بكرش وعنده السكر والضغظ وحريقو سجاير وكبير فى السن ومضغوط فى الشغل وحظو نحس
Hypercholesterolemia. Old age - more in males.
Diabetes mellitus. Sedentary and stressful life.
Hypertension Positive Family history
Smoking. ) معلومتين ( االكل و الستات+
Incidence: Common nowadays especially in males
Site: Below renal arteries and may affect iliac arteries
Clinically: Felt on physical examination as a pulsatile mass in the abdomen.
Complications: ( يفرقع- يضغط- ) يكون جلطه
1- Local pressure effect (not serious)
2- Thrombosis with embolism to legs (laminated thrombus)
3- Retro or intraperitoneal hemorrhage (fatal)
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CVS MODULE EL-Nemr PATHOLOGY
Thoracic aortic aneurysm
Risk factors include: (HBC )مارفان و سفليس فى ال
- Hypertension
- Bicuspid aortic valve
- Cystic medial degeneration.
- Connective tissue disease (eg, Marfan syndrome).
- Tertiary syphilis
Complications: ( يضغط – يفرقع- ) يكون جلطه
1-pressure effect on
Nerve → recurrent laryngeal nerve paralysis.
Bone → vertebral, sternal or rib erosion.
Neighboring structures → esophagus, heart, lung.
2-Hemorrhage (fatal)
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CVS MODULE EL-Nemr PATHOLOGY
SYPHILITIC ANEURYSM
Pathogenesis:
Syphilitic aortitis begins in the adventitia involving the vasa vasora (End arteritis
obliterans) → Ischemia and inflammation → scarring and weakness of the vascular
wall.
Morphology:
1. Saccular or fusiform aneurysm occurs in tertiary stage of syphilis.
2. Confined to the ascending aorta and aortic arch
( Rich in lymphatics and rich in Treponema organisms).
3. The aneurysm enlarges and extends to aortic valve ring → aortic insufficiency.
AORTIC DISSECTION
Cause: Longitudinal intimal tear forming a false lumen.
Risk factors include: (HBC )مارفان فى ال
- Hypertension
- Bicuspid aortic valve
- Connective tissue disease (eg, Marfan syndrome).
N.B: Marfan syndrome is defective synthesis of the scaffolding protein fibrillin
Clinically:
Can present with tearing, sudden-onset chest pain radiating to the back
+/- markedly unequal blood pressure in arms.
CXR can show mediastinal widening.
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CVS MODULE EL-Nemr PATHOLOGY
Types: (Two types)
Stanford type A (proximal):
involves Ascending aorta (DeBakey type II)
May extend to aortic arch or descending aorta (DeBakey type I)
May result in acute aortic regurgitation or cardiac tamponade.
Treatment: surgeryƒ
Stanford type B (distal):
involves only descending aorta (Below left subclavian artery). (DeBakey type III)
Treatment: medically with β-blockers, then vasodilators.
Complications:
1- Local Pressure effect (organ ischemia)
2- Aortic rupture → death.
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CVS MODULE EL-Nemr PATHOLOGY
Berry Aneurysm
Cause: congenital deficiency of arterial media
Site: medium sized vessels in the base of the brain on circle of willis.
Results: rupture aneurysm → subarachnoid hemorrhage.
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CVS MODULE EL-Nemr PATHOLOGY
Arteriovenous (A/V) aneurysm
Other names: Cirsoid or ravemose aneurysm
It is Abnormal communication between an artery & vein.
Tortous complex or dilated arteries and veins.
Causes: Congenital or acquired (trauma)
Complications: ( يفرقع- يضغط- ) يكون جلطه
1- Thrombosis: is often laminated and may be protective by preventing rupture
but it often causes ischemia.
2- Local pressure effect.
3- Ischemia: in the distal territory. It is also caused by dissection.
4- Rupture (Hemorrhage that may be fatal)
A- Cerebral berry aneurysm → subarchnoid hemorrhage
B- Dissecting aneurysm of thoracic aorta into pericardial cavity → cardiac
failure and cardiac tamponade
C- Abdominal aortic aneurysm → massive retroperitoneal hemorrhage
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