Difference between revisions of "Pulmonary embolism"

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*Pulmonary foreign body embolism.
*Pulmonary foreign body embolism.
*Pulmonary septic embolism.
*Pulmonary septic embolism.
*Pulmonary bone marrow embolism.


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

Revision as of 04:27, 2 December 2011

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.
  • Pulmonary bone marrow 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 CALM SHAPES):[2]
    • Protein C deficiency.
    • Antiphospholipid antibody syndrome (APLA).
    • Leiden factor V deficiency.
    • Malignancy.
    • Protein S deficiency.
    • Homocystinemia.
    • Antithrombin III deficiency.
    • Prothrombin G20210A.[3]
    • Excess factor VIII.
    • Sticky platelet syndrome.

Gross (VTE)

Features:

  • Intravascular spaghetti (multiple cylindrical clots - from smaller vessels) with cream sauce (gray fibrin).
  • Leg swelling.
  • Lines of Zahn.[4]
    • 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 gray dark purple or
bilayered red/yellow
Pressurized yes; "ejects itself" from lumen no; needs to be pulled-out
Consistency
-elastic modulus (E)
-fracture toughness (K)
firm (high E)
brittle (low K)
jello (low E)
elastic (high K)
Image - gross thrombus (pathguy.com),
thrombus (thrombosisadviser.com)
coronary thrombus (luc.edu)[5]
Image - micro. pre- & post-mortem (elsevier.es)[6] thrombus (oxfordjournals.org),
thrombi (ucsf.edu)

Microscopic (VTE)

Features:

  • Layers consisting of platelets and fibrin alternating with layers of RBCs; Lines of Zahn.[4]

Images:

Microscopic (fat embolism)

Features:

  • Fat in vessels.

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. Thomas RH (November 2001). "Hypercoagulability syndromes". Arch. Intern. Med. 161 (20): 2433–9. PMID 11700155. http://archinte.highwire.org/cgi/content/full/161/20/2433.
  3. Online 'Mendelian Inheritance in Man' (OMIM) 176930
  4. 4.0 4.1 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.
  5. URL: http://www.meddean.luc.edu/lumen/meded/mech/cases/case1/list.htm. Accessed on 8 October 2010.
  6. URL: http://www.elsevier.es/cardio_eng/ctl_servlet?_f=40&ident=13142654. Accessed on: 8 October 2010.
  7. URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html. Accessed on: 6 December 2010.