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Lungs are distended and red. The reddish coloration of the tissue is due to congestion (alveolar capillaries are engorged with blood). Some normal pink.

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Presentation on theme: "Lungs are distended and red. The reddish coloration of the tissue is due to congestion (alveolar capillaries are engorged with blood). Some normal pink."— Presentation transcript:

1 Lungs are distended and red. The reddish coloration of the tissue is due to congestion (alveolar capillaries are engorged with blood). Some normal pink tissue is seen at the edge of the lung (arrows).

2 Acute pulmonary congestion and edema A frothy exudate fills the bronchus (arrow).

3 Pulmonary congestion and edema Frothy exudate being extruded from the lung tissue.

4 Pulmonary congestion and edema The lung section has a pale red color indicating proteinaceous material within the lung.

5 Arrows: Edema fluid within the alveoli 1: Thickened pleura

6 Arrows: Edema filled alveoli

7 1: Edema fluid within the alveoli Arrows: Congestion (RBCs) in the alveolar capillaries

8 Liver: Chronic Passive Congestion Note the accentuation of the centrilobar pattern evidenced by the dark brown staining areas in this tissue.

9 Liver: Chronic Passive Congestion The central veins are red and the surrounding hepatic tissue is pale tan-brown.

10 Liver: Chronic Passive Congestion Slightly visible centrilobar pattern

11 Liver: Chronic Passive Congestion Accentuated lobar pattern with a dark red stain surrounding the central veins in the liver lobules (arrows)

12 Liver lobules Congestion and RBC accumulation in the sinusoidal spaces around the central vein. Note that the portal triads (arrows) are quite normal and there is no evidence of congestion.

13 Central vein illustrating congestion and some loss of liver parenchymal cells A mild increase in connective tissue around the central vein is evident in this section.

14 Liver: Chronic Passive Congestion Macrophages distended with a brown pigment (arrow). These resident macrophages (Kupffer cells) are part of the reticuloendothelial system and normally line the sinusoidal spaces in the liver where they phagocytose the RBCs that pool, and eventually die, in the central vein region.

15 Cut surface of a liver (left) with Chronic Passive Congestion compared to the cut surface of a nutmeg (right)

16 Heart: Mural Thrombosis Arrow: Well formed thrombus tightly attached to the myocardium near the apex of the left ventricle

17 Thrombis (1) attached to the Myocardium (2)

18 Border between the thrombus on the right (1) and the endocardium on the left (2) There is a line of inflammatory cells at this interface (arrows).

19 Border between the thrombus (1) and the endocardium (2) In this region there is less inflammation at the border zone.

20 Heart: Mural Thrombosis This illustrates the layered effect of the thrombus.

21 Heart: Mural Thrombosis Note the pale region which contains primary platelets (degranulated platelets) with some fibrin (1), and the red areas which contain RBCs, some leukocytes, and fibrin (2).

22 Heart: Mural Thrombosis 1: The pale regions contain primary platelets (degranulated platelets) with some fibrin. 2: The red areas contain RBCs, some leukocytes, and fibrin.

23 Thrombosed Coronary Artery (arrows)

24 Coronary Artery: Thrombosis The thrombus (1) completely occludes the vessel. Note the layering of the thrombus. The fibrous cap is ruptured (arrow) and there is hemorrhage into the atherosclerotic plaque. Note the cholesterol crystals in the plaque.

25 Coronary Artery: Thrombosis Ruptured fibrous cap (arrows) with hemorrhage into the atherosclerotic plaque.

26 Coronary Artery: Thrombosis Ruptured fibrous cap (arrows) with hemorrhage into the atherosclerotic plaque. Note the presence of cholesterol crystals.

27 Coronary Artery: Thrombosis Thrombus attached to wall of vessel. There is early organization of the thrombus (arrow).

28 Coronary Artery: Thrombosis Thrombus attached to the wall of the vessel. Note the early organization with in- growth of fibroblasts and small blood vessels from the wall of the artery (arrows).

29 Coronary Artery: A mural thrombus has undergone reorganization. The mural thrombus has been invaded by the in-growth of fibroblasts and small blood vessels from the wall of the artery. The thrombotic material has been phagocytosed and removed by macrophages and is replaced by fibrous connective tissue and blood vessels. This reorganized thrombus still compromises the lumen of the vessel.

30 Coronary Artery: Thrombosis Adventitia (1) and Media (2) contain inflammatory cells. The recanalized portion of the vessel is composed of fibrous connective tissue and contains numerous small blood vessels. There is a small area of hemorrhage (arrow) in the central portion of this image.

31 Coronary Artery: Thrombosis Adventitia (1) and Media (2) contain inflammatory cells. The recanalized portion of the vessel (3) is composed of fibrous connective tissue and contains numerous small blood vessels (arrows).

32 Coronary Artery: Thrombosis Luminal surface of re-canalized vessel Note the vessel lumen is lined by endothelial cells (arrows).

33 Lung: Thromboemboli in pulmonary arteries

34 Heart with main pulmonary artery opened Note the thromboembolus filling the pulmonary artery (arrows).

35 Leg muscle and veins Arrows: Thrombus

36 Lung with large thrombus lodged at this branch point in the pulmonary artery Note the hemorrhage and congestion in the surrounding lung parenchyma.

37 Wall of the pulmonary artery (1) containing the thromboembolus In this case the artery wall looks normal. If this was a thrombus instead of a thromboembolus, you would expect to see some damage in the artery wall that would have initiated the thrombus. Note the Lines of Zhan in the thromboembolus (arrows).

38 Infarcted lung The tissue is congested and has a very bland appearance due to coagulation necrosis in the lung parenchyma. You can still see the outlines of the alveoli and the cells that make up the alveoli, but there is almost complete loss of nuclei throughout this section.

39 Infarcted testisCut surface (Note: filled with blood) Because of the anatomy of the blood supply to the testis, torsion of the blood vessels often leads to venous occlusion (due to compression of thin walled veins) but not arterial occlusion. Thus, blood can get in but it can’t get out. This leads to hypoxia and eventually to hemorrhagic necrosis.

40 Opened abdomen at autopsy, demonstrating loops of infarcted bowel (arrow) Vascular occlusion can lead to ischemic necrosis of the bowel. In this case, a section of bowel herniated through a fibrous connective tissue band and was strangulated, leading to ischemic necrosis.

41 Fibrous band between uterus and adjacent tissue The fibrous scar tissue is probably left over from a pervious surgery or an infection. A loop of bowel herniated through the opening produced by this fibrous band and became incarcerated leading to the ischemic necrosis seen in the previous image.

42 Lung: Microabscesses due to septic embolization Note the small 2-3 mm lesions scattered throughout this lung tissue (arrows).

43 Myocardium with multiple embolic lesions scattered throughout the left and right ventricles

44 Section of lung (left) and myocardium (right) Both pieces of tissue have multiple embolic lesions seen as blue staining areas with massive infiltration of inflammatory cells (arrows).

45 Focal lesions in the lung produced by septic emboli Note these are clearly demarcated from the relatively normal surrounding lung tissue.

46 Septic abscesses illustrating the colonies of bacteria within necrotic cellular debris (arrows) This is typical of an abscess.

47 Myocardium with Septic Abscesses (arrows)

48 Abscesses within the myocardium illustrating colonies of bacteria as dark blue-staining material (arrow)

49 Myocardial abscess stained with a special Gram tissue stain to illustrate the colonies of bacteria in this myocardial tissue (arrows)

50 Aorta opened lenghtwise with the luminal surface visible Note the rough surface with ulcerations and adherent thrombotic material. There is a mild dilation (aneurysm) at the distal aorta just at the bifurcation with an accumulation of thrombus.

51 Lumen of aorta from previous image The rough, ulcerated surface and thrombotic material can easily be seen.

52 Kidney Several blood vessels can be identified at the corticomedullary junction (arrows)

53 Arcurate arteries with a chronic embolus Note the needle-shaped space (arrow) within the lumen of this artery (arrow) which represents the space occupied by the cholesterol crystal that was dissolved away during histologic processing.

54 Atherosclerotic embolus Note the cholesterol clefts (1) and thrombotic material (2) that occlude this artery.

55 Mesenteric artery with atherosclerotic embolus Again, note the cholesterol clefts and thrombotic material that occlude this artery.


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