Pulmonary embolism

Pulmonary embolism is often on the differential in autopsies, as it is not easy to diagnose clinically.

Clinical

• Shortness of breath (dyspnea) - classic symptom.
• Tachycardia.
• Chest pain.
• Findings associated with deep vein thrombosis
  • Leg pain.
  • Leg swelling.

Notes:

• Venous thrombosis OR~=12 for PE.

Risks

• Trauma.
• Immobility.
• Pregnancy.
• Medications (e.g. OCPs).
• Hypercoagulable states (memory device CALMSHAPES):
  • Protein C deficiency.
  • Antiphospholipid antibody syndrome (APLA).
  • Leiden factor V deficiency.
  • Malignancy.
  • Protein S deficiency.
  • Homocystinemia.
  • Antithrombin deficiency.
  • Prothrombin G20210A.
  • Excess factor VIII.
  • Sticky platelet syndrome.

Gross

• Intravascular spagetti with cream sauce.
• Leg swelling.

Microscopic

Features:

• Organized blood components (RBCs, WBCs) in layers with organization (fibrin); Lines of Zahn = layers of components

Images:

• Lines of Zahn (utah.edu).
• Lines of Zahn (ucsf.edu).

See also

• Pulmonary pathology.