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Acute cellular rejection
Diagrams / tables

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Forms of cardiac rejection

Cardiac allograft dysfunction workup

Radiology images

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T2 cardiac MRI

Hyperenhancement on cardiac MRI

Doppler echocardiography

Doppler strain

Microscopic (histologic) images

Contributed by Carolyn Glass, M.D., Ph.D.

ISHLT 0R

ISHLT 1R

ISHLT 2R

ISHLT 3R


Amyloidosis
Radiology images

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Biopsy Proved ATTR cardiac amyloidosis with positive uptake

Biopsy proved ATTR cardiac amyloidosis with positive uptake

Microscopic (histologic) images

Contributed by Jaishree Jagirdar, M.D.
Amyloid deposition in myocardium Amyloid deposition in myocardium

Amyloid deposition in myocardium

Trichrome stain

Trichrome stain

Crystal violet stain

Crystal violet stain


Congo red stain Congo red stain

Congo red stain

Congo red stain

Congo red stain

Electron microscopy images

Contributed by Bradley Farris, M.D.
Amyloid deposition with beta pleated sheets Amyloid deposition with beta pleated sheets

Amyloid deposition with beta pleated sheets


Anomalous coronary artery
Diagrams / tables

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Classification of coronary anomalies

Clinical images

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MRI during cardiac systole and end diastole

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Coronary arteries with 3D reconstructions


Aortic aneurysms
Radiology images

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Chest radiograph

Chest radiograph

Ultrasound Ultrasound

Ultrasound

Computed tomography

Computed tomography

Angiography

Angiography


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50 mm round mass with calcification

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Coronary angiogram

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After CABG

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Distal left main aneurysm

Clinical images

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Descending artery aneurysm

Gross images

Contributed by Carla Dominguez Gonzalez, B.S.
Autopsy findings

Autopsy findings



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Right coronary artery

Microscopic (histologic) images

Contributed by Carla Dominguez Gonzalez, B.S.
Abdominal aortic aneurysm with rupture

Abdominal aortic aneurysm with rupture

Thoracic Aortic Aneurysm

Thoracic aortic aneurysm

Severe medial atrophy

Severe medial atrophy

Elastic lamellar disruption

Elastic lamellar disruption

Adventitia inflammation and lipid deposition

Adventitia inflammation and lipid deposition

Alcian blue staining - MEMA

Alcian blue staining - MEMA


Arrhythmogenic right ventricular cardiomyopathy
Clinical images

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Increase of transverse cardiac diameter

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Enlargement of right ventricle and atrium

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Cardiac echocardiogram

Gross images

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Severe dilation of RV

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RV dilatation

Microscopic (histologic) images

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Early fibrosis and adipocytes infiltration


Atherosclerotic coronary artery disease
Radiology images

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Coronary angiogram

Intravascular ultrasound

Multidetector computed tomography

Gross images

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Coronary artery atherosclerosis

Aorta involved by
atherosclerosis

Microscopic (histologic) images

Contributed by Robert F. Corliss, M.D. and Jefree J. Schulte, M.D.
Coronary artery plaque

Coronary artery plaque

Coronary artery thrombus

Coronary artery thrombus

Coronary artery recanalized thrombus

Coronary artery recanalized thrombus

Coronary plaque with early thrombus

Coronary plaque with early thrombus


Lipid rich plaque

Lipid rich plaque

Foam cells

Foam cells

Cholesterol clefts


Cardiac fibroma
Radiology images

Contributed by Stephen P. Sanders, M.D.
MRI (cine SSFP)

MRI (cine SSFP)

MRI (LGE technique)

MRI (LGE technique)

Gross images

Contributed by Chrystalle Katte Carreon, M.D. and AFIP
Macroscopic features

Macroscopic features

Cut surface features

Cut surface features

Large septal mass Large septal mass

Large septal mass

Homogeneous mass

Homogeneous mass

Large circumscribed mass

Large circumscribed mass

Microscopic (histologic) images

Contributed by Chrystalle Katte Carreon, M.D.
Abundant collagen

Abundant collagen

Immature appearance

Immature appearance

Entrapped myocardium

Entrapped myocardium

Dystrophic calcifications

Dystrophic calcifications


Lack of tumor capsule

Lack of tumor capsule

Entrapped myocardium (desmin)

Entrapped myocardium (desmin)

Abundant elastic fibers

Abundant elastic fibers


AFIP images
Cellular lesion in infant

Cellular lesion in infant

Collagen deposition

Collagen deposition

Central fibroma cells

Central fibroma cells

Calcification

Calcification


Infiltrative margin

Infiltrative margin

Trichrome

Trichrome

Von Gieson elastin

Von Gieson elastin


Cardiac myxoma
Radiology images

Contributed by Giuseppe Vergaro, M.D., Ph.D. and Vladyslav Chubuchnyi, M.D.
Left atrial myxoma

2D echocardiography

Left atrial myxoma

Cardiac magnetic resonance

Gross images

Contributed by Angela Pucci, M.D., Ph.D. and Giovanni Bartoloni, M.D.
Polypoid

Polypoid

Hemorrhage

Hemorrhage

Villous morphology

Villous morphology

Soft and friable projections

Soft and friable projections

Chalky aspect

Chalky aspect

Microscopic (histologic) images

Contributed by Angela Pucci, M.D., Ph.D. and @DrTravisBrown on Twitter
Left atrial myxoma

Left atrial myxoma

Myxoma cell nest

Myxoma cell nest

Myxoma cells in cord structure or isolated

Myxoma cells in cord structure or isolated

Myxoma cells around blood vessel

Myxoma cells around blood vessel

Gandy-Gamna bodies

Gandy-Gamna bodies

Perls staining

Gandy-Gamna bodies (Perls staining)


Inflammatory infiltrates

Inflammatory infiltrates

Hemorrhage

Hemorrhage

Glands in cardiac myxoma

Glands in cardiac myxoma

Calretinin

Calretinin

CD31+ vessels

CD31+ vessels

S100 immunoreactivity

S100 immunoreactivity


αSMA+

αSMA+

CK+ gland in cardiac myxoma

CK+ gland in cardiac myxoma

Cardiac myxoma Cardiac myxoma Cardiac myxoma Cardiac myxoma

Cardiac myxoma

Electron microscopy images

Contributed by Angela Pucci, M.D., Ph.D. and Giovanni Bartoloni, M.D.
Myxoma cell

Myxoma cell


Chambers
Gross images

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Trisomy 13

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ADS and VSD


Chronic allograft vasculopathy
Diagrams / tables

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Arteriographic classification

Radiology images

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Coronary angiography

CT angiography

Intravascular ultrasound

Coronary angiography

Optical coherence tomography

Gross images

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Coronary artery hyperplasia

Microscopic (histologic) images

Contributed by Carolyn Glass, M.D., Ph.D.

Explant, concentric intimal hyperplasia

Explant, diffuse intimal hyperplasia

Explant, coronary artery stenosis

Explant, coronary artery occlusion


Conduction tissue
Diagrams / tables

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Purkinje network

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Compact atrioventricular node

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Conduction system

Microscopic (histologic) images

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Sinoatrial (SA) node

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Sinus node fibrosis


Connective tissue diseases
Diagrams / tables

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Rheumatic diseases and sites of involvement

Microscopic (histologic) images

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Various images


Coronary vessels
Diagrams / tables

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Anterior circulation

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Posterior circulation

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Coronary arteries

Microscopic (histologic) images

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Venule

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Various images

Electron microscopy images

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Small arteriole


Cystic tumor of the atrioventricular node
Radiology images

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MRI of the thorax showing tumor

Gross images

AFIP images
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Tumor outlined by
arrowheads (RA-right
atrium, RV-right ventricle,
TV-tricuspid valve)
Microscopic (histologic) images

AFIP images
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Normal anatomy (no tumor) with
IAS-interatrial septum (tumors are
located inferiorly), TV-tricuspid
valve and VS-ventricular septum
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Large cysts
filled with
proteinaceous
debris
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Multiple small cysts not visible to naked eye

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Cysts with irregular shape surrounded by fibrous stroma

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Cyst may have two
cell lining, with inner
lining composed of
small cuboidal cells

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Tumor nests and
cysts replace muscle
bundles in inferior
interatrial septum
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Cuboidal cells and clear, sebaceous-type cells

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Squamous differentiation and calcification of luminal debris

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Nests of cells resembling urothelium



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H&E and AE1/AE3+

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Cyst wall showing the large
cyst lining of simple
cuboidal epithelium

Degenerative valve disease
Diagrams / tables

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Pathophysiology of degeneration of valves Pathophysiology of degeneration of valves

Pathophysiology of degeneration of valves

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Potential pathways

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MVP subtypes

Gross images

Contributed by Aliya N. Husain, M.D.
Mitral valve

Mitral valve



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Minimally diseased
aortic valve (left) and
severely stenotic
aortic valve (right)

Microscopic (histologic) images

Contributed by Aliya N. Husain, M.D.
Mitral valve

Mitral valve

Aortic valve calcification

Aortic valve calcification

Mitral valve Mitral valve

Mitral valve


Drug induced valvular heart disease
Diagrams / tables

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5HT signaling pathways

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Heart chambers, valves, and valvular histology

Microscopic (histologic) images

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Mitral valve leaflets, Movat pentachrome stain


Embryology
Diagrams / tables

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Development of heart

Videos


Fibromuscular dysplasia
Clinical images

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Medial fibroplasia

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Intimal fibroplasia

Microscopic (histologic) images

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Medial fibroplasia


Giant cell arteritis
Microscopic (histologic) images

Contributed by Mark R. Wick, M.D.

Various images

Elastic stain



AFIP images

Intramammary arterial lumen
is mostly obliterated by
subintimal and mural inflammation,
including giant cells (arrows)

Transmural necrotizing inflammation
of medium sized mammary vessels,
with elastic stain showing partial
destruction of elastic layer


Histology
Gross images

Normal cardiac specimen


Contributed by Melanie C. Bois, M.D.
Heart, anterior view

Heart, anterior view

Heart, short axis section

Heart, short axis section

Microscopic (histologic) images

Contributed by Melanie C. Bois, M.D.
Heart, microscopy

Heart, microscopy

Cardiomyocytes

Cardiomyocytes


Hypertrophic cardiomyopathy
Gross images

Contributed by Saranya Singaravel, M.B.B.S.

Transverse section

Microscopic (histologic) images

Contributed by Saranya Singaravel, M.B.B.S.

Myocardial hypertrophy and disarray

Hypertrophied cardiomyocyte with a whorled apperance


Idiopathic restrictive cardiomyopathy
Radiology images

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Echocardiographic morphological
features typical of idiopathic RCM

Gross images

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Left: gross speci-
men demonstrating
prominent biatrial
enlargement
Microscopic (histologic) images

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Right: light
microscopy
showing marked
interstitial fibrosis

Infective endocarditis
Diagrams / tables

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Duke criteria for diagnosis

Clinical images

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Osler nodes on a finger and foot

Gross images

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Large vegetation on atrial aspect of valve

Microscopic (histologic) images

Contributed by R. Amita, M.D.
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Mycotic aneurysm

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Dense inflammation and fibrinoid necrosis

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Valve destruction with necrosis, bacterial clump



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H&E, gram stain


Infective myocarditis
Radiology images

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MRI: acute myocarditis

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Increased T2-weighted signal intensity

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Echocardiograms

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Gadlinium-enhanced cardiac MRI

Diagrams / tables

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Pathophysiological process of viral myocarditis

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Algorithm for diagnosis in suspected myocarditis

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Treatment algorithm based on EMB findings

Microscopic (histologic) images

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Endomyocardial biopsy

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Acute and chronic myocarditis


Lambl excrescence
Clinical images

Contributed by Pallavi Khattar, M.D., Puneet Bedi, M.D. and John T. Fallon, M.D., Ph.D.

Papillary giant fibroelastoma of aortic valve

Microscopic (histologic) images

Contributed by Pallavi Khattar, M.D., Puneet Bedi, M.D. and John T. Fallon, M.D., Ph.D.

H&E

CD34

Elastin stain

S100



AFIP images

Finger-like projection
extending from valve
surface without branching



Nonatherosclerotic coronary artery disease
Clinical images

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Coronary artery aneurysm

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Small aneurysm

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Small aneurysm in thyrocervical trunk

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Multiple aneurysmal changes


Noninfective endocarditis
Diagrams / tables

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Differences between NBTE and infective endocarditis

Clinical images

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Mitral valve with masses

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Mitral valve with mass

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Enlarging mitral valve mass

Gross images

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Typical finding

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Typical appearances

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Large NBTE vegetations

Microscopic (histologic) images

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Uniform eosinophilic appearance


Noninfective myocarditis
Diagrams / tables

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Etiology of Myocarditis

Radiology images

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Transthoracic cardiac echocardiograms

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MRI, TIRM

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Pericardial effusion of 1.2 cm

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MRI, IR, FLASH


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Subendocardial delayed enhancement

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Increased septal wall thickness

Microscopic (histologic) images

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Acute myocarditis with lymphocytic infiltration

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Endomyocardial biopsy

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Eosinophilic infiltration

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Necrotizing eosinophilic myocarditis

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Eosinophilic myocarditis


Noninfective pericarditis
Microscopic (histologic) images

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No granulomatous inflammation


Papillary fibroelastoma
Radiology images

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Echocardiography

Echocardiography

Echocardiography and magnetic resonance imaging

Echocardiography and MRI

Clinical images

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Tricuspid valve

Tricuspid valve

Gross images

Contributed by Melanie C. Bois, M.D.
Surgical excision

Surgical excision

In nonaqueous medium

In nonaqueous medium


AFIP images
Tumor in noncoronary sinus

Tumor in noncoronary sinus



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Multiple small fronds resembling a sea anemone

Multiple small fronds resembling a sea anemone

Causing sudden death due to occlusion of right coronary ostium

Causing sudden
death due to
occlusion of right
coronary ostium
Microscopic (histologic) images

Contributed by Melanie C. Bois, M.D.
Arborizing fronds

Arborizing fronds

Avascular cores

Avascular cores


AFIP images
Arising from aortic valve cusp

Arising from aortic valve cusp

Movat pentachrome stain

Movat pentachrome stain

Avascular tumor fronds growing into a cardiac chamber

Avascular tumor fronds growing into a cardiac chamber

Architecture obscured by scarring

Architecture obscured by scarring

Videos

Resection of large aortic valve papillary fibroelastoma


Primary and secondary dilated cardiomyopathy
Gross images

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Ventricles dilated more than atria

Microscopic (histologic) images

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Cardiomyocyte multinucleation

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Adenomatous hyperplasia


Prosthetic valves
Radiology images

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Starr-Edwards mechanical valve

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Bjork-Shiley concavo-convex valve

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St Jude Medical bileaflet prosthesis

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Prosthetic aortic valve

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Aortic prosthetic valve before & after IV heparin

Diagrams / tables

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Prosthetic cardiovascular devices

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AHA/ACC recommendations

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Gross examination of prosthetic heart devices

Gross images

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Mitral valve prosthesis
shows significant pannus
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Mechanical mitral valve prosthesis

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Synthetic chordae tendinae

Microscopic (histologic) images

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Valve sewing cuff, atrial
endocardium, native
mitral leaflet tissue
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Synthetic chorda surrounded by tissue fibrosis

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Segment of coronary artery


Rhabdomyoma
Gross images

AFIP images
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Right ventricular mass

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Rhabdomyomatosis in patient
with tuberous sclerosis
and multiple minute tumors
studding epicardium


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Left ventricular tumor causing sudden death in children ages 1-2

Microscopic (histologic) images

AFIP images
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Spider cell (center)
and intracellular
myofilaments
(oil emersion)
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Muscle specific actin
highlights spider
cells and cross
striations (arrowheads)


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Drawings from 1938 report

Electron microscopy images

AFIP images
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Abundant glycogen, small and
sparse mitochondria, fragmented
irregular myofilaments with Z bands


Sarcoidosis
Radiology images

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Late gadolinium enhancement (LGE)

Gross images

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Myocardial infiltrates

Microscopic (histologic) images

Contributed by Carolyn Glass, M.D., Ph.D.

Cardiac biopsy


Syphilis
Clinical images

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Dilated aortic root and ascending aorta

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Enlarged aortic root

Microscopic (histologic) images

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Various images


Takotsubo cardiomyopathy
Radiology images

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Ventriculogram: characteristic ballooning patterns

Cardiac MRI with USPIOs

Electron microscopy images

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Interstitial widening in acute phase

Videos

Illustrated walkthrough of the essential features of Takotsubo cardiomyopathy

Ventricular angiography video showing the 4 main subtypes of Takotsubo cardiomyopathy


Valves
Diagrams / tables

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Fibrous skeleton of heart

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Aortic root structures

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Mitral valve annulus

Gross images

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The four heart valves

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Tricuspid valve

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Isolated tricuspid valve

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Pulmonary valve

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Mitral valve and aortic root


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Mitral leaflets

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Mirtal valve apparatus

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Mitral valve
commissural
chordae tendinae

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Aortic value, right coronary leaflet

Microscopic (histologic) images

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Tricuspid valve

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Annulus of the pulmonary root

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Section through the pulmonary root


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Posterior mitral leaflet

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Section through aortic root

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IHC of aortic valves

Electron microscopy images

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Annulus tissue

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Commissure tissue

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Arrangement of collagenous fibrils

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Recent Heart & vascular pathology Pathology books

Ashworth: 2019

Buja: 2015

Burke: 2015

Husain: 2021

IARC: 2015

Leone: 2017

Lucena: 2015

Miller: 2023

Thiene: 2016



Find related Pathology books: cardiovascular, forensic, lung, mediastinum/serosa, pediatric
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