Vascular thrombus

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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

Vascular thrombus is an uncommon pathology specimen that may be from an artery or vein.

Venous thrombus and arterial thrombus redirect here. Pulmonary embolism is dealt with separately in the pulmonary embolism article.

General

Risk factors - think Virchow's triad:

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

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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

  1. 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.
  2. 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.