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. 2020 Jul 12;7(1):e000532. doi: 10.1136/bmjresp-2019-000532

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© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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H&E (×200), various grades of histological changes (A–F). (A) Muscular artery with medial hypertrophy (increased number of smooth muscle nuclei arranged in parallel around the lumen). (B) Muscularisation of arterioles (thick muscle layer in arterial wall composed of numerous smooth muscle cells with closely spaced nuclei). (C) Intimal proliferation and fibrosis in addition to medial hypertrophy. (D) Concentric intimal fibrosis resulting in circumferential luminal narrowing. (E, F) Plexiform lesions; concentric intimal fibrosis causing near luminal obliteration and multiple small vascular spaces and expansion and partial destruction of the arterial wall with extension of the lesion into the perivascular connective tissue.