Venous Changes in Pulmonary Arterial Hypertension;

Cholesterol Granuloma

Figure 1. Normal Pulmonary Vein

Veins are distinguished from arteries by their location in interlobular septa or, if intra-acinar, by their connection to interlobular veins.


Figure 2. Veins in PAH

Veins here show intimal fibrous thickening of their walls, a common finding in PAH. Part of a plexiform lesion is present at the top right.

Find 3 veins.


Figure 3. Cholesterol Granuloma

Multiple empty, needle-shaped clefts, from which cholesterol esters have been dissolved during preparation, are surrounded by multinucleated giant cells and chronic inflammatory cells. The crystals are thought to be derived from blood of focal hemorrhages. These granulomas are characteristic, but not diagnostic, of pulmonary hypertension.

Find a multinucleated giant cell without crystal clefts.

Find a cluster of empty clefts surrounded by multinucleated giant cells.

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Vein with intimal fibrosis



































Multinucleated giant cell
































Cluster of empty clefts and multinucleated giant cells