Page 244 - Concise Pathology for Exam Preparation ( PDFDrive )

10 Blood Vessels 229

DISEASES OF THE BLOOD VESSELS

Q. Define vasculitis.
Ans. Vasculitis (angiitis) is an inflammatory process involving vessels. Depending on the
vessel involved vasculitis is labelled arteritis, capillaritis or venulitis.

Q. Classify vasculitis.
Ans. Vasculitis is classified based on:
1. Pathogenesis
(a) Direct infection
(i) Bacterial, eg, Neisseria, streptococci and staphylococci, M. tuberculosis and
M. leprae
(ii) Rickettsial, eg, Rocky Mountain spotted fever
(iii) Spirochaetal, eg, syphilis
(iv) Fungal, eg, aspergillosis and mucormycosis
(v) Viral, eg, herpes zoster and varicella virus
(b) Immunologic
(i) Immune complex mediated
- Infection associated, eg, hepatitis B and C viruses
- Henoch–Schönlein purpura
- Systemic lupus erythematosus (SLE) and rheumatoid arthritis
- Drug induced
- Cryoglobulinaemia
- Serum sickness
(ii) Antineutrophil cytoplasmic antibody (ANCA) mediated
- Wegener granulomatosis
- Microscopic polyangiitis (microscopic polyarteritis)
- Churg–Strauss syndrome
(iii) Direct antibody mediated
- Good pasture syndrome (anti-GBM antibodies)
- Kawasaki disease (antiendothelial antibodies)
(iv) Cell mediated
- Organ allograft rejection
(v) Unknown
- Giant cell arteritis
- Polyarteritisnodosa (PAN)
- Takayasu arteritis
2. Vessel size (2012 International Chapel Hill Consensus Conference on the Nomencla-
ture of Vasculitis)
(a) Large vessel vasculitis
(i) Giant cell (temporal) arteritis: Granulomatous arteritis of the aorta and its
major branches, with predilection for extracranial branches of carotid artery
(ii) Takayasu arteritis: Granulomatous inflammation of aorta and its major branches
(b) Medium-sized vessel vasculitis
(i) Polyarteritis nodosa (classic): Necrotizing inflammation of medium-sized or
small arteries without glomerulonephritis or vasculitis in arterioles, capillaries
or venules
(ii) Kawasaki disease: Arteritis involving large-, medium-sized or small arteries,
associated with mucocutaneous syndrome, usually seen in children
(c) Small vessel vasculitis
(i) Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis: Patients
with circulating antibodies to neutrophilic cytoplasmic antigens.
(ii) Wegener granulomatosis with polyangiitis: Granulomatous inflammation
involving the respiratory tract with necrotizing vasculitis affecting small to
medium-sized vessels. Necrotizing glomerulonephritis is common.

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