MHD I CRIOVSCULR II LORTORY 0/5/5 Case Organ Set Organ Set 2 Organ Set 3 Case (for Organ Sets 3) 72 year old man with a history of diabetes mellitus type 2, HTN, and hyperlipidemia presents with progressive dyspnea on exertion, bilateral lower extremity edema and generalized fatigue. He has noticed a 0 pound weight gain over the past 2 weeks. On physical exam he has findings of jugular venous distention, bilateral lower lung field crackles, hepatomegaly and bilateral 2+ lower extremity edema to above the knee.
Case Develop a clinical differential diagnosis. Which diagnosis do you favor and why? Case Organ Set Case, Organ Set Compare and contrast the gross morphologic in the normal heart in and the diseased heart in. 2
Case, Organ Set Compare and contrast the microscopic findings in the normal heart in and the diseased heart in (H&E Low power). From which part of heart gross specimen was this section taken? What are the arrows indicating? Case, Organ Set Compare and contrast the microscopic findings in the normal heart in and the pathology in (H&E Higher power). What are, 2 and 3 Labeling? 2 3 Case, Organ Set Correlate the clinical findings with the pathologic findings. What is the underlying cause of the pathologic changes? 3
Case Organ Set 2 Case, Organ Set 2 Identify the organ and key anatomic components. Compare and contrast the normal organ in and the pathology in. Weight: 500 gm Weight: 800 gm Case, Organ Set 2 Describe the normal histology of the lung. e sure to explain what labels D are highlighting. C H&E Medium Power C D H&E Low Power 4
Case, Organ Set 2 Describe the normal histology of the lung. e sure to explain what labels C,D and * are highlighting. D C D * * C D C H&E High Power Case, Organ Set 2 diseased lung Describe the histologic findings. e sure to explain what is highlighting. Compare to normal H&E Low Power H&E Low Power Case, Organ Set 2 Describe the histologic findings. e sure to explain what C are highlighting. C H&E High Power 5
Case, Organ Set 2 Describe the gross image. Describe the histologic findings in. What does the pink material in the alveoli represent? H&E Medium Power Case, Organ Set 2 Diagnosis? Correlate the gross and histologic findings of the lung with the clinical findings. Case Organ Set 3 6
Case, Organ Set 3 Identify the organ and key anatomic components. Compare and contrast the normal organ in and the pathology in. Case, Organ Set 3 Compare and contrast the normal liver histology in and the pathology in on H&E Low Power. e sure to identify and describe what and 2 are highlighting. 2 2 Case, Organ Set 3 Compare and contrast the normal liver histology in and the pathology in on H&E High Power. e sure to identify and describe what and * are highlighting. * * * * * 7
Case, Organ Set 3 Diagnosis? Correlate the clinical findings with the morphologic findings. What are potential long term complications of this process in this organ? 43 year old woman develops progressive shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and lower extremity edema. On physical exam jugular venous pulse is elevated. On cardiac exam the apical impulse is in the 5th intercostal space, lateral to the left midclavicular line. There is a II/VI holosystolic murmur at the apex which radiates to the axilla. S3 is heard at the apex. On lung auscultation there are bilateralcrackles over 2/3 of the lower lung fields. There is dullness to percussion. There is mild tender hepatomegaly. Her feet and legs are edematous to above the knee. Her symptoms progressed despite maximal medical therapy and she undergoes heart transplantation. 8
Pre Transplant Chest X ray Comment on the heart size. What is the arrow indicating? Compare and contrast the normal echocardiogram in with the Patient s pre transplant echocardiogram in. What is your clinical diagnosis based on the history, physical and imaging findings? 9
Compare and contrast the normal gross findings in and the pathology in. Weight: 300 gm Weight: 650 gm Compare and contrast the normal gross findings in and the pathology in. Compare and contrast the normal histologic findings in and the pathology in. 0
What is your pathologic diagnosis? List possible etiologies for this condition. dditional history: this patient s symptoms began shortly after delivering her third child. What etiology do you now favor? Correlate the clinical findings with the pathology. What is the likely cause of the murmur? Case 3
Case 3 78 year old man presents with sudden onset of low mid back pain. His past history is significant for coronary artery disease and coronary artery bypass surgery. He has a 60 pack year smoking history. On examination, a pulsatile mass can be felt in the lower abdomen. On auscultation of the mass a bruit is appreciated. Case 3 Compare and contrast the normal gross findings in the schematic and the pathology in gross specimen. Case 3 Different patient. Compare and contrast the normal gross findings in and the pathology in. 2
Case 3 What is your diagnosis? Correlate the clinical findings with the pathology. Case 3 What are the potential complications of this disease process? What is the arrow pointing to in CT scan? What is CT scan depicting? Case 4 54 year old man with a history of hypertension presents with 0/0 tearing chest pain radiating to his back. The pain subsequently radiated down his abdomen. 3
Case 4 Develop a differential diagnosis for the cause of the pain. Case 4 Findings at autopsy lungs kidneys C = intimal surface of the abdominal aorta Case 4 What is your diagnosis? Correlate the clinical findings with the pathology. 4
Case 4 Compare and contrast aortic aneurysm and aortic dissection ortic neurysm ortic Dissection Clinical Symptoms Gross Finding Predisposing Factor Sites Involved Patient Population 5