Secondary Histologic Features of Veno-occlusive Disease

A section of the proximal pulmonary artery shows several secondary changes.

1. Give two changes seen in the media (below the lower 2 arrows).

2. Name two changes in the intima, indicating the significance of the cells near the top arrow.

Answer

Clinical summary Discussion

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Secondary Histologic Features of Veno-occlusive Disease

Small infarcts: The small, subpleural consolidations laterally on the left probably represent infarcts.

Infarcts and hemosiderosis: A wedge-shaped infarct is present subpleurally at the right (arrow). The brown area corresponds to hemosiderosis.

Infarct: Histologically, this infarct is old and collagenized with honeycombing and a cholesterol granuloma (arrow).

Hemosiderosis: The brown color seen focally in the slice of lung above corresponds to collections of hemosiderin-filled alveolar macrophages.

Clinical summary Discussion

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Secondary Histologic Features of Veno-occlusive Disease

Dilated bronchial vessels: This section of a small airway from another patient is stained with the elastic van Gieson stain.

What is the significance of the mural vessels, one of which is indicated at the arrow?

Answer

The epithelium is sloughed in this postmortem tissue.

Clinical summary Discussion

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Secondary Histologic Features of Veno-occlusive Disease

Answer

What is the significance of the mural vessels, one of which is indicated at the arrow?

These are dilated bronchial vessels that may take pulmonary venous blood back to the heart when parenchymal pulmonary veins are obstructed. They empty into the proximal pulmonary vein. Bronchoscopically, these vessels may appear as hyperemic streaks or pools of blood.

 

Clinical summary Discussion

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Secondary Histologic Features of Veno-occlusive Disease

Answer

1. Give two changes seen in the media (below the lower 2 arrows).

The media shows thickening and an increase in bluish, intercellular matrix that indicates remodeling. As a result, the vessel dilates.

 

 

2. Name two changes in the intima, indicating the significance of the cells near the top arrow.

The intima shows fibrous thickening by myointimal cells with an increase in bluish, intercellular matrix that indicates remodeling. The cells at the arrow are foamy histiocytes surrounded by some lymphoid cells that signify atheroma formation. See below for radiographic correlation.

Remodeling of the main pulmonary arteries in hypertension produces both thickening of the wall and dilation. The latter is seen on the radiograph. Occasionally, hoarseness results from compression of the recurrent laryngeal nerve as it passes between the dilated left pulmonary artery and the aorta.

Clinical summary Discussion

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