Vascular thrombus
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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.
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.[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)
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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
- ↑ 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.
- ↑ 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.