GPR: 2021 - Week 06

From MGH Learn Pathology

Clinical history

55-year-old man with PMHx of alcoholism, smoking, and diabetes. He presented with 3-4 weeks of shortness of breath and lower extremity edema.


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Infective endocarditis
  • Vegetations are fleshy, soft, clot-like, and friable
  • Can have valve abscess and rupture
  • Complications: septic emboli and infarcts (brain, spleen, kidneys, liver), mycotic (pseudo) aneurysms, post-infectious glomerulonephritis
  • Causative organisms: Staphylococcus aureus (31%), Viridans streptococci (17%)
  • Risk factors: intravenous drug abuse, indwelling catheter, hemodialysis, dental procedure
 

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Calcific degeneration

  • Nodular calcifications located near base of cusps
  • Leaflet thickening, fibrosis, and retraction
  • Obstruction to cardiac outflow (aortic stenosis)
  • Degenerative process
  • Risk factors: older age, congenital abnormality (bicuspid valve), hypertension, elevated serum low-density lipoprotein, renal dysfunction, abnormalities in calcium/phosphate metabolism
 

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Myxomatous degeneration of aortic valve

  • No masses or vegetations
  • Valve leaflets appear gelatinous
  • Disruption of valve fibrosa and replacement by acid mucopolysaccharides and cystic change
  • Most frequently affects mitral valve (69%); aortic valve involvement in 34%; tricuspid valve involvement in 5%
  • Risk factors: older age, hypertension, coronary artery disease
 


  • Baris Boyraz
  • Chris Mount

This week's Gross Pathology Roundup was presented by Lisa Yuen MD, PhD on 2021-02-08.