Pathology Quiz

1. Pathology Quiz RHD, IE, Congenital HD

2. Heart Valve. E = endothelium, M = myocardium, S = fibroelastic supporting structures and F = lamina fibrosa Histologically heart valves consist of fibroelastic tissue (lamina fibrosa) covered by endothelium

3. This is infective endocarditis. The aortic valve demonstrates a large, irregular, reddish tan vegetation.Virulent organisms, such as Staphylococcus aureus, produce an "acute" bacterial endocarditis, while some organisms such as Streptococcus viridans produce a "subacute" bacterial endocarditis. http://library.med.utah.edu/WebPath/CVHTML/CV037.html

4. The more virulent bacteria causing the acute bacterial form of infective endocarditis can lead to serious destruction, as shown here in the aortic valve. Irregular reddish tan vegetations overlie valve cusps that are being destroyed. Portions of the vegetation can break off and become septic emboli. http://library.med.utah.edu/WebPath/CVHTML/CV038.html

5. Here is a valve with infective endocarditis. The blue bacterial colonies on the lower left are extending into the pink connective tissue of the valve. Valves are relatively avascular, so high dose antibiotic therapy is needed to eradicate the infection. http://library.med.utah.edu/WebPath/CVHTML/CV042.html

6. This is a mechanical valve prosthesis of the older ball and cage variety. Such mechanical prostheses will last indefinitely from a structural standpoint, but the patient requires continuing anticoagulation because of the exposed non-biologic surfaces. The superior aspect (here the left atrium) is seen at the left, while the outflow is at the right into the left ventricle in this mitral valve prosthesis. http://library.med.utah.edu/WebPath/CVHTML/CV183.html

7. At the right is a probe patent foramen ovale in an adult. A metal probe lifts the septum secundum and reveals the opening. Normally, the left atrial pressure keeps the foramen closed, but if right atrial pressures rise with pulmonary hypertension (as with pulmonary embolus), the foramen may open and even allow a thrombus to go from right to left. This is a "paradoxical embolus", rare (seen on the left here), and so called because a thromboembolus arising from the venous circulation can end in the systemic circulation.

8. Active rheumatic carditis in a girl aged 11. There was a 4 year history of recurrent attacks of rheumatic fever and of persistent mitral and aortic incompetence with severe heart failure. Death occurred suddenly. Note the thickening of the mitral (blue arrows) and aortic cusps (black arrows) with rows of vegetations near their edges, the fibrosis of the left atrialendocardium, the dilatation and hypertrophy of all cardiac chambers, and the chronic obliterativepericarditis. Tiny vegetations were also present on the atrial surface of the tricuspid valve.

9. Infective endocarditis. Features to note are the thickened fibrotic valve leaflet (black arrow), the vegetation (blue arrows) containing pink fibrin and platelets, and the dark blue colonies of bacteria (red arrow), better seen in the higher power photomicrograph in B.

10. Stenosed, calcified, bicuspid aortic valve. Woman aged 66. Heart weighed 610 g. This condition can be found incidentally without any history of rheumatic fever.

11. Mitral and aortic valve prostheses (arrow) inserted in a man aged 49 with heart failure due to chronic valve disease following rheumatic fever at the age of 3 years.

12. Histology - Rheumatic myocarditis. The classical Aschoff body is seen here. The cells are located in the perivascular region within the myocardium. The ‘Anitschkow’ cells are plump activated macrophages (arrowed in B), and these are admixed with other inflammatory cells. The ‘Anitchkow’ cells have chromatin arranged in a central ribbon and this has been likened to the appearance of a caterpillar (hence "caterpillar cells").