Aortic blebs: Possible site of aneurysm rupture

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Presentation transcript:

Aortic blebs: Possible site of aneurysm rupture Glenn C. Hunter, MD a, Stewart C. Leong, MD b, Gloria S.M. Yu, MD b, Kenneth E. McIntyre, MD a, Victor M. Bernhard, MD a Journal of Vascular Surgery Volume 10, Issue 1, Pages 93-99 (July 1989) DOI: 10.1016/0741-5214(89)90291-7 Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 CT scan shows an AAA and renal cyst. The calcified aortic wall is discontinuous, with protrusion of the bleb beyond the wall (arrowhead). Journal of Vascular Surgery 1989 10, 93-99DOI: (10.1016/0741-5214(89)90291-7) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Microscopic section of the bleb seen in Fig. 1 shows the thrombus-filled lumen and markedly attenuated aortic wall and inflammatory cell infiltrate (arrowhead). (Hematoxylineosin stain; original magnification × 4.) Journal of Vascular Surgery 1989 10, 93-99DOI: (10.1016/0741-5214(89)90291-7) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Microscopic section of the bleb removed from patient 4 shows the progressive diminution in the content of elastic fibers along the circumference as one progresses from the intact aneurysmal wall (A) into the area of the bleb (B), with complete loss of elastic fibers at the apex (C) (large arrowhead). There is also a defect in the intima, with subintimal hemorrhage (small arrowhead). Journal of Vascular Surgery 1989 10, 93-99DOI: (10.1016/0741-5214(89)90291-7) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 A, Section through the wall of a bleb shows the dark-staining, fragmented elastic tissue (arrowhead), with marked inflammatory, cell infiltrate consisting of lymphocytes, plasma cells, and multinucleate giant cells. (Verhoeff's elastin stain; original magnification × 50.) B, Higher magnification of the inflammatory infiltrate shows lymphocytes, plasma cells, and a multinucleate giant cell. Journal of Vascular Surgery 1989 10, 93-99DOI: (10.1016/0741-5214(89)90291-7) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Section through apex of the bleb removed from patient 6 shows microscopic rupture with absence of the aortic wall. The lumen of the bleb is filled by hematoma-containing cholesterol clefts. The residual portion of the wall is indicated by the arrowhead (Hematoxylin-eosin stain; original magnification × 25.) B, Section shows complete absence of elastic tissue. Cholesterol clefts and lipid-containing histiocytes are present in the periadventitial adipose tissue. (Verhoeff's elastin stain; original magnification × 50.) Journal of Vascular Surgery 1989 10, 93-99DOI: (10.1016/0741-5214(89)90291-7) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions