Pulmonary embolism

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Pulmonary embolism is often on the differential in autopsies, as it is not easy to diagnose clinically.

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

  • 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

  • Intravascular spagetti with cream sauce.
  • Leg swelling.

Microscopic

Features:

  • Organized blood components (RBCs, WBCs) in layers with organization (fibrin); Lines of Zahn = layers of components

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.