Morphopathology SET 13 Rheumatic Lesions on Heart including Myocarditis/Endocarditis/Vege

by Qamar Ahmad

Fibrinous Pericarditis Rheumatic, it gives the appearance of Bread-Butter aspect. Sometimes, the translucent pericardial wall turns into a thick

Fibrinous Pericarditis Rheumatic, it gives the appearance of Bread-Butter aspect. Sometimes, the translucent pericardial wall turns into a thick

Vegetations The 2 small red arrows at the Aorta junction represents Vegetations. The valve is also perforated, indicating it’s a chronic injury.

Vegetations The 2 small red arrows at the Aorta junction represents vegetations. The valve is also perforated,

The red arrow on the inside represents a vegetation which is secondary to a previous lesion caused by SABE(sub-acute bacterial endocarditis) Also there is Aortic stenosis which caused Left ventricular

The red arrow on the inside represents a vegetation which is secondary to a previous lesion caused by SABE(sub-acute bacterial endocarditis) Also there is Aortic stenosis which caused Left ventricular

The red arrow on the inside represents a vegetation which is secondary to a previous lesion caused by SABE(sub-acute bacterial endocarditis) Also there is Aortic stenosis which caused Left ventricular

Another example of SABE with multiple vegetations

Another example of SABE with multiple vegetations

Another example of SABE with multiple vegetations

Mitral stenosis, the valves are permenently open. Both cavities are large, indication a Mitral Disease

Mitral stenosis, the valves are permenently open. Both cavities are large, indication a Mitral Disease (Regurgitation + Stenosis)

Mitral stenosis. Mitral valve is permenently closed, due to fibrous rigidity.

Mitral stenosis. Mitral valve is permenently closed, due to fibrous rigidity.

Mitral stenosis. Mitral valve is permenently closed, due to fibrous rigidity.

Mitral valve. Stenosed and permanently open. There is functional enlargement of the other side of the heart, which leads to tricuspid insufficiency.

Mitral valve. Stenosed and permanently open. There is functional enlargement of the other side of the heart, which leads to tricuspid insufficiency.

Mitral valve, permently closed. Gives the appearance of Fishmouth.

Mitral valve, permently closed. Gives the appearance of Fishmouth.

Mitral valve, permently closed. Gives the appearance of Fishmouth.

Extra notes: Infectious endocarditis can be of two types: Acute/Subacute. Differentiating between them via their macroscopical appearance is a bit confusing. In acute, there is no previous lesion and the injury is new and “de novo”. There is sepsis at times which can give undulating fever. The vegetation at the valve is due to fibrin + Leucocytes + PMN + the bacterial/viral agent. In SABE, there is asymptomatic infection. There is no abscess formation and no vegetations in the first instances. However, there is an apical ‘granuloma’ formation on top of the previously diseased valve, leading to a secondary vegetation. These vegetations are friable and can cause emboli usually. Complications of acute are Infaraction and sepsis. It has a rapid onset and there is usually ulceration and perforation of the valve. In subacute the duration is slow and the complication are not usually abscess formation but emboli and granulomas. Myocarditis/Endocarditis: Rheumatic myocarditis: The myocardium becomes intense red and ‘hypocontractile’. There is usually a large, diffuse and non specific injury. Rheumatic Endocarditis: It has a specific injury, usually around the blood vessels. The valves show cardinal signs of inflammation. They become larger than usual and there is annular errosion which eventually leads to Thrombi(veruci) Thrombi usually adhere to endocardium and don’t form embolism. In chronic

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