Path: PVD and Acute Lung Injury

embolism

intravascular solid, liquid, or gaseous mass caries by the blood to a site distant from its point of origin

• Fat

• Air

• Thrombus

• Bacteria

• Amniotic fluid

• Tumor

what are the types of pulmonary embolism?

fat

which type of pulmonary embolism are associated with long bone fractures

pulmonary embolism

most common preventable COD in hospitalized patients

large leg or pelvic vein (deep)

a pulmonary embolism typically begins as a thrombus that forms in ?

1. stasis (post-op, long travel)

2. hypercoagulability (BC, pregnancy, factor V deficiency)

3. endothelial damage

what are the three components of virchow’s triad that may predispose thrombi formation

doppler ultrasound

imaging test of choice for deep venous thrombosis

CT pulmonary angiography (would NOT be the first choice)

imaging test of choice for PE

negative (high sensitivity, low specificity)

D-dimer lab test if ______, can rule out DVT

saddle embolus in pulmonary artery

medium size thromboemboli (blocking a pulmonary artery to a lobule or set of lobules)

hemorrhagic pulmonary infarction is usually caused by what type of thromboembolus?

infarct

what type of infarct in the lung

bronchial arteries from systemic circulation are not cut off (supply ~1% of blood to the lungs)

why are infarcts due to medium sized thromboemboli hemorrhagic even when the pulmonary artery system is cut off?

hemorrhagic pulmonary infarct

pulmonary embolus

premortem (lines of zahn present)

premortem or postmortem pulmonary embolus?

pulmonary hypertension

many small PE at once or over a period time could eventually lead to ?

>25 mm

what mean pulmonary pressure is considered pulmonary hypertension?

1. medial hypertrophy (muscular, smaller arteries and arterioles)

2. intimal fibrosis (medium)

3. luminal narrowing, reduplication of elastic lamina (small and arterioles)

4. atheromas of pulmonary artery (large)

5. plexiform lesions (‘swiss cheese’)

what are pathologic features of pulmonary hypertension

pulmonary hypertension

buzzword: plexiform lesion

plexiform lesion

dilated artery develops intraluminal capillary tufts forming webs bridging vascular lumen

1. COPD

2. congenital or acquired heart disease

3. obstructive sleep apnea

4. recurrent pulmonary thromboemboli

5. mutlifactorial

what are the 5 causes of pulmonary hypertension, according to WHO

familial pulmonary hypertension

buzzword: BMPR2 gene inactivation

BPMR2

gene that functions to inhibit proliferation and favor apoptosis of vascular smooth muscle cells; mutation associated with genetic primary pulmonary hypertension

plexogenic lesion

pulmonary hypertension

pulmonary hypertension

noncardiogenic pulmonary edema

acute lung injury is aka?

acute lung injury

characterized by abrupt onset of significant hypoxemia and bilateral pulmonary infiltrates in the absence of cardiac failure

acute lung injury

acute respiratory distress syndrome (ARDS) is a manifestation of?

• A = abnormal chest imaging (bilateral opacities)

• R = respiratory failure timing (1 week)

• D = decreased oxygenation (<315)

• S = symptoms of respiratory failure/origin of edema

berlin definition with kigali modification of ARDS

ARDS

inflammation associated increase in vascular permeability and epithelial and endothelial death

neonatal RDS

inadequate surfactant level due to lung immaturity

infection: speis, diffuse pulmonary infections, gastric aspiration

most common conditions associated with development of ARDS

hyaline membranes

alveolar walls lined with ____________ in ARDS

hyaline membranes

fibrin-rich fluid, cytoplasmic and lipid remnants of necrotic epithelial cells in alveolar walls in ARDS

1. edema

2. hyaline membranes (alveolar cell necrosis and fibrin deposition)

what will be seen in the acute phase of lung injury (1-7 days)

hyaline membranes

ARDS

prematurity (also maternal diabetes and C-section)

what is the most contributing risk factor for neonatal RDS

surfactant

neonatal RDS is due to inadequate ________ levels

neonatal RDS

hyaline membranes

formed of fibrinogen, fibrin, and necrotic epithelial cells in neonatal RDS

hyaline membranes

neonatal RDS

false (normal at birth, onset of respiratory distress minutes to hours later)

T/F: infants with neonatal RDS have onset before birth

necrotizing enterocolitis (also patent ductus arteriosus - not pictured)

persistent low oxygen tension in neonatal RDS can lead to?

1. retinopathy of prematurity (retrolental fibroplasia)

2. intraventricular hemorrhage

3. bronchopulmonary dysplasia

therapeutic supplemental oxygen in neonatal RDS can lead to ?

1. delay delivery

2. L/S ratio of 2 (lecithin-sphingomyelin)

3. maternal steroids before birth

what are methods to prevent neonatal RDS (3)