A 35-year-old man with a 15 pack-year smoking history presents with severe claudication of the right foot, Raynaud phenomenon, and superficial thrombophlebitis. Pedal pulses are absent. He has no diabetes, hypertension, or dyslipidemia. Angiography shows segmental occlusive lesions in small and medium vessels of the extremities with corkscrew collaterals. Which pathological finding is most characteristic of his condition?

• A Foam cell-rich atheromatous plaques with a necrotic lipid core
• B Inflammatory thrombus with preserved internal elastic lamina and intact vessel wall architecture ✓
• C Acute neutrophilic infiltration of the vasa vasorum with fibrinoid necrosis
• D Granulomatous panarteritis with multinucleated giant cells and adventitial fibrosis

Explanation

This is thromboangiitis obliterans (Buerger disease), a non-atherosclerotic segmental inflammatory occlusive disease of small and medium arteries and veins strongly linked to heavy tobacco use. The key pathological feature is a highly cellular acute inflammatory thrombus with microabscesses, while the internal elastic lamina and overall vessel wall architecture remain intact, unlike atherosclerosis where the wall is destroyed. Corkscrew collaterals are a characteristic angiographic finding. Option A describes atherosclerosis. Option B is correct.

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.