Difference between revisions of "Vascular thrombus"

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#redirect [[Ditzels#Vascular_thrombus]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Laminations_in_a_thrombus_-_high_mag.jpg
| Width      =
| Caption    = Thrombus with laminations. [[H&E stain]]. (WC/Nephron)
| Synonyms  =
| Micro      = layers consisting of platelets and fibrin - classically alternating with layers of RBCs (known as ''lines of Zahn'')
| Subtypes  =
| LMDDx      = tumour embolus, thromboembolus, fat embolism, amniotic fluid embolus, stasis (post-mortem)
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Staging    =
| Site      = [[blood vessels]]
| Assdx      = atrial fibrillation, hypercoagulable states (e.g. cancer)
| Syndromes  =
| Clinicalhx =
| Signs      = dependent on severity and location
| Symptoms  =
| Prevalence =
| Bloodwork  = D-dimer +ve
| Rads      =
| Endoscopy  =
| Prognosis  = dependent on severity, location and underlying cause (if present)
| Other      =
| ClinDDx    =
| Tx        = clot buster, thrombectomy, anticoagulants
}}
'''Vascular thrombus''' is an uncommon [[pathology]] specimen that may be from an artery or vein.
 
''Venous thrombus'' and ''arterial thrombus'' redirect here.  ''Pulmonary embolism'' is dealt with separately in the [[pulmonary embolism]] article.
==General==
*Uncommonly comes to [[pathology]].
 
Risk factors - think [[Virchow's triad]]:
*Stasis, e.g. atrial fibrillation.
*Hypercoagulable states, e.g. cancer - see ''[[risks factors venous thromboembolism]]''.
*Endothelial injury.
 
Clinical:
*D-dimer elevated.<ref name=pmid23784703>{{Cite journal  | last1 = Kleinegris | first1 = MC. | last2 = ten Cate | first2 = H. | last3 = ten Cate-Hoek | first3 = AJ. | title = D-dimer as a marker for cardiovascular and arterial thrombotic events in patients with peripheral arterial disease. A systematic review. | journal = Thromb Haemost | volume = 110 | issue = 2 | pages = 233-43 | month = Aug | year = 2013 | doi = 10.1160/TH13-01-0032 | PMID = 23784703 }}</ref>
==Gross==
: See ''[[pulmonary embolism]]''.
Features:
*Dull appearance.
*Laminations.
 
==Microscopic==
Features:
*Layers consisting of platelets and fibrin.
**Classically alternating with layers of RBCs - known as ''Lines of Zahn''.<ref name=Ref_PBoD8_124>{{Ref PBoD8|124}}</ref>
 
Note:
*Multiple laminations (layers), in general, suggest that clot was formed in a dynamic environment, i.e. in the context of blood flow.
 
DDx:
*Tumour embolus - malignant cells.
*Thromboembolus - may require [[clinical history]].
*[[Fat embolism]].
*Amniotic fluid embolus - in the context of pregnancy/postpartum.
*Foreign body.
 
===Images===
<gallery>
Image:Laminations_in_a_thrombus_-_low_mag.jpg | Laminated thrombus - low mag. (WC)
Image:Laminations_in_a_thrombus_-_high_mag.jpg | Laminated thrombus - high mag. (WC)
</gallery>
====www====
*[http://library.med.utah.edu/WebPath/ATHHTML/ATH031.html Lines of Zahn (utah.edu)].
*[http://pathhsw5m54.ucsf.edu/case9/image94.html Lines of Zahn (ucsf.edu)].
 
==Sign out==
<pre>
BLOOD CLOT, LEFT ILIAC ARTERY, THROMBECTOMY:
- THROMBUS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
BLOOD CLOT, LEFT ARM - BRACHIAL ARTERY, THROMBECTOMY/EMBOLECTOMY:
- THROMBUS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
===Micro===
The sections show layers of red blood cells alternating with fibrin and white blood cells (Lines of Zahn).
 
==See also==
*[[Cardiovascular pathology]].
*[[Ditzels]].
 
==References==
{{Reflist|1}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Ditzels]]
[[Category:Cardiovascular pathology]]

Latest revision as of 13:10, 6 April 2016

Vascular thrombus is an uncommon pathology specimen that may be from an artery or vein.

Vascular thrombus
Diagnosis in short

Thrombus with laminations. H&E stain. (WC/Nephron)
LM layers consisting of platelets and fibrin - classically alternating with layers of RBCs (known as lines of Zahn)
LM DDx tumour embolus, thromboembolus, fat embolism, amniotic fluid embolus, stasis (post-mortem)
Site blood vessels
Associated Dx atrial fibrillation, hypercoagulable states (e.g. cancer)
Signs dependent on severity and location
Blood work D-dimer +ve
Prognosis dependent on severity, location and underlying cause (if present)
Treatment clot buster, thrombectomy, anticoagulants

Venous thrombus and arterial thrombus redirect here. Pulmonary embolism is dealt with separately in the pulmonary embolism article.

General

Risk factors - think Virchow's triad:

Clinical:

  • D-dimer elevated.[1]

Gross

See pulmonary embolism.

Features:

  • Dull appearance.
  • Laminations.

Microscopic

Features:

  • Layers consisting of platelets and fibrin.
    • Classically alternating with layers of RBCs - known as Lines of Zahn.[2]

Note:

  • Multiple laminations (layers), in general, suggest that clot was formed in a dynamic environment, i.e. in the context of blood flow.

DDx:

  • Tumour embolus - malignant cells.
  • Thromboembolus - may require clinical history.
  • Fat embolism.
  • Amniotic fluid embolus - in the context of pregnancy/postpartum.
  • Foreign body.

Images

  • Laminated thrombus - low mag. (WC)

  • Laminated thrombus - high mag. (WC)

www

Sign out

BLOOD CLOT, LEFT ILIAC ARTERY, THROMBECTOMY:
- THROMBUS.
- NEGATIVE FOR MALIGNANCY.

BLOOD CLOT, LEFT ARM - BRACHIAL ARTERY, THROMBECTOMY/EMBOLECTOMY:
- THROMBUS.
- NEGATIVE FOR MALIGNANCY.

Micro

The sections show layers of red blood cells alternating with fibrin and white blood cells (Lines of Zahn).

See also

References

  1. ↑ Kleinegris, MC.; ten Cate, H.; ten Cate-Hoek, AJ. (Aug 2013). "D-dimer as a marker for cardiovascular and arterial thrombotic events in patients with peripheral arterial disease. A systematic review.". Thromb Haemost 110 (2): 233-43. doi:10.1160/TH13-01-0032. PMID 23784703.
  2. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 124. ISBN 978-1416031215.
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