Recurrent pulmonary thromboemboli diagnosed at autopsy.Recurrent pulmonary thromboembolism is a condition in which multiple small thromboemboli gradually obstruct the pulmonary arterial tree over months to years. The thromboemboli are clinically silent, as they are too small to cause acute right ventricular failure right ventricular failure n. Congestive heart failure manifested by distention of the neck veins, enlargement of the liver, and dependent edema. or pulmonary infarcts. We present the case of a 20-year-old female diagnosed with recurrent pulmonary thromboemboli at autopsy. A 20-year-old morbidly obese female presented with a 4- to 5-month history of non-productive cough and 2 weeks of dyspnea on exertion dyspnea on exertion Cardiology Shortness of breath which occurs with effort, often a sign of heart failure or ischemia . She denied any other past medical history. A CT scan of the chest revealed a large embolus embolus (ĕm`bələs), foreign matter circulating in and obstructing a blood vessel. It may be a portion of a clot that has separated from the wall of a vessel (see thrombosis), a bubble of gas or air (known as an air embolus), a globule of in the distal right main pulmonary artery. Studies for DVTs, hypercoagulable and connective tissue disorders were negative. An echocardiogram showed moderate concentric left ventricular hypertrophy left ventricular hypertrophy Cardiology Enlargement of the left ventricle often linked to the prolonged hemodynamic stress of CHF, characterized by myocardial cell hypertrophy, ↑ left ventricular wall thickness, ↓ ventricular compliance, ↑ , severe tricuspid regurgitation, severe pulmonary hypertension, and dilatation of the right atrium and ventricle. Anticoagulation therapy was complicated by episodes of severe hemoptysis Hemoptysis Definition Hemoptysis is the coughing up of blood or bloody sputum from the lungs or airway. It may be either self-limiting or recurrent. Massive hemoptysis is defined as 200-600 mL of blood coughed up within a period of 24 hours or less. from hypervascular areas and pseudoaneurysms in the middle lobe of the right lung requiring embolization. Death was pronounced the next day following sudden cardiopulmonary arrest. Autopsy examination revealed evidence of recurrent pulmonary thromboemboli with associated pulmonary hypertension and right ventricular heart failure. Organized and recanalized thromboemboli were seen within the elastic arteries of the lungs forming fibrous septa with multiple recanalized vascular channels. Extensive collagen and elastic tissue deposition was seen surrounding the recanalized vascular channels. The vessels proximal to the thromboemboli had medial hypertrophy. A large, recent embolus was identified in the right pulmonary artery. Cardiomegaly cardiomegaly /car·dio·meg·a·ly/ (-meg´ah-le) abnormal enlargement of the heart. car·di·o·meg·a·ly n. Enlargement of the heart. Also called macrocardia, megalocardia. and right ventricular hypertrophy right ventricular hypertrophy Cardiology An ↑ in myocardial mass which may be due to interventricular septal defects or ↑ blood flow–eg, hyperthyroidism were also seen. The embolized vessels and pseudoaneurysms were not identifiable at autopsy. This case is presented to highlight the pathologic and clinical differences between acute pulmonary embolus and chronic recurrent pulmonary thromboemboli in order to increase awareness of this entity when the patient's initial presentation suggests a solitary acute event. Christopher M. Schuler, MD, and M.G.F. Gilliland, MD. East Carolina University, Greenville, NC. |
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