Difference between revisions of "Pulmonary embolism"

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Notes:
Notes:
*Post-mortem thrombi: one (superior) yellow portion (called "chicken fat") and one (dependent) red portion (RBCs); components layer due to gravity.
*Post-mortem thrombi: one (superior) yellow portion (called "chicken fat") and one (dependent) red portion (RBCs); components layer due to gravity.
===Pre- and post-mortem clots===
{| class="wikitable"
|'''Feature/time'''
|'''Pre-mortem'''
|'''Post-mortem'''
|-
|Shininess
| dull
| shiny
|-
|Adherent to wall
| yes
| no
|-
|Colour
| grey
| dark purple ''or''<br> bilayered red/yellow
|-
|Pressurized
| yes; ejects <br>itself
| no; needs to <br>be pulled-out
|-
|Image
| [http://eurheartj.oxfordjournals.org/content/early/2010/01/12/eurheartj.ehp557/F3.expansion.html micro]
| ?
|}


==Microscopic (VTE)==
==Microscopic (VTE)==

Revision as of 20:29, 8 October 2010

Pulmonary embolism, abbreviated PE, is often on the differential in autopsies, as it is not easy to diagnose clinically. Pulmonary embolism is a non-specific term; it may refer to a number of things, including:

  • Pulmonary venous thromboembolism.
  • Pulmonary fat embolism.
  • Pulmonary foreign body embolism.
  • Pulmonary septic embolism.

PE usually refers to pulmonary venous thromboembolism, abbreviated VTE, if not otherwise specified.

Clinical

  • Shortness of breath (dyspnea) - classic symptom.
  • Tachycardia.
  • Chest pain.
  • Findings associated with deep vein thrombosis
    • Leg pain.
    • Leg swelling.

Notes:

  • Venous thrombosis OR~=12 for PE.[1]

Risks factors (VTE)

  • Trauma.
  • Immobility.
  • Pregnancy.
  • Medications (e.g. OCPs).
  • Hypercoagulable states (memory device CALMSHAPES):[2]
    • Protein C deficiency.
    • Antiphospholipid antibody syndrome (APLA).
    • Leiden factor V deficiency.
    • Malignancy.
    • Protein S deficiency.
    • Homocystinemia.
    • Antithrombin deficiency.
    • Prothrombin G20210A.
    • Excess factor VIII.
    • Sticky platelet syndrome.

Gross (VTE)

Features:

  • Intravascular spagetti with cream sauce.
  • Leg swelling.
  • Lines of Zahn.[3]
    • Pale layers consisting of platelets and fibrin alternating with layers of RBCs; components layer during blood flow.

Notes:

  • Post-mortem thrombi: one (superior) yellow portion (called "chicken fat") and one (dependent) red portion (RBCs); components layer due to gravity.

Pre- and post-mortem clots

Feature/time Pre-mortem Post-mortem
Shininess dull shiny
Adherent to wall yes no
Colour grey dark purple or
bilayered red/yellow
Pressurized yes; ejects
itself
no; needs to
be pulled-out
Image micro ?

Microscopic (VTE)

Features:

  • Layers consisting of platelets and fibrin alternating with layers of RBCs; Lines of Zahn.[3]

Images:

See also

References

  1. Reissig A, Haase U, Schulze E, Lehmann T, Kroegel C (July 2010). "[Diagnosis and therapy of pulmonary embolism prior to death]" (in German). Dtsch. Med. Wochenschr. 135 (30): 1477–83. doi:10.1055/s-0030-1262435. PMID 20648405.
  2. URL: http://archinte.highwire.org/cgi/content/full/161/20/2433. Accessed on: 15 September 2010.
  3. 3.0 3.1 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.