Veins and lymphatics
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Transcript of Veins and lymphatics
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Veins and lymphatics
By Dr S Homathy
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Disorders of veins
• Varicose vein• Phlebothrombosis• Thrombophlebitis
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Varicose vein
• Abnormally dilated, tortuous veins• Produced by prolonged increase in
intraluminal pressure and loss of vessel wall support
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Types and sites
• Superficial veins of the upper and lower leg– Prolonged standing leads to
• Increased venous pressure• venous stasis• Pedal oedema
– Females> males– Obesity increases the risk.– Pregnancy
• Oesophageal varices• Haemorrhoids
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Clinical features
• Home work
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Phlebothrombosis and Thrombophlebitis
• Deep leg veins acccount of > 90% of cases. • What is Phlebothrombosis (DVT)?• What is Thrombophlebitis ?• What are the predisposing factors / causes of
DVT?• Migratory thrombophlebitis?
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Superior and inferior vena caval syndrome
SVS• Caused by – Neoplasm compress or invade the SVC• Bronchogenic carcinoma / mediastinal lymphoma
• Clinical features–Marked dilation of veins of head, neck and arms– Cyanosis– Respiratory distress due to pulmonary vessel
compression
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IVS• Caused by– Neoplasm compress / invade the vessel
(hepatocellular, renal cell carcinoma)– Thrombus from hepatic, renal, lower extremities
• Clinical features– Lower extremity oedema– Distension of superficial collateral vein of the
lower abdomen–Massive proteinuria in case of renal vein
involvement
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Lymphangitis and lymphoedema
• Causes and consequences?– Home work
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Tumours
• Benign- haemangioma• Intermediate lesion• Highly malignant – angiosarcoma
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Haemangiomas
• Very common• Characterized by increased numbers of
normal or abnormal vessels filled with blood• Commonly present at birth• Most are expand with growth• Many capillary lesion regress with time
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Clinical variant of Haemangiomas
Capillary haemangioma• Most common variant• Occurs in the– skin, – subcutaneous tissues – mucous membranes of the oral cavities and lips– Liver – Spleen– kidneys.
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MorphologyGross • Bright reed to blue• Few mm to several cm in dm• At the level with surface / slightly elevated• Have intact overlying epithelium
Histology • Unencapsulated, aggregates of closely packed, thin –
walled capillaries• Usually blood filed and lined by flattened epithelium• Vessels are separated by scant cT stroma• Lumen partioally or completely thrombosed and organised
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Strawberry Hemangiomas
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Cavernous haemangioma
• Characterised by large, dilated channels • Less well circumscribed • Frequently involve deep structures.
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Morphology Gross• Red- blue, soft, spongy masses
Histology • Sharply defined, unencapsulated• Composed of large, cavernous blood - filled
vascular spaces separated by a mild to moderate amount of CT stroma
• Intravascular thrombosis with associated dystrophic calcification is common
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• Similar to strawberry hemangiomas but are more deeply situated.
• They may appear as a red-blue spongy mass of tissue filled with blood
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Cavernous hemangioma of the skin. H&E stain.
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Cavernous liver hemangioma
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Pyogenic granuloma
• Is a capillary haemangioma• Rapidly growing peduncular red nodule• Seen on the skin, gingival or oral mucosa• Bleed easily often ulcerated
Histology• Proliferating capillaries• Accompanied by extensive oedema• Acute and chronic inflammatory infiltrate