Diseases of the blood vessels
Lab 9 - atherosclerosisThis is a normal coronary artery. The lumen is large, without any narrowing by atheromatous plaque. The muscular arterial wall is of normal proportion.
The coronary artery shown here has narrowing of the lumen due to build up of atherosclerotic plaque. Severe narrowing can lead to angina, ischemia, and infarction.
This section of coronary artery demonstrates remote thrombosis with recanalization to leave only two small, narrow channels.
There is a severe degree of narrowing in this coronary artery. It is "complex" in that there is a large area of calcification on the lower right, which appears bluish on this H&E stain. Complex atheromas have calcification, thrombosis, or hemorrhage. Such calcification would make coronary angioplasty difficult.
This distal portion of coronary artery shows significant narrowing. Such distal involvement is typical of severe coronary atherosclerosis, such as can appear with diabetes mellitus or familial hypercholesterolemia. This would make a coronary bypass operation difficult.
There is a pink to red recent thrombosis in this narrowed coronary artery. The open, needle-like spaces in the atheromatous plaque are cholesterol clefts.
This high magnification of the atheroma shows numerous foam cells and an occasional cholesterol cleft. A few dark blue inflammatory cells are scattered within the atheroma.
This is about as normal as an adult aorta in America gets. The faint reddish staining is from hemoglobin that leaked from RBC's following death. The surface is quite smooth, with only an occasional faint small yellow lipid streak visible.
Put down that jelly doughnut and look carefully at this aorta. The white arrow denotes the most prominent fatty streak in the photo, but there are other fatty streaks scattered over the aortic surface. Fatty streaks are the earliest lesions seen with atherosclerosis in arteries.
These three aortas demonstrate mild, moderate, and severe atherosclerosis from bottom to top. At the bottom, the mild atherosclerosis shows only scattered lipid plaques. The aorta in the middle shows many more larger plaques. The severe atherosclerosis in the aorta at the top shows extensive ulceration in the plaques.
Atherosclerotic aneurysm of the aorta in which a large "bulge" appears just above the aortic bifurcation. It is prone to rupture when they reach about 6 to 7 cm in size. On physical examination felt as a pulsatile mass in the abdomen. Most are located below the renal arteries.
This microscopic cross section of the aorta shows a large overlying atheroma on the left. Cholesterol clefts are numerous in this atheroma. The surface on the far left shows ulceration and hemorrhage. Despite this ulceration, atheromatous emboli are rare (or at least, complications of them are rare).
aortic atheroma with foam cells and cholesterol clefts.
This is severe atherosclerosis of the aorta in which the atheromatous plaques have undergone ulceration along with formation of overlying mural thrombus.
This is the left coronary artery from the aortic root on the left. Extending across the middle of the picture to the right is the anterior descending branch. This coronary shows severe atherosclerosis with extensive calcification. At the far right, there is an area of significant narrowing.
This is coronary atherosclerosis with the complication of hemorrhage into atheromatous plaque, seen here in the center of the photograph. Such hemorrhage acutely may narrow the arterial lumen.
Cross sections of this anterior descending coronary artery demonstrate marked atherosclerosis with narrowing. This is most pronounced at the left in the more proximal portion of this artery. In general, the worst atherosclerosis is proximal, where arterial blood flow is more turbulent. More focal lesions mean that angioplasty or bypass can be more useful procedures.
The anterior surface of the heart demonstrates an opened left anterior descending coronary artery. Within the lumen of the coronary there is a dark red recent coronary thrombosis. The dull red color to the myocardium as seen below the glistening epicardium to the lower right of the thrombus is consistent with underlying myocardial infarction.
At high magnification, the dark red thrombus is apparent in the lumen of the coronary. The yellow tan plaques of atheroma narrow this coronary significantly, and the thrombus occludes it completely.
A thrombosis of a coronary artery is shown here in cross section. This acute thrombosis diminishes blood flow and leads to ischemia and/or infarction, marked clinically by the sudden onset of chest pain.
Lt.v aneurysm
Abdominal aortic aneurysm. A, External view, gross photograph of a large aortic aneurysm that ruptured. B, Opened view, with the location of the rupture tract indicated by a probe.Aortic dissection
Aortic dissection. A, Gross photograph of an opened aorta with proximal dissection originating from a small, oblique intimal tear (probe), allowing blood to enter the media and creating a retrograde intramural hematoma.Thromboangiitis obliterans (Buerger disease). The lumen is occluded by a thrombus containing abscesses, and the vessel wall is infiltrated with leukocytes.
Raynaud phenomenon. A, Sharply demarcated pallor of the distal fingers resulting from spasm of the digital arteries. B, Cyanosis of the fingertips.
small blue nodule irregular in shape and slowly growing: Hemangioma of the tongue:
Microscopy small benign proliferating endothelial cells, spindle in shape with large nuclei and absenc of atypia: capillary hemangioma
Microscopy: large vascular spaces loined by thin benign endothelial cells, spindle in shape: cavernous hemangioma.
Gross: small two red lesions in intrenal surface of lower lip, easily bleed, result from mtrauma. Pyogenic granuloma of the lip