A 26-year-old man who smokes 20 cigarettes daily presents with rest pain and ulceration of the toes of both feet. Examination shows absent dorsalis pedis pulses but normal upper limb and femoral pulses. He gives a history of recurrent painful nodules along his lower limb veins. Angiography shows segmental occlusions of distal tibial and pedal arteries with corkscrew collaterals. Which histological finding would confirm the diagnosis?

• A Granulomatous inflammation with giant cells and fragmentation of the internal elastic lamina
• B Acute transmural inflammation of all three layers of a medium-sized artery with a organizing thrombus containing microabscesses ✓
• C Subendothelial IgA and C3 deposition in small vessels
• D Medial calcification without luminal narrowing

Explanation

This is thromboangiitis obliterans (Buerger disease): a young male heavy smoker with distal extremity ischemia, preserved proximal pulses, corkscrew collaterals, and migratory superficial thrombophlebitis. Histology shows an acute transmural inflammatory infiltrate involving arteries and veins with an organizing thrombus that characteristically contains microabscesses with neutrophils surrounded by granulomatous inflammation. Giant cell granulomatous arteritis suggests giant cell or Takayasu arteritis, which affect large elastic arteries, not distal digital vessels.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.