Pleural Vascular Changes in HPS

These images are from the 64-year-old woman with alcoholic cirrhosis.

spider

Figure 1. Pleural Surface of a Slice of Lung Perfused via the Pulmonary Artery with Barium-gelatin

Here, the basal pleura shows several collections of barium-filled vessels not seen in normal lungs perfused via the pulmonary artery. These represent connections of the pulmonary arteries with the bronchial vessels, which normally perfuse the pleura. At the upper right note the multiple spider-like branches from a central source.

Find the spider.

bronchialvess

Figure 2. Histologic Section of Pleural Spider

Here, a thickened pleura contains multiple thick- and thin-walled vessels representing bronchial arteries and veins. When these are found in a biopsy specimen, they suggest the diagnosis of HPS, provided that pleural adhesions are absent in the area.

Find the collection of enlarged bronchial vessels.

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Figure 3. Bronchial to Pleural Vein Connection

Here, a histologic section shows the connection between a pleural bronchial vein and a pulmonary vein in an interlobular septum. A pulmonary artery and accompanying airway are present at the upper left.

Find the bronchial vein.

Find the pulmonary vein in the interlobular septum.

Find the pulmonary artery.

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Pleural spider

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Cluster of dilated bronchial arteries and veins

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Pulmonary vein in interlobular septum

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Pulmonary artery

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