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心脏横截面,箭头所指心室动脉瘤,位于非常薄的室壁上。血液在动脉瘤处淤滞,使得此处形成附壁血栓。

A cross section through the heart reveals a ventricular aneurysm with a very thin wall at the arrow. Note how the aneurysm bulges out. The stasis in this aneurysm allows mural thrombus, which is present here, to form within the aneurysm.

冠状动脉搭桥术采用自体静脉(隐静脉)。其中最粗的移植血管向下经过心脏的中心直到与冠脉的左前降支汇合,另一支位于冠脉旋支右方的移植血管呈“Y”形延伸。

This patient underwent coronary artery bypass grafting with autogenous vein (saphenous vein) grafts. The largest of these runs down the center of the heart to anastomose with the left anterior descending artery distally. Another graft extends in a "Y" fashion just to the right of this to branches of the circumflex artery. A white temporary pacing wire extends from the mid left surface.

主动脉瓣以上7厘米处有一破裂(箭头所指),主动脉管近端显示明显的动脉粥样硬化。

There is a tear (arrow) located 7 cm above the aortic valve and proximal to the great vessels in this aorta with marked atherosclerosis. This is an aortic dissection.

镜下见主动脉的破裂(箭头所指)贯穿整个中膜,而且可见中膜血液渗出(星号所指)。

Microscopically, the tear (arrow) in this aorta extends through the media, but blood also dissects along the media (asterisk).

血液渗出突破中膜时,主动脉剥离导致心包积血,大量出血致心包填塞。

An aortic dissection may lead to hemopericardium when blood dissects through the media proximally. Such a massive amount of hemorrhage can lead to cardiac tamponade.

主动脉纵向剖开可以清楚地看到局部结构。剖面图的两端可见红褐色的血栓在主动脉内延伸。左边的内膜已经破裂,使得主动脉形成了一个“双管腔”。见重度动脉粥样硬化合并囊状中层坏死以及高血压,增加了剖开术的危险性。

This aorta has been opened longitudinally to reveal an area of fairly limited dissection that is organizing. The red-brown thrombus can be seen in on both sides of the section as it extends around the aorta. The intimal tear would have been at the left. This creates a "double lumen" to the aorta. This aorta shows severe atherosclerosis which, along with cystic medial necrosis and hypertension, is a risk factor for dissection.

图示破裂已达肌层。主动脉破裂是最严重且最紧急的,病人可能在极短的时间内死亡。血液可沿主动脉向上或向下剥离动脉。血液沿大血管附近向上剥离,可封闭颈总动脉;血液向下剥离,可封闭冠状动脉。

Here, the dissection went into the muscular wall. In any case, an aortic dissection is an extreme emergency and can lead to death in a matter of minutes. The blood can dissect up or down the aorta. Blood dissecting up around the great vessels can close off the carotids. Blood can dissect down to the coronaries and shut them off.

右颈动脉受到血液压迫,这些血液来自主动脉向上的破裂口,也可能来自冠状动脉的破裂口。主动脉剥离病人可能出现的症状有严重的胸痛(主动脉远端剥离)或中风(因颈动脉剥离)或心肌缺血(因冠状动脉剥离)。

The right carotid artery is compressed by blood dissecting upward from a tear with aortic dissection. Blood may also dissect to coronary arteries. Thus patients with aortic dissection may have symptoms of severe chest pain (for distal dissection) or may present with findings that suggest a stroke (with carotid dissection) or myocardial ischemia (with coronary dissection).

镜下主动脉切面中的红色血块表示缩小的主动脉夹层。由于主动脉剥离所致,主动脉剥离时,血液在压力下从内膜向外穿透肌层到达外膜。

This microscopic cross section of the aorta demonstrates a red blood clot that is compressing the aortic lumen. This occurred as a result of aortic dissection in which there was a tear in the intima followed by dissection of blood at high pressure out through the muscular wall to the adventitia. This blood dissecting out can lead to sudden death from hemothorax.

马凡综合征病人见主动脉根部上部发生剥离,主动脉向上撕裂。破裂发生后的很短时间内,心包积血和心包填塞接踵而来。

This aortic dissection occurred just above the aortic root in a patient with Marfan's syndrome. The tear extends across the aorta. Hemopericardium with tamponade occurred within minutes of this event.


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