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Cvs misc-1-csbrp

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For Undergraduate students of Medicine (MBBS)

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Cvs misc-1-csbrp

  1. 1. CVS - Miscellaneous CSBR.Prasad, MD., DEC-2014-CSBRP
  2. 2. Raynaud’s phenomenon (RP) • Paroxysmal exaggerated vasoconstriction of digital arteries and arterioles • Results in cyanosis and pallor • Sometimes may affect: Nose, ear and lips • Types: – Primary RP • Response to cold / emotional stress • CF: Atrophic changes may develop in the course of time – Secondary RP • SLE, Scleroderma, Buerger’s disease DEC-2014-CSBRP
  3. 3. Raynaud’s phenomenon DEC-2014-CSBRP
  4. 4. Buerger’s disease Thromboangiitis obliterans - TAO • Def: It’s segmental, thrombosing arteritis affecting small & medium sized vessels of acute or chronic nature • Men <40yrs • Smokers • Arteries: Tibial, femoral, peroneal & popleteal • Upper limb involvement – 70% • More common in Asians than in Western countries DEC-2014-CSBRP
  5. 5. Buerger’s disease Thromboangiitis obliterans - TAO Morphology: • Thrombosis • Initially: Neutrophil exudate in all the layers – microabscesses • Later: lymphocytes and macrophages, occasionally giant cells • Musculature of the media and elastic laminae are preserved DEC-2014-CSBRP
  6. 6. DEC-2014-CSBRP
  7. 7. Buerger’s disease Thromboangiitis obliterans - TAO DEC-2014-CSBRP
  8. 8. Buerger’s disease Thromboangiitis obliterans - TAO Clinical features: • Intermittent claudication – In the instep – Less commonly in the calf – Rarely in the upper limbs • Later: pain comes on at night and is relieved by walking / hanging the leg over the side of bed • Pulse may be absent in the small vessels like Dorsalis pedis and Radial • Raynaud’s phenomenon – 50% of patients develop this when the hands are exposed to cold • Migratory superficial thrombophlebitis • Gangrene DEC-2014-CSBRP
  9. 9. Buerger’s disease Thromboangiitis obliterans - TAO DEC-2014-CSBRP
  10. 10. Buerger’s disease Thromboangiitis obliterans - TAO DEC-2014-CSBRP
  11. 11. Varicose veins • Abnormally dilated tortuous veins • Due to: – Prolonged increased pressure within – Loss of vessel wall support • Site: Superficial vessels of lower limbs are affected • Women more commonly affected • Obesity increases the risk • Familial tendencies are seen in some • CF: Edema, Stasis dermatitis, Ulceration, Thombosis NOTE: Embolism is not a feature of thrombosis of superficial veins. It’s commonly associated with DVTDEC-2014-CSBRP
  12. 12. DEC-2014-CSBRP
  13. 13. Stasis dermatitis DEC-2014-CSBRP
  14. 14. Varicose veins • Other sites for varocosities: – Esophageal varices (due to PHT) – Hemorrhoides (due to PHT, Pregnancy, Constipation) – Varicocele • Complication: Bleeding DEC-2014-CSBRP
  15. 15. Esophageal varices in PHT DEC-2014-CSBRP
  16. 16. Portal hypertension (PHT) DEC-2014-CSBRP
  17. 17. Varococele What is the importance of ACUTE left sided varicocele ? DEC-2014-CSBRP
  18. 18. Thrombophlebitis & Phlebothrombosis • Interchangeable terms • Components: – Venous thrombosis and – Inflammation • Sites: – Deep veins of legs – Periprostatic plexus in male – Pelvic venous plexus in female – Large veins of skull & dural sinuses DEC-2014-CSBRP
  19. 19. Thrombophlebitis & Phlebothrombosis Causes: • Peritoneal infections – Appendicitis – Salpingitis • PLT hyperactivity – PCV – Myelofibrosis • Prolonged immobilization • Systemic hypercoagulability – Adenocarcinoma • Complications of DVT – Pulmonary embolism Trousseau’s sign (Migratory thrombophlebitis) DEC-2014-CSBRP
  20. 20. Known for: Trousseau sign of malignancy Trousseau sign of latent tetany Trousseau-Lallemand bodies "use new drugs quickly, while they still work" During his later years Trousseau developed pancreatic cancer. Coincidentally, he previously described Trousseau sign of malignancy and developed a similar finding in himself. This cancer limited his activities and eventually proved fatal. Armand Trousseau (1801-1867) DEC-2014-CSBRP
  21. 21. Case: Identify the abnormality. Give your differentials. Marcos Duarte Siosaki, M.D., and Ana Tarsila Souza, M.D. N Engl J Med 2013; 368:e7February 7, 2013 DOI: 10.1056/NEJMicm1204740
  22. 22. Case: Identify the abnormality. Give your differentials. Marcos Duarte Siosaki, M.D., and Ana Tarsila Souza, M.D. N Engl J Med 2013; 368:e7February 7, 2013 DOI: 10.1056/NEJMicm1204740 Virchow's node or Troisier's node
  23. 23. Dr.Troisier The French pathologist Charles Emile Troisier noted in 1889 that other abdominal cancers, too, could spread to the Virchow’s node Cf DEC-2014-CSBRP
  24. 24. Tumors of blood vessels DEC-2014-CSBRP
  25. 25. Hemangiomas • Very common tumors • Increased number of blood vessels filled with blood • Many of the capillary lesions seen in infancy may regress spontaneously as the child grows (by the age of 7years) • Some hemangiomas involve large portions of the body – Angiomatosis DEC-2014-CSBRP
  26. 26. Capilalry Hemangioma • Sites: Skin, subcutis, oral cavity, liver, spleen, kidney • Strawberry angioma – new borns Morphology: • Bright red to blue • Closely packed thin walled blood vessels • Lined by flat endothelium • Scant connective tissue • Hemorrhages, thrombosis, hemosiderin laden MØ DEC-2014-CSBRP
  27. 27. Capillary angioma DEC-2014-CSBRP
  28. 28. Capillary angioma - Strawberry angioma DEC-2014-CSBRP
  29. 29. Capillary Angioma DEC-2014-CSBRP
  30. 30. Cavernous angioma • Large dilated vascular channels • Less well circumscribed • Frequently involve deep structures • May be a part of VHL, Muffucci syndromes Morphology: • Red blue soft spongy masses • Large intercommunicating vascular channels • Modest connective tissue stroma • Thrombosis and calcification DEC-2014-CSBRP
  31. 31. Cavernous angioma DEC-2014-CSBRP
  32. 32. Muffucci syndrome Cavernous angiomas + Enchondromas DEC-2014-CSBRP
  33. 33. Cavernous angioma DEC-2014-CSBRP
  34. 34. Granuloma pyogenicum (Pregnancy tumor) • A form of capillary angioma • Rapidly growing • Pedunculated red nodule • Skin, gingiva, oral mucosa • “Bleeds on touch” • Capillaries arranged in lobular fashion • Finger like epidermal projections at the margins DEC-2014-CSBRP
  35. 35. Granuloma pyogenicum (Pregnancy tumor) DEC-2014-CSBRP
  36. 36. Granuloma pyogenicum DEC-2014-CSBRP
  37. 37. Granuloma pyogenicum (Pregnancy tumor) DEC-2014-CSBRP
  38. 38. Hemangiomas - gist DEC-2014-CSBRP
  39. 39. Bacillary Angiomatosis Bacillary angiomatosis is a vascular proliferation in immunocompromised hosts Caused by: • Bartonella henselae • Bartonella quintana Morphology: • Skin lesions are red papules and nodules, or rounded subcutaneous masses • Histologically: – Capillary proliferation with prominent epithelioid endothelial cells – Nuclear atypia and mitoses – Stromal neutrophils, nuclear dust, and the causal bacteria DEC-2014-CSBRP
  40. 40. Bacillary Angiomatosis DEC-2014-CSBRP
  41. 41. Kaposi sarcoma (KS) Forms of KS: • Chronic KS (Classic) • Lymphadenopathic KS • Transplant associated KS • AIDS associated KS Pathogenesis: • HHV8 (KSHV) • Latent infection in endothelial cells > [p53 inhibitors + Cyclin-D equivalent + viral G protein which induces VEGF] > Cellular proliferation DEC-2014-CSBRP
  42. 42. Kaposi sarcoma (KS) Morphology: • Patches / plaques / nodules • Red / purple / violaceous • Dermal accumulations of spindle cells with slit like spaces with extravasated RBCs • Hemosiderin laden macrophages • Mitotic figures are common in nodular form Nodular forms often heralds LN and visceral involvement IFN-α anti-VEGF are effective DEC-2014-CSBRP
  43. 43. Kaposi sarcoma DEC-2014-CSBRP
  44. 44. Kaposi sarcoma – Nodular form DEC-2014-CSBRP
  45. 45. Kaposi sarcoma DEC-2014-CSBRP
  46. 46. Kaposi sarcoma DEC-2014-CSBRP
  47. 47. Kaposi sarcoma DEC-2014-CSBRP
  48. 48. Angiosarcoma • Malignant endothelial neoplasm • Primarily affects older adults • Tumor may occur at any site – Skin, soft tissue, breast, and liver • Liver: Thorostrat, Vinyl chloride Morphology: • Skin: Asymptomatic red papules or nodules • Plump, atypical endothelial cells forming vascular Channels • Wildly undifferentiated tumors with a solid spindled appearance and no discernible blood vessels • IHC: CD31 or von Willebrand factor DEC-2014-CSBRP
  49. 49. Angiosarcoma DEC-2014-CSBRP
  50. 50. Angiosarcoma DEC-2014-CSBRP
  51. 51. Angiosarcoma DEC-2014-CSBRP
  52. 52. Epithelioid angiosarcoma DEC-2014-CSBRP
  53. 53. E N D DEC-2014-CSBRP

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