Embolism Flashcards
What is an embolism?
An intravascular mass that travels and occludes downstream vessels
Where do 95% of emboli come from?
Thrombi
What characterizes an atherosclerotic embolus?
Characterized by atherosclerotic plaques/cholesterol clefts in embolus
What events are frequently associated with fat emboli?
Trauma to bones (particularly long bones) and soft tissue trauma
What condition is frequently caused by fat emboli?
Dyspnea and petechiae on the skin covering the chest.
Describe decompression sickness
Divers who ascend to quickly precipitate nitrogen gas out of their blood. Air bubbles form and can cause joint/muscle pain (bends) or respiratory Syx (chokes).
Explain how amniotic fluid can result in maternal embolism. How is an amniotic embolus classified histologically?
Amniotic fluid during birth enters maternal circulation causing SOB, neuro Syx and DIC (amniotic fluid is thrombogenic). Amniotic emboli contain squamous cells and keratin debris from the fetal skin.
What is the likely cause of pulmonary embolism?
Thromboembolus from DVT of the lower extremity, normally femoral, iliac, or popliteal veins.
Why are PE normally clinically silent?
Lung has dual blood supply via pulmonary and bronchial arteries and emboli are normally small and self-resolving
What two conditions favor pulmonary infarction?
Obstruction of medium/large artery of a person with pre-existing cardiopulmonary compromise.
Clinical presentation of PE
SOB, hemoptysis, pleuritic chest pain, pleural effusion
Laboratory and test results
V/Q mismatch: abnormal Q, Spiral CT: vascular filling defect in lung, lower extremity Doppler US to find DVT, D-dimer elevation (due to lysing of PE and DVT), gross examination: wedge-shaped infarct
With what kind of pulmonay embolus does sudden death occur?
Large saddle embolus that blocks left and right pulmonary arteries or with significant occlusion of large pulmonary artery. Death due to electrochemical dissociation
What condition may arise from chronic emboli that are reorganized over time?
Pulmonary hypertension
Where do systemic emboli generally originate and where do they most commonly end up?
Left heart from thromboembolus and ends up most commonly in lower extremities
