Condition

Monckeberg
medial
sclerosis
Atherosclerosi
s

Arteriosclerosi
s
Hyaline
arteriosclerosi
s

Hyperplastic
arteriosclerosi
s
Aortic
Aneurysm

Cause
Key presentations
Calcific deposits in
Loss of elasticity, concentric
muscular arteries
intimal expansion
benign
Chronic
- Inc CRP
inflammatory and
- Imaging reveals mass in
healing response to
lower abdominal aorta MC
endothelial injury - Possible thrombosis (to
occurs in the
coronary artery = chest pain
INTIMA
on exertion)
- downstream ischemia
- Possible aneurysm
- Possible MI, stroke
- Microscopic:
- fatty streaks (early)
- fibrous cap (smooth mm
cells, macrophages, foam
cells, lymphocytes,
collagen, elastin,
proteoglycans,
neovascularizations
- necrotic center cell
debris, cholesterol
crystals, foam cells, Ca
Hardening of
Normally small and medium
arteries
sized arterioles and arteries
Plasma protein
leakage across
injured endothelial
cells AND inc
smooth mm cell
matrix synthesis
Response to injury

Thinned ventricular
wall/structural
defect causes
outpouching

microscopic: hyaline thickening

w luminal narrowing

Typical pt
50+ yo pt
Pt 40-60 yoa,
postmenopausal
MC, fhx
atherosclerosis,
obese, smokes,
HTN, DM,
hyperhomocystei
nemia possible C.
pneumoniae
infection
- suspect DM is
the cause in
YOUNGER MAN or
PREMENOPAUSAL
WOMAN

Older pt, possible

downstream
ischemia
Older person, HTN,
DM, normally w
renal pathology
(Nepherosclerosis dt
chronic HTN)

Onion-skin lesions, luminal

Pt w severe
narrowing
malignant HTN
Fibroid deposits and vessel wall (stage 2)
necrosis
Cystic medial degeneration Young pt w
- d/t HTN ascending aorta
developmental
- d/t atherosclerosis
abnormalities (berry
abdominal aorta
aneurysm)
- d/t tertiary syphilis small
Pt w one of the
vessels, vasa vasorum of
following:
thoracic aorta
- HTN
- Syphilis
- Marfan (fibrillin)
- Infection
- recent trauma
- Ehlers-Danlos
(defective type III
collagen)
- Vit C def (altered

Thoracic
aneurysm

Aortic
dissection

Weakening of the
artery walls

respiratory difficulties (d/t

encroachment on the lungs)
difficulty swalling
(compression of esophagus)
pain (erosion of bones)

cystic medial degeneration

- sudden onset excrutiating
pain, usually beginning in
anterior chest and radiating
to back b/w scapulae
- cardiac tamponade
- uneven pulses

red white blue digits

(proximal to distal)
- primary: symmetric
- secondary: hx of other
underlying issue
Varicose veins Prolonged, inc
- hemosiderin deposition and
(venous
intraluminal
dermal fibrosis w brownish
stasis)
pressure, loss of
discoloration and skin
vessel wall support
roughening
- edema, pain
- also, esophageal varices,
hemorrhoids
Thrombophleb Thrombophleb
Distended veins
itis and
venous thrombosis
phlebothromb causing
osis
inflammation
Phleobothrombosis
thrombosis in
vein independent
of inflammation
Raynauds
phenomenon

Exaggerated
vasoconstriction of
digital arteries

SVC syndrome Neoplasm

compressing or
invading SVC
IVC syndrome Neoplasm growing
inside vein and
obstruct IVC

Dusky cyanosis and marked

dilation of head, neck, and arm
veins
- Leg edema
- Distension of lower
abdominal superficial
collateral veins
- Massive proteinuria (if renal
involvement)

collagen
crosslink)
- Loeyz-Deitz
- Ascorbic a
deficiency
Hypertensive pt

male, 40-60 yoa

w HTN
- younger pts w
systemic or
localized
abnormalities
of ct
- female who just
gave birth
Young woman

Obese young
woman
Pregnant woman

Pt w/ hx of CHF,
prolonged
immobilization, local
infection, or
systemic
hypercoagulability
May get PE
If pt has tumor =
Trosseaus
syndrome likely

Lymphangitis

Inflammation dt
bacterial infection
and spread thru
lymph

exudate in lymph
painful enlargement of
lymph nodes
red, painful subq streaks

Pt who has hx of
exposure to
group A betahemolytic
streptococci

Lymphedema

Primary isolated
congental defects
Secondary block
of previous normal
lymphatic

Milroy dz

Congenital
lymphedema

Pyogenic
granuloma

Trauma,
pregnancy

Cavernous
hemangioma

Congenital

large red cyst (cerebellum,

brain stem, eye grounds, etc.)

Glomus tumor

Modified smooth
mm cells arising
from glomus body
(thermoregulation)
Macular cutaneous
lesion vessel
dilation

Painful tumor in distal

phalanges beneath nail beds

Nevus
flammeus

Spider
telangiectasia
(spider veins)

Hyperestrogenic
states

Hereditary
hemorrhagic
telangiectasia
(Osler-Weber-

Autosomal
dominant disorder

enlarged lymph nodes

persistence = peau du
orange, milky
accumulations in lymph

lymphedema in lower
legs and feet (at birth,into
infancy)
- males: fluid in scrotum
- upslanting toenails,
creases in toes
- wartlike growth
- prominent leg veins
- cellulitis
proliferating capillaries w
interspersed edema and
inflammatory infiltrates

Large birthmark
If pt has:
- leptomeningeal
angiomatous mass
- MR
- Seizures
- Hemiplegia
- Skull radiopacities
suspect Sturge Weber
syndrome
Pulsatile minute subq arterioles
arranged in radial fashion
around central core, usually
above waist
- Frequent nosebleeds
- Coughing blood
- GI or genitourinary bleeding
- multiple small aneurysmal

Pt has congenital
defect
OR
Pt has either:
- tumor
- recent surgery
- fibrosis
- postinflammatory
thrombosis
Young pt has fhx
of lymphedema
presentations

Pt just experienced
trauma
OR
Pregnant pt (will see
in gingiva)
Baby pt
Pt has a cystic
neoplasm in
pancreas in liver
(secondary to von
Hippel Lindau)

Young pt

- Pregnant pt
- Alcoholic patient
w hepatic
cirrhosis
Young pt

Rendu dz)

telangiectasias on skin and

mucous membrane

Baclllary
angiomatosis

Kaposis
sarcoma

Bacteria induces
host H1F1
VEGF (vascular
proliferation)
Caused by gramnegative bacillus of
Bartonella family
Infection w HHV8

Hepatic
angiosarcoma

Exposure to
arsenic, PVC, and
thorotrast

Lymphangiosa
rcoma

Chronic
lymphedema

Hemangioperi
cytoma

Pericyte tumor

Lesions in the skin, bone,

brain, other organs
Silver stain shows clusters
of tangled bacilli

Pt w AIDS and
infection w
bartonella

Nodules or blotches that may

be red, purple, brown, or black,
and are usually papular The
lesions of Kaposi sarcoma are
dome- shaped, dusky redbrown, or purplish papules
Microscopic: sheets of
plump, spindle-shaped cells
creating slit-like vascular
spaces filled with
erythrocytes
- chronic/classic - lower
extremities
- Lymphadenopathic lymph
nodes w occasional visceral
involvement
- Transplant nodal, mucosal,
visceral
- AIDS anywhere in skin and
mucous membrane, lymph
nodes, GI tract
- cutaneous lesions that begin
as small, well-demarcated
red nodules
- evolve into fleshy gray-white
soft tissue masses
- microscopic: all degrees of
differentiation
(undifferentiated lesions
with cellular atypia, giant
cells, plump anaplastic
EC)

Pt w HHV8
infection
- Elderly men of
eastern European
or Mediterranean
(chronic/classic)
- African descent
(lymphadenopath
ic)
- Recent transplant
pt on immunesuppressants
(transplantassoc)
- Pt w AIDS (AIDSassoc)

Pt w recent
exposure to
pesticide, PVC
(plastics),
thorotrast

Pt had hx of
breast ca w
radical
mastectomy
presents w pain
in ipsilateral arm
-

tumor on lower
extremities or
retroperitoneum
slowly enlarging, painless
mass
branching capillary channels
encased by nests and

Trosseaus
sign

Malignancy
inducing
hypercoagulability

masses of spindle-shaped to
round cells extrinsic to EC
basement membrane
Vessel inflammation dt blood
clot, recurring or in different
locations over time

Pt has hx of tumor,
or pt has hx of
inflammation dt
clotting