HEMODYNAMIC DISORDERS&

THROMBOSIS

Edema

Edema

Normal alveoli

Pulmonary Edema

Fluid in Trachea/Bronchi

Abdominal Ascites

Edematous Brain

Normal Brain

Hyperemia and Congestion

Congestion and Hyperemia

CONGESTION AND HYPEREMIA

Congested Lungs

Acute Pulmonary Congestion

“Heart Failure Cells” in Alveoli Chronic Pulmonary Congestion

Congested and Enlarged Spleen

Nutmeg Liver

• A descriptive term for a liver with chronic passive congestion, a hepatopathy due to cardiac decompensation and failure.

• If the congestion is severe, these changes may be accompanied by haemorrhagic necrosis

Nutmeg liver

Microscopically, the nutmeg pattern results from congestion around the central veins, as seen here.

This is usually due to a "right sided" heart failure.

• Liver is divided histologically into lobules.

• The center of the lobule is the central vein.

• At the periphery of the lobule are portal triads.

• Functionally, the liver can be divided into three zones, based upon oxygen supply.

• Zone 1 encircles the portal tracts where the oxygenated blood from hepatic arteries enters.

• • Zone 3 is located around central veins, where

oxygenation is poor. Zone 2 is located in between.

Hemorrhage

• Petechiae measure less than 3 mm.

• Purpura measure 0.3–1 cm.

• Ecchymoses greater than 1 cm.

• Here are petechial hemorrhages seen on the epicardium of the heart.

• Petechiae (pinpoint hemorrhages) represent bleeding from small vessels and are classically found when a coagulopathy is due to a low platelet count.

• They can also appear following sudden hypoxia.

• The blotchy areas of hemorrhage in the skin are called ecchymoses (singular ecchymosis), or also as areas of purpura.

• Ecchymoses are larger than petechiae. • They can appear with coagulation disorders.

Intracerebral Hemorrhage

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.

Intracerebral Hemorrhage

Pericardial Hemorrhage

Hemostasis and Thrombosis

THROMBOSIS -Virchow triad

Thrombus - MorphologyArterial

Arise in arteries

Grow in retrograde fashion (towards the heart)

Forms at site of Endothelial injury (AS), turbulence (aneurysms)

Pale/ white

Lines of Zahn

Venous

Arise in deep veins and superficial veins (popleteal Femoral Iliac),

Antigrade

At site of stasis (lower extremities)

Red / dark

No lines of Zahn

• These are "lines of Zahn" which are the alternating pale pink bands of platelets with fibrin and red bands of RBC's forming a true thrombus.

Venous Thrombi: Clinical

Thrombotic VegetationsMitral Valve

Photo: Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.

Abdominal Aortic Aneurysm Thrombus

Deep Vein Thrombosis (DVT)

Plaque with Recent Thrombus

ThrombosisOutcomes

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.

Early Organizing Thrombus

Embolism

Embolization (Embolus)Thromboembolism of Pulmonary Artery

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003; . Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.

Infarction

Infarction (Infarct)Lung (Left); Spleen (Right)

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.

Pulmonary Infarction

Small Intestine Infarction

Kidney InfarctionReplaced by Fibrotic Scar (Left)

Pale Infarct (Wedge) of Spleen

Thanks