Page 122 - Textbook of Pathology, 6th Edition

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SECTION I

Figure 5.10 CVC lung. The alveolar septa are widened and thickened due to congestion, oedema and mild fibrosis. The alveolar lumina
contain heart failure cells (alveolar macrophages containing haemosiderin pigment).

MORPHOLOGY OF CVC OF ORGANS Microscopically, the changes of congestion are more
marked in the centrilobular zone due to severe hypoxia
CVC Lung than in the peripheral zone. The central veins as well as
Chronic venous congestion of the lung occurs in left heart the adjacent sinusoids are distended and filled with blood.
failure (Chapter 16), especially in rheumatic mitral stenosis The centrilobular hepatocytes undergo degenerative
so that there is consequent rise in pulmonary venous changes, and eventually centrilobular haemorrhagic necrosis
pressure. may be seen. Long-standing cases may show fine
centrilobular fibrosis and regeneration of hepatocytes,
Grossly, the lungs are heavy and firm in consistency. The resulting in cardiac cirrhosis (Chapter 21). The peripheral
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sectioned surface is dark The sectioned surface is rusty zone of the lobule is less severely affected by chronic
brown in colour referred to as brown induration of the hypoxia and shows some fatty change in the hepatocytes
lungs. (Fig. 5.12).
Histologically, the alveolar septa are widened due to the
presence of interstitial oedema as well as due to dilated
and congested capillaries. The septa are mildly thickened CVC Spleen
due to slight increase in fibrous connective tissue. Rupture Chronic venous congestion of the spleen occurs in right heart
of dilated and congested capillaries may result in minute failure and in portal hypertension from cirrhosis of liver.
intra-alveolar haemorrhages. The breakdown of
erythrocytes liberates haemosiderin pigment which is Grossly, the spleen in early stage is slightly to moderately
taken up by alveolar macrophages, so called heart failure enlarged (up to 250 g as compared to normal 150 g), while
cells, seen in the alveolar lumina. The brown induration in long-standing cases there is progressive enlargement
observed on the cut surface of the lungs is due to the and may weigh up to 500 to 1000 g. The organ is deeply
pigmentation and fibrosis (Fig. 5.10). congested, tense and cyanotic. Sectioned surface is gray
tan (Fig. 5.13).
CVC Liver Microscopically, the features are as under (Fig. 5.14):
i) Red pulp is enlarged due to congestion and marked
Chronic venous congestion of the liver occurs in right heart
failure and sometimes due to occlusion of inferior vena cava sinusoidal dilatation and here are areas of recent and old
and hepatic vein. haemorrhages. Sinusoids may get converted into
capillaries (capillarisation of sinusoids).
Grossly, the liver is enlarged and tender and the capsule ii) There is hyperplasia of reticuloendothelial cells in the
is tense. Cut surface shows characteristic nutmeg* red pulp of the spleen (splenic macrophages).
appearance due to red and yellow mottled appearance, iii) There is fibrous thickening of the capsule and of the
corresponding to congested centre of lobules and fatty trabeculae.
peripheral zone respectively (Fig. 5.11).
iv) Some of haemorrhages overlying fibrous tissue get
deposits of haemosiderin pigment and calcium salts; these
*Nutmeg (vernacular name jaiphal) is the seed of a spice tree that grows
in India, used in cooking as spice for giving flavours.