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VASCULAR DISORDERS (PE/ infarct (H (microscopy) (P. infarct (Central bland…

- - - - Middle
        →haemorrhage
        
        Small
        → respiratory: V w/o Q
        → haemodynamic: ↑ R to BF
        → infarction (uncommon in children, more common in ❤️ and lung disease)
  - - - Day 1 - Lines of Zahn (RBC, fibrin, platelet, neutrophil)
        
        Day 2 - organization, fibroblast and capillary ingrowth
        
        Day 3 - recanalization
    - - Wedge + base on pleura
      - Central bland necrosis
        
        Ghost of lung architecture (red=dead)
        
        haemorrhage
        
        active fibroblast at edge
        
        squamous metaplasia
        
        reactive atypia
        
        🚩 SCAR
- - - - ie idiopathic/ familial
        
        Heath & Edwards Grades
        → congenital ♥️ disease & L to R shunt
        
        I medial hypertrophy
        
        II intimal prol
        
        III intimal fibrosis
        
        IV plexiform/ dilation lesion, necrotizing arthritis
  - - - ↓ vasodilators (prostacyclin, nitric acid)
        
        Vasoconstriction & platelet adhesion
        
        Cell proliferation due to GF & cytokine release
  - - - DDx?
        1º pHTN, plexiform arteriopathy
        
        Tx?
        
        vasodilator, viagra
        
        anticoagulant
        
        prostacyclin
- - - - A?
        Triad → inflammation of resp tract, vessel and kidney
      - S?
        CP, cough, haemoptysis, systemic (fever, fatigue, weight loss)
        +Sinusitis, RF, anemia
      - I?
        
        Scan - lung nodule, cavity either mets of abscess radiology
        
        Serology - Anti-neutrophil cytoplasmic nodule (ANCA) fluorescent microscopy
        
        Specimen - necrosis causing cavitating lesion, haemorrhagic parenchyma
        
        C-ANCA - granular in WG
        P-ANCA - perinuclear in polyangiitis
      - H?
        
        Large necrosis - dirty/ blue/ basophilic
        
        Microabscess - neutrophil/ eosinophil
        
        Multinucleate giant cell
        
        Necrotizing vasculitis eccentric
        
        Granuloma inflam
        
        Squamous metaplasia
        
        Other DDx: TB, fungal
    - - Anti-GBM antibodies bind to capillary basement membranes → activate neutrophils → inflammation → glomerulonephritis & alveolar capillaritis
      - S?
        SOB, cough, haemoptysis, hypoxia
        +smoking, (less) infection, cocaine
      - I?
        CXR - pulmonary infiltrates due to haemoglobin in alveoli
        Iron def anemia
      - T?
        methylprednisolone plasmapharesis → mycophenalate mofetil & LD prednisolone
        Aim: for hypoxia, nodular infiltrate, ↓ anti-GBM Abx