Deep vein thrombosis and pulmonary embolism: Pathology review

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Deep vein thrombosis and pulmonary embolism: Pathology review

Respiratory system

Apnea and hypoventilation

Apnea of prematurity

Sleep apnea

Pleura and pleural space disorders


Pleural effusion



Deep vein thrombosis and pulmonary embolism: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 55-year-old woman comes to the emergency department because of new onset shortness of breath and chest pain for the past 3 hours. She reports that she was walking to her car when the symptoms started, and she describes the pain as sharp and worse with deep inhalation. Additionally, she says she has been coughing up bloody mucus for the past hour. Her medical history is significant for breast cancer, for which she is currently undergoing radiation therapy. Her temperature is 37.5°C (99.5°F), pulse is 110/min, respirations are 24/min, blood pressure is 140/80 mm Hg, and oxygen saturation is 89% on room air. Troponin is 0.08 ng/mL and brain natriuretic peptide (BNP) is 425 pg/mL. Which of the following is the best investigation for diagnosing this patient’s condition?  


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.


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  6. "American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients" Blood Advances (2019)
  7. "Pathophysiology of Heart Disease" Wolters Kluwer Health (2015)

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