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Inflammatory heart diseases
Fiedler interstitial myocarditis From cases of the Pathology Department - U.M.F. “Gr. T. Popa” Iasi
Fig.16.1
Fig.16.1-2. Fiedler interstitial myocarditis • Myocarditis of unknown etiology and cause of SCD with CF in children • Diffuse interstitial inflammatory infiltrate composed of neutrophiles, lymphocytes,
macrophages and multinucleated giant cells • Extensive myocyte necrosis
Fig.16.2
Viral interstitial myocarditis From cases of the Pathology Department - U.M.F. “Gr. T. Popa” Iasi
Fig.16.3
Fig.16.3-4 Viral myocarditis• Interstitial mononuclear inflammatory infiltrate and variable
diffuse interstitial edema • Myocardial fibers with degenerative lesions that range from
minimal to moderate; focal myocite necrosis.
Fig.16.4
Rheumatic myocarditis From cases of the Pathology Department - U.M.F. “Gr. T. Popa” Iasi
Fig.16.5. Aschoff granuloma
Fig.16.6. Rheumatic myocarditis• Aschoff granuloma: micronodular lesion located in the myocardial
connective interstitium with paravascular disposition • Aschoff granuloma is composed of:
– Central area of fibrinoid necrosis – Aschoff cells: large cells, bazophilic cytoplasm, and 1 or 2 nuclei – Anicikov cells: fusiform cells with irregular nuclei, looking as
caterpillar – Macrophages, lymphocytes, and plasma cells, fibroblasts
Rheumatic mitral and aortic stenosis From: Stevens A. J Lowe J. Pathology. Mosby 1995
Macroscopically, mitral valves are thickened, hard, with fused comissures, defining a small, round or slit-like orifice looking as a mouth-fish.
In AS, aortic cusps are thickened by fibrosis, comissures are fused, and aortic oriffice is narrowed.
Fig.16.7.
EISA VS EIAvegetative E. vs ulcero-vegetative E.
FD Infectious agents, with low virulence, originating from asymptomatic infectious foci + intermittent bacteriemia: Streptococcus viridans, fungi.
Infectious agents, with high virulence, originating from acute infectious foci, clinical manifested: lung abscess + permanent bacteriemia: staphylococcus, etc.
Site Previous valvular lesions: CR, MCC Normal valvular apparatus
MA
MI
MA-multiple, friabile, vegetations placed on the valvular apparatus.
MI-the vegetations consist of dense aggregates of fibrin and platelets and a small number of microorganisms and neutrophils.
MA-Bulky, friable, vegetations arranged on the surface of valves with damaging of the valvular apparatusperforation or rupture.
MI-the vegetations consist of aggregates of fibrin and platelets, and a large number of microorganisms and neutrophils.
CO - CHF-chronic heart failure
- systemic embolism heart, spleen or renal infarcts
- focal glomerulonephritis
- AHF-acute HF (valve perforation or rupture)
- Systemic embolism-pyoemic microabcesses in lungs and kidney
- valvular ring abscess and myocardial abscess
Fig.16.8
Fig.16.9. Macroscopy: multiple, polypoid, gray-reddish and friable vegetations, arranged in bouquet on the mitral valve surfaces, and small vegetations grouped on adjacent parietal endocardium, too. Usually, they don’t produce valvular damages: rupture or perforation.
Subacute infectious endocarditis-(vegetant endocarditis) - EISAFrom: Stevens A. J Lowe J. Pathology. Mosby 1995
Fig.16.9
Fig.16.10. Macroscopy: bulky, gray-reddish, friable, vegetations located on the surface of aortic sigmoid valves and parietal endocardium. By perforation, ulceration and rupture of valves, results valvular incompetence and acute heart failure
Fig.16.10
Acute infectious endocarditis-(ulcerovegetant endocarditis) - EIA