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Difference between revisions of "Pulmonary embolism"
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*Pulmonary septic embolism. | *Pulmonary septic embolism. | ||
*Pulmonary bone marrow embolism. | *Pulmonary bone marrow embolism. | ||
*Pulmonary tumour embolism. | |||
*Pulmonary amniotic fluid 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. | ||
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===Clinical=== | ===Clinical=== | ||
*Shortness of breath (dyspnea) - classic symptom. | *Shortness of breath ([[dyspnea]]) - classic symptom. | ||
*Tachycardia. | *Tachycardia. | ||
*Chest pain. | *Chest pain. | ||
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Note: | Note: | ||
*The triad has a limited practical use. Like many questions about mechanism, the greatest utility, | *The triad has a limited practical use. Like many questions about mechanism, the greatest utility, might be pimping medical students and residents. | ||
===Risks factors | ===Risks factors venous thromboembolism=== | ||
A general mnemonic for hypercoagulable states ''PIANO'':<ref>URL: [http://www.usmle-forums.com/usmle-step-1-mnemonics/252-causes-hypercoagulable-states.html http://www.usmle-forums.com/usmle-step-1-mnemonics/252-causes-hypercoagulable-states.html]. Accessed on: 8 December 2011.</ref> | A general mnemonic for hypercoagulable states ''PIANO'':<ref>URL: [http://www.usmle-forums.com/usmle-step-1-mnemonics/252-causes-hypercoagulable-states.html http://www.usmle-forums.com/usmle-step-1-mnemonics/252-causes-hypercoagulable-states.html]. Accessed on: 8 December 2011.</ref> | ||
*'''P'''regnancy. | *[[pregnancy|'''P'''regnancy]]. | ||
*'''I'''mmobility. | *'''I'''mmobility. | ||
*'''A'''ccidental injury. | *'''A'''ccidental injury. | ||
*'''N'''ephrotic syndrome. | *[[Nephrotic syndrome|'''N'''ephrotic syndrome]]. | ||
*'''O'''ral contraceptive pills. | *[[Oral contraceptive pill|'''O'''ral contraceptive pills]]. | ||
Hypercoagulable states due to intrinsic causes (memory device ''CALM SHAPES''):<ref name=pmid11700155>{{cite journal |author=Thomas RH |title=Hypercoagulability syndromes |journal=Arch. Intern. Med. |volume=161 |issue=20 |pages=2433–9 |year=2001 |month=November |pmid=11700155 |doi= |url=http://archinte.highwire.org/cgi/content/full/161/20/2433}}</ref> | Hypercoagulable states due to intrinsic causes (memory device ''CALM SHAPES''):<ref name=pmid11700155>{{cite journal |author=Thomas RH |title=Hypercoagulability syndromes |journal=Arch. Intern. Med. |volume=161 |issue=20 |pages=2433–9 |year=2001 |month=November |pmid=11700155 |doi= |url=http://archinte.highwire.org/cgi/content/full/161/20/2433}}</ref> | ||
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==Microscopic (VTE)== | ==Microscopic (VTE)== | ||
Features: | Features: | ||
*Layers consisting of platelets and fibrin alternating with layers of RBCs | *Layers consisting of platelets and fibrin alternating with layers of RBCs - known as ''Lines of Zahn''.<ref name=Ref_PBoD8_124>{{Ref PBoD8|124}}</ref> | ||
Images | Note: | ||
*Multiple laminations (layers), in general, suggest that clot was formed in a dynamic environment, i.e. in the context of blood flow. | |||
===Images=== | |||
*www: | *www: | ||
**[http://library.med.utah.edu/WebPath/ATHHTML/ATH031.html Lines of Zahn (utah.edu)]. | **[http://library.med.utah.edu/WebPath/ATHHTML/ATH031.html Lines of Zahn (utah.edu)]. | ||
**[http://pathhsw5m54.ucsf.edu/case9/image94.html Lines of Zahn (ucsf.edu)]. | **[http://pathhsw5m54.ucsf.edu/case9/image94.html Lines of Zahn (ucsf.edu)]. | ||
<gallery> | |||
Image:Laminations_in_a_thrombus_-_low_mag.jpg | Laminated thrombus - low mag. (WC) | |||
Image:Laminations_in_a_thrombus_-_high_mag.jpg | Laminated thrombus - high mag. (WC) | |||
</gallery> | |||
==Microscopic (fat embolism)== | ==Microscopic (fat embolism)== | ||
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Images: | Images: | ||
*[http://library.med.utah.edu/WebPath/jpeg2/FOR001.jpg Fat embolism (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html]. Accessed on: 6 December 2010.</ref> | *[http://library.med.utah.edu/WebPath/jpeg2/FOR001.jpg Fat embolism (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/fofrm.html]. Accessed on: 6 December 2010.</ref> | ||
==Microscopic (amniotic fluid)== | |||
Features:<ref name=pmid13576364>{{Cite journal | last1 = ATTWOOD | first1 = HD. | title = The histological diagnosis of amniotic-fluid embolism. | journal = J Pathol Bacteriol | volume = 76 | issue = 1 | pages = 211-5 | month = Jul | year = 1958 | doi = | PMID = 13576364 }}</ref> | |||
*Pulmonary vessels with fetal debris - particularly squamous cells. | |||
Notes: | |||
*Can easily be missed.<ref name=pmid9104942>{{Cite journal | last1 = Kobayashi | first1 = H. | last2 = Ooi | first2 = H. | last3 = Hayakawa | first3 = H. | last4 = Arai | first4 = T. | last5 = Matsuda | first5 = Y. | last6 = Gotoh | first6 = K. | last7 = Tarao | first7 = T. | title = Histological diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc alpha 2-6GalNAc epitope. | journal = Hum Pathol | volume = 28 | issue = 4 | pages = 428-33 | month = Apr | year = 1997 | doi = | PMID = 9104942 }}</ref> | |||
*[[Alcian blue stain]] useful. (???) | |||
Images: | |||
<gallery> | |||
Image:Amniotic_fluid_embolism.jpg | Amniotic fluid embolism. (WC/Rosen) | |||
</gallery> | |||
==See also== | ==See also== | ||
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*[[Cholesterol embolism]]. | *[[Cholesterol embolism]]. | ||
*[[Cerebral fat embolism]]. | *[[Cerebral fat embolism]]. | ||
*[[Vascular thrombus]]. | |||
*[[Intimal sarcoma]]. | |||
==References== | ==References== | ||