IN DETAIL ABOUT PATHOLOGY [ GROSS & MICROSCOPY] OF INFARCTS, CONGESTION OF DIFFERENT ORGANS FOR PRACTICAL CLASS FOR MBBS & CASE DISCUSSION .

1. SPLENIC
INFARCT,
CVC SPLEEN
CVC LUNG
PRACTICAL
CLASS
Dr Meenu E V
MBBS MD DNB

2. Spleen
A lymphoreticular organ
Weight : 150gm
Blood supply : splenic artery  central arterioles ->
vascular sinuses -> splenic venules -> splenic vein

3. Gross : capsulated, homogeneous, soft, dark
red mass [ red pulp] with grey white nodules
[ white pulp / malpighian bodies]

4. Microscoscopy :
capsule , extend to form trabeculae
Red pulp consist of network of thin
walled venous sinuses which contain
rbc, wbc, & macrophages - blood
spaces are arranged in cords called
cords of Billroth
White pulp – lymphoid follicle with
eccentrically placed arteriole

5. Function
– Maintain immunity , where B & T cells multiply
– Sequesterate & remove, normal & abnormal blood cells
– Regulate portal blood flow
– A site of extramedullary hematopoiesis

6. Disorders of spleen
– Splenic infarct
– Splenomegaly
– Hypersplenism
– Splenic rupture
– Tumours
– Cvc

7. Case 1
60yr / female
 c/o abdominal pain x 4 days,
breathlessness & Palpitation x 2 weeks
 H/o hypertension , smoking , dyslipidemia
 O/E - HR – 180/mt, BP – 140/90 mm Hg,
 Abdominal exam - epigastric & left upper quadrant tenderness
 ECG : Atrial fibrillation
 Ultrasonography - hypodense lesion in spleen with decreased vascular supply
 CT angiography - investigation of choice

8. Infarct

11. Splenic infarct
2 types : segmental / global
arterial / venous
Etiology :
 Splenic artery occlusion [ secondary to cardiac emboli]  white infarcts
 Thrombosis of splenic vein , secondary to pancreatitis
 Wegners granulomatosis / vasculitis
 Sickle cell disease -> autoinfarction
 Leukemia / lymphoma / myelofibrosis
 Blunt trauma – long vascular pedicle

12. Gross
– Wedge shaped, white grey infarct
involving capsule
– Infarct heals as large depressed scars
– Recent infarct – haemorrhagic
– Old infarct – fibrotic, pale yellow-
grey

13. Microscopy
– Necrotic areas – homogenous
pink
– Hematoidin crystals +
– Hemosiderin laden
macrophages, Inflammatory cells
around margin of infarct

14. Complication
– Hemorrhage
– Rupture
– Abscess
– Pseudocyst formation
Treatment : depends on etiology
Conservative treatment / splenectomy

15. Case 2
80 yr male
 c/o progressive dyspnea x 2 weeks [ worsens with exercise and sleeping /
orthopnea]
H/O MI x 4 yrs back, hypertension +, hyperlipidemia+
O/E – PR – 100/mt, feeble, RR – 30/mt, SpO2 – 80 %
 cyanosis +, mild pedal edema, BP - 150/100 mmHg
Respiratory system - wheeze +, bilateral crepitation,+
CVS - Cardiomegaly +
Chest X ray - cardiomegaly, prominent bronchial marking

16. Organs affected
by congestion
Lungs – heart failure
cells
Liver - nutmeg liver
Spleen – Gamna
Gandy Bodies
Kidney
HEART
FAILURE
LEFT HF
Pressure into Pumonary
Vein
CVC LUNGS
RIGHT HF
Pressure into Systemic Venous system
CVC LIVER CVC SPLEEN CVC KIDNEY

18. Hyperaemia Congestion
Localised increase in volume of blood
within organ
Due to increased inflow – arterial /
arteriolar dilatation
Active process
Tissue ll b red - more oxygenated
blood
Tissue will be warm
Localised increase in volume of blood
within organ
Due to diminished outflow – impaired
venous drainage
Passive process
Red- blue in colour – deoxygenated
blood
Cold & clammy

19. CHRONIC VENOUS CONGESTION OF
LUNG
Long standing accumulation of deoxygenated blood along with damage to the
tissue
ETIOLOGY
Left heart failure – back pressure
Obstruction of veins due to thrombi

20. Gross
 Lungs are heavy, firm
 C/S – dark, rusty brown – brown
induration

22. Microscopy
 Alveolar septa widened & thickened - due to
interstitial odema & dilated, congested
capillaries in septal wall & fibrosis
 Rupture of dilated capillaries - intra-alveolar
haemorrhages, hemosiderin laden
macrophages [ heart failure cells] in alveolar
lumen
 Brown induration on gross – due to
pigmentation & fibrosis

23. Cvc spleen
– Causes :
– Right heart failure
– Portal hypertension in liver cirrhosis
GROSS : enlarged, congested, capsule
tensed, C/S – grey tan, FIRM

24. Microscopy
– Red pulp enlarged due to marked
sinusoidal dilatation & congestion.
– Old & new haemorrages.
– Splenic macrophages increased
– Within haemorrhage : hemosiderin
pigment + Calcium salts + Fibrosis
organised to form GAMNA GANDY
BODIES / SIDEROFIBROTIC
NODULES.

25. Cvc liver

26. THANK YOU