Vascular

PULMONARY DISEASES
OF VASCULAR ORIGIN
DR BASHIR MOHAMED SAEED
Pulmonary Vascular Disorders
• 1. Pulmonary edema
Definition:
fluid accumulation within the lungs usually due to disruption of
forces or endothelial injury
Etiopathogenenis
1) Increased hydrostatic pressure: left-sided heart failure, mitral
valve stenosis, fluid overload
2) Decreased oncotic pressure: nephrotic syndrome, or liver
disease
3) Increased capillary permeability: infections, drugs (heroin),
shock, radiation
Morphological changes
Gross: wet, heavy lungs; usually worse in lower lobes
Microscopically: intra-alveolar fluid, engorged capillaries,
hemosiderin-laden macrophages (heart-failure cells)
2.Pulmonary emboli (PE) and
pulmonary infarction
• Embolus: A detached intravascular solid, liquid or gaseous
mass that is carried by the blood to a site distant from its point
of origin
• 99% of all emboli are thromboemboli
• Rarer – bone, marrow, atheroma, fat, tumour, FBs [ cotton,
cardiac catheter], parasites, amniotic fluid
• 95% PE arise in thrombi in large deep veins of Lower Limbs
Risk factors
1) prolonged bed rest
2) leg surgery
3) severe trauma
4) CHF
5) use of oral contraceptives (especially those with high estrogen
content),
6) disseminated cancer
7) and genetic causes of hypercoagulability.
8) Risk of recurrence is high.
Morphology and complications
Gross
A large embolus may embed in the main
pulmonary artery or its major branches or
lodge astride the bifurcation as a saddle
embolus wedge-shaped, hemorrhagic
infarction
On histologic examination, the hallmark of
fresh infarcts is coagulative necrosis of the
lung parenchyma and hemorrhage.
Complications
• i. Large emboli (saddle emboli) may cause sudden death
• ii. Septic emboli may result in a pulmonary abscess
3. Pulmonary hypertension
Definition: increased pulmonary artery pressure, usually due to
increased vascular resistance or blood flow
Etiology
COPD and interstitial disease (hypoxic vasoconstriction)
Multiple ongoing pulmonary emboli
Mitral stenosis and left heart failure
Congenital heart disease with left to right shunts
(ASD,VSD,PDA)
Primary (idiopathic))
pathogenesis
• According to current thinking, pulmonary endothelial cell
and/or vascular smooth muscle dysfunction is the probable
underlying basis for most forms of pulmonary hypertension.
• Endothelial cell dysfunction reduces production of vasodilatory
agents (e.g., nitric oxide, prostacyclin) while increasing
synthesis of vasoconstrictive mediators like endothelin.
• In addition, there is production of growth factors and
cytokines that induce the migration and replication of vascular
smooth muscle and elaboration of extracellular matrix.
morphology
(1) in the main elastic arteries: atheromas similar to those in systemic atherosclerosis;
(2) in medium-sized muscular arteries: proliferation of myointimal cells and smooth muscle
cells, causing thickening of the intima and media with narrowing of the lumina; and
(3) in smaller arteries and arterioles: thickening, medial hypertrophy, and reduplication of the
internal and external elastic membraneswhich is sometimes narrowed to the point of near-
obliteration.
• Persons with idiopathic pulmonary arterial hypertension have characteristic plexiform lesions,
in which endothelial proliferation forms multiple lumina within small arteries where they branch
from a medium-sized artery.
Complication
• Right ventricular hypertrophy
• Right heart failure (cor pulmonale)
4. Goodpasture Syndrome
• Goodpasture syndrome, an autoimmune disease characterized
by a proliferative, usually rapidly progressive,
glomerulonephritis and hemorrhagic interstitial pneumonitis.
• caused by antibodies targeted against the collagen
Morphology
• GROSS: The lungs are heavy, with areas of red-brown
consolidation, due to diffuse alveolar hemorrhage.
• Microscopic examination demonstrates focal necrosis of
alveolar walls associated with intra-alveolar hemorrhages,
fibrous thickening of the septa, and hypertrophic type II
pneumocyte
Cont….
• Presence of hemosiderin, both within macrophages and
extracellularly, is characteristic, indicating earlier episode(s) of
hemorrhage.
• The characteristic linear pattern of immunoglobulin
deposition (usually IgG, sometimes IgA or IgM) that is the
hallmark diagnostic finding in renal biopsy specimens also may
be seen along the alveolar septa.

Vascular

Uploaded by

Copyright:

Available Formats

Vascular

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Vascular

Uploaded by

Copyright:

Available Formats

PULMONARY DISEASES

You might also like