Embolism Flashcards
When staining a slide, you notice that there are cholesterol clefts on it. What could this be from?
Atheroscleotic embolus due to and atherosclerotic plaque that dislodged.
What is an embolism and what is the most common type?
Intra vascular mass that travels and occluded downstream vessels. Thromboembolus.
Which structures is a fat embolus associated with? How does it present on physical exam?
Associated with bone fractures particularly long bones and soft tissue trauma. Develops while fracture is still present or shortly after repair. Characterized by dyspnea (fat with bone marrow element is found at pulmonary vessel location) and petichiae on the chest.
When is gas embolus seen? What are its two presentations? What is the chronic form?
Seen in decompression sickness and laparoscopic surgery when air is pumped into abdomen. Nitrogen gas precipitates out of blood due to rapid ascent by divers. “Bends” involves joint and muscle pain while “chokes” involves respiratory symptoms. Chronic form is Caisson disease characterized by multifocal ischemic necrosis of bone.
When looking at a slide you see squamous cells and keratin debris. What type of embolus is it? How does it present?
Amniotic fluid embolus enters maternal circulation during labor or delivery. Squamous cells and keratin debris are from fetal skin. Presents with dyspnea, neurologic symptoms and DIC (due to the thrombogenic nature of amniotic fluid).
What causes pulmonary embolism? Which veins are involved? How does it present clinically?
Usually due to thromboembolus. DVT of lower extremities is most common source. Femoral, iliac or popliteal veins. Clinically silent because lung has a dual blood supply (pulmonary and bronchial arteries) and embolus is usually small.
What causes pulmonary infarction? How doe it present?
Pulmonary infarction occurs if a large or medium size pd artery is obstructed in patients with pre-existing cardiopulmonary compromise. Presents with shortness of breath, hemoptysis, pleuritic chest pain and pleural effusion.
A 48 year old minister Presents with shortness of breath, hemoptysis, pleuritic chest pain and pleural effusion. What do you think she has and what tests would you like to order to figure out what’s happening? What are the possible results? What does the gross exam findings look like?
She has pulmonary infarction.
- V/Q lung scan shows mismatch a nd perfusion is abnormal
- Spiral CT shows a vascular filling defect in the lung
- Lower extremity doppler ultrasound useful to detect DVT
- D-dimer is elevated
Gross examination reveals a hemorrhagic, wedge shaped infarct.
How does PE cause pulmonary HTN? Sudden death?
Pulmonary hypertension may arise with chronic emboli that are reorganized over time. Sudden death occurs with a large saddle embolus that blocks both left and right pulmonary arteries or with significant occlusion of a large pulmonary artery. Death is due to electromechanical dissociation.
What causes systemic embolus? Where does it usually arise? Which areas does it affect?
Usually due to thromboembolism. Most commonly arises in the left heart. Travels down systemic circulation to occlude flow to organs, most commonly the lower extremities.
