Presentation on theme: "Lungs are distended and red"— Presentation transcript:
1Lungs are distended and red 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).
2Acute pulmonary congestion and edema A frothy exudate fills the bronchus (arrow).
3Pulmonary congestion and edema Frothy exudate being extruded from the lung tissue.
4Pulmonary congestion and edema The lung section has a pale red color indicating proteinaceous material within the lung.
5Arrows: Edema fluid within the alveoli 1: Thickened pleura
11Liver: Chronic Passive Congestion Accentuated lobar pattern with a dark red stain surrounding the central veins in the liver lobules (arrows)
12Liver lobulesCongestion 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.
13Central 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.
14Liver: 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.
15Cut surface of a liver (left) with Chronic Passive Congestion compared to the cut surface of a nutmeg (right)
16Heart: Mural Thrombosis Arrow: Well formed thrombus tightly attached to the myocardium near the apex of the left ventricle
24Coronary 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.
25Coronary Artery: Thrombosis Ruptured fibrous cap (arrows) with hemorrhage into the atherosclerotic plaque.
26Coronary Artery: Thrombosis Ruptured fibrous cap (arrows) with hemorrhage into the atherosclerotic plaque.Note the presence of cholesterol crystals.
27Coronary Artery: Thrombosis Thrombus attached to wall of vessel.There is early organization of the thrombus (arrow).
28Coronary 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).
29Coronary Artery: A mural thrombus has undergone reorganization 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.
30Coronary 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.
31Coronary 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).
32Coronary Artery: Thrombosis Luminal surface of re-canalized vesselNote the vessel lumen is lined by endothelial cells (arrows).
36Lung with large thrombus lodged at this branch point in the pulmonary artery Note the hemorrhage and congestion in the surrounding lung parenchyma.
37Wall 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).
38Infarcted lungThe 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.
39Infarcted testis Cut 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.
40Opened 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.
41Fibrous 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.
42Lung: Microabscesses due to septic embolization Note the small 2-3 mm lesions scattered throughout this lung tissue (arrows).
43Myocardium with multiple embolic lesions scattered throughout the left and right ventricles
44Section 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).
45Focal lesions in the lung produced by septic emboli Note these are clearly demarcated from the relatively normal surrounding lung tissue.
46Septic abscesses illustrating the colonies of bacteria within necrotic cellular debris (arrows) This is typical of an abscess.
48Abscesses within the myocardium illustrating colonies of bacteria as dark blue-staining material (arrow)
49Myocardial abscess stained with a special Gram tissue stain to illustrate the colonies of bacteria in this myocardial tissue (arrows)
50Aorta 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.
51Lumen of aorta from previous image The rough, ulcerated surface and thrombotic material can easily be seen.
52KidneySeveral blood vessels can be identified at the corticomedullary junction (arrows)
53Arcurate 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.
54Atherosclerotic embolus Note the cholesterol clefts (1) and thrombotic material (2) that occlude this artery.
55Mesenteric artery with atherosclerotic embolus Again, note the cholesterol clefts and thrombotic material that occlude this artery.