Pulmonary embolism

From Libre Pathology
Jump to navigation Jump to search

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 - gross thrombus (pathguy.com),
thrombus (thrombosisadviser.com)
coronary thrombus (luc.edu)[4]
Image - micro. pre- & post-mortem (elsevier.es)[5] thrombus (oxfordjournals.org), thrombi (ucsf.edu)

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.
  4. URL: http://www.meddean.luc.edu/lumen/meded/mech/cases/case1/list.htm. Accessed on 8 October 2010.
  5. URL: http://www.elsevier.es/cardio_eng/ctl_servlet?_f=40&ident=13142654. Accessed on: 8 October 2010.