Deep vein thrombosis and pulmonary embolism: Pathology review
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Deep vein thrombosis and pulmonary embolism: Pathology review
Respiratory system
Lower respiratory tract disorders
Acute respiratory distress syndrome
Cyanide poisoning
Decompression sickness
Methemoglobinemia
Pulmonary changes at high altitude and altitude sickness
Congenital pulmonary airway malformation
Pulmonary hypoplasia
Tracheoesophageal fistula
Pneumonia
Lung cancer
Pancoast tumor
Superior vena cava syndrome
Apnea of prematurity
Meconium aspiration syndrome
Neonatal respiratory distress syndrome
Sudden infant death syndrome
Transient tachypnea of the newborn
Alpha 1-antitrypsin deficiency
Asthma
Bronchiectasis
Chronic bronchitis
Cystic fibrosis
Emphysema
Hypersensitivity pneumonitis
Idiopathic pulmonary fibrosis
Restrictive lung diseases
Sarcoidosis
Respiratory system pathology review
Apnea, hypoventilation and pulmonary hypertension: Pathology review
Cystic fibrosis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Lung cancer and mesothelioma: Pathology review
Obstructive lung diseases: Pathology review
Pleural effusion, pneumothorax, hemothorax and atelectasis: Pathology review
Pneumonia: Pathology review
Respiratory distress syndrome: Pathology review
Restrictive lung diseases: Pathology review
Tuberculosis: Pathology review
Assessments
Deep vein thrombosis and pulmonary embolism: Pathology review
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Content Reviewers
Hannah is a 42 year old woman who came to the emergency department due to pain in her right calf.
She reports flying from Japan back to the United States 2 days ago.
She denies fever, chills, or history of trauma to the leg.
She reports a 25 pack year smoking history for 20 years, and she takes oral contraceptive pills.
On physical examination, she is stable, and her BMI is 32.
Her right leg is shown in this image.
On laboratory investigation, her D-dimer levels are elevated.
Deep vein thrombosis, or DVT and pulmonary embolism, or PE are a spectrum of clinical manifestations that result from venous thromboembolism.
The pathogenesis and risk factors of both DVT and PE centers around Virchow’s triad, that is; stasis of blood flow, hypercoagulability, and endothelial injury.
Board exams like to test your ability to identify a PE by using scenarios that promote venous stasis such as paralysis after a stroke, the postoperative period, as well as long drives or flights.
People with varicose veins are also at risk of DVT, because incompetent venous valves prevent proper venous outflow, causing stasis.
An interesting risk factor is pregnancy, where the enlarged uterus may compress the iliac veins, causing stasis of venous outflow.
Another similar cause is May-Thurner syndrome where the left iliac vein gets sandwiched between the right iliac artery anteriorly and the lumbar vertebrae posteriorly, which also leads to venous stasis.
Now, the coagulation system is normally balancing clot formation and clot lysis.
Hypercoagulability occurs is when the scale is tipped towards clot formation.
Sources
- "Rapid Review Pathology" Elsevier (2018)
- "Fundamentals of Pathology" H.A. Sattar (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pulmonary embolism from amniotic fluid, fat, and air" Prog Cardiovasc Dis. 1994 (1994)
- "Infective Endocarditis" New England Journal of Medicine (2013)
- "American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients" Blood Advances (2019)
- "Pathophysiology of Heart Disease" Wolters Kluwer Health (2015)
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