aka thromboangiitis obliterans, a vasculitis of medium and sm-sized arteries, principally the tibial and radial arteries. Histologically, there is acute and chronic inflammation of the arterial walls, often with thrombosis of the lumen, whc can undergo organization and recanalization. This segmental thrombosing vasculitis often extends into contiguous veins and nerve (indicative of Buergers) The inflammatory process may eventually encase all three structures (arteries, veins, and nerves) in fibrous tissue.
Buerger's results from direct endothelial cell toxicity from tobacco products or from hypersensitivity to them. MC seen in heavy cigarette smoker <35yrs old. MC in Israel, Japan, and India. Calf, foot, or hand intermittent claudication may be seen, AWA superficial nodular phlebitis and cold sensitivity (Raynauds). Severe distal pain, can results and may be due to neural involvement. Later complications include ulceration and gangrene of the toes, feet or fingers.
MC benign vascular proliferations in adults. They are sm, bright red, cutaneous papules that appear in pts during adulthood. consist of dilated capillaries and post-capillary venules in the papillary dermis and do NOT regress spontaneously. # inc with age. LM-sharply circumscribed areas of congested capillaries and post-capillary venules in the papillary dermis.
MC in pregnancy, liver dz, and in pts that take OCPs or estrogen supplements. The are dilated cutaneous arterioles the present as central papule with radiating blanching capillaries.
may be present at birth or develop later in life. they present as soft blue compressible masses up to a few centimeters in size. They may appear on the kin, mucosa, deep tissues, and viscera, if skin, they are based in the dermis. LM-reveals lg dilated vascular spaces. Associated with VHL dz
benign tumors that consist of dilated lymphatic spaces lined by endothelium. MC occur on the neck and are lobulated, compressible and usually transilluminate. Associated with Turner's and Down's.
are dilated, tortuous veins resulting from prolonged increases in intraluminal pressure and from loss of vessel-wall tensile strength. The predominant location of varicosities are in superficial veins of the leg. Risk factors are all related to a chronic inc in lower extremity venous pressure ad include long periods of standing, age >50, obesity, and multiple pregnancies. Defective venous wall development may account for a familial tendency. Varicose dilation of veins leads to incompetent venous valves, venous stasis/congestion, edema, and inc incidence of thrombosis. Complications results from the poor blood flow-painful thromboses, stasis dermatitis, skin ulcerations, poorly healing wounds, and superficial infections that may promote chronic varicose ulcers. Although DVT are the #1 cause of PE, varicose vein thromboses are restricted to the superficial venous system, thus thromoembolism is very infrequent with varicose veins. MCC is atherosclerotic plaques at the junction of the aorta and renal artery. Most ps are in their 60s or 70s and have multiple atherosclerosis-related comorbidities (coronary artery dz, carotid stenosis, peripheral vascular dz). Less frequently, RAS is a manifestation of fibromuscular dysplasia, a dz predominantly affecting women 20-30 yrs. In this case, the narrowing of multiple segments of the renal artery occurs "string of beads". on LM of the smaller kidney, tubular atrophy with dec tubular epithelial size, tubulosclerosis, patchy inflammation, and fibrosis of the interstitium and glomerular atrophy would be seen. the other kidney is enlarged due to compensatory hypertrophy.
Pts present with HTN, Proceed cautiously with ACE inhibitors when RAS is present bc elevated levels of angio II are necessary to maintain glomerular filtration in these pts, and a sudden decrease in renal function may develop. Abdominal and flank bruits, present during both systole and diastole, are specific for RAS, although bruits may not be present.
the presence of ab against neutorphil myeloperoxidase, aka p-ANCA, suggest microscopic polyantiitis or Churg-Strauss vasculitis. the additional finding of asthma and eosinophilia makes Churg-Strauss syndrome the most likely diagnosis. Churg-Strauss is defined as the combo of adult-onset asthma, eosinophilia, history of allergy, mono or polyneuropathy, migratory/transient pulmonary infiltrates, and paranasal sinus abnormalities. Wrist drop can develop secondary to a radial nerve mononeuropathy. Possible causes of mononeuopathy include compression, trauma, diabetic vasculopathy, or vasculitis.