new_n_lost
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Examination of an autopsy specimen from a Mexican immigrant demonstrates a heart with massive dilation of the aortic root and adjacent aortic arch. Opening the aorta reveals a smooth interior wall without obvious lesions.
If a histological section through the aortic wall is made, which of the following would most likely be seen?
A. A heavy eosinophilic infiltrate
B. Fibrinoid necrosis with a neutrophilic infiltration
C. Focal fragmentation of elastic elements
D. Obliterative endarteritis of the vasa vasorum
E. Ring-like calcification of the vessel media
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| hope4dabest
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A ...??
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| drgho
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D. Thertiary syphilis??
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| jean robert
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D
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| SURVIVOR
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C? Marfan's? 
There's no intimal lesion which is why i wont go for syphilis! I aint sure though? 
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| paheli
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i think it's A
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| new_n_lost
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paheli wrote:
i think it's A
Explain why do think its A please.
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| paheli
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it sounds like chagas dz. most commonly causes mega esophagus, megacolon. but can also cause cardiomegaly. later can affect aortic root. and his being a south american points to chagas.
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| Aashi
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paheli wrote:
it sounds like chagas dz. most commonly causes mega esophagus, megacolon. but can also cause cardiomegaly. later can affect aortic root. and his being a south american points to chagas.
Chagas disease---->Mostly seen among south and central americans..A frequent cause of dilated Cardiomyopathy or Triad of megacolon,mega esophagus and MEGA heart..in dilated C.M BOTH the ventricles are dilated----->systolic dysfunction of the heart and CHF, mega esophagus--->dysphagia to solids , odynophagia and mega colon--->bouts of abd pain and constipation..
In my opinion ,apart from hailing from MEXICO, this pt DOESN'T have any other s/s pointing towards chagas
Most probably this is a case of tertiary syphillis---->non atherosclerotic aortic root aneurysm-------> so I would go for D
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| hope4dabest
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Aashi wrote:
Most probably this is a case of tertiary syphillis---->non atherosclerotic aortic root aneurysm-------> so I would go for D
In tertiary sphilis there is scarring of aota which is due to treponema action on the intima and in question its given cut open aorta is smooth
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| new_n_lost
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hope4dabest wrote: In tertiary sphilis there is scarring of aota which is due to treponema action on the intima and in question its given cut open aorta is smooth
Goljan RR 2nd Ed. pg 158 Point D sub part 2
Tunica media is the middle layer
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| new_n_lost
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Aashi wrote:
Most probably this is a case of tertiary syphillis---->non atherosclerotic aortic root aneurysm-------> so I would go for D
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| new_n_lost
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The correct answer is D.
Massive dilation of the aortic root with an absence of atherosclerotic vessel lesions strongly suggests a syphilitic aneurysm. These aneurysms are a manifestation of tertiary syphilis and have become very uncommon now, probably due to a combination of deliberate therapy and therapy of undiagnosed disease when antibiotics are given for some other condition. The histologic hallmark of the syphilitic aneurysm is a plasma cell lesion of the small blood vessels (the vasa vasorum) that supply the aorta, and eventually obliterate the small vessel lumina.
Choice A is a feature of Churg-Strauss syndrome, which is a variant of polyarteritis nodosa that involves vessels smaller than the aorta.
Choice B is a feature of polyarteritis nodosa, which involves vessels smaller than the aorta.
Choice C is a feature of cystic medial necrosis, which can cause aortic dissection.
Choice E is a feature of Mِnckeberg's arteriosclerosis, which involves vessels smaller than the aorta.
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