Embolism
Thromboembolism
Systemic
Pulmonary
Types
1.
a.
b.
Sites of Origin
2.
a.
b.
c.
d.
(80%) Intracardiac mural
thrombi
2/3 from left ventricular
wall infarcts
1/3 from dilated left artria
20 to mitral stenosis
20% from
Aortic aneurysm
Ulcerated artheromatous
plaque thrombi
Fragmentation of vulvular
vegetation
Paradoxical embolism
1.
Complications
Ischeamia and
infarction of multiple
organs correspond to
the site of origin of the
thrombus
2. Areas commonly
affected
a. 75%
i. Lower extremities
b. 15%
i. Spleen
ii. Intestines
iii. Kidneys
c. 10%
i.
Brain
1.
95% from deep vein
thrombus, the veins
include
a. Saphenous vein
b.
Popliteal vein
1.
Saddle embolism
a.
Impacted at the
bifurcation of
pulmonary artery
b.
Sudden death due to
acute cor-pulmonale
i. CVS collapse
ii. Right ventricular
failure
iii. Massive hypoxia
c.
No evident of infarction
2.
Additional Info’s
Extend of damage
due to embolization
depends on
a. Tissue’s
vulnerability to
ischeamia
b. Calliber of
occluded vessels
c.
Collateral blood
supply
3.
2.
Emboli passes through
septal defect into
systemic circulation
Small multiple
embolism
a.
1.
1.
1.
Fat Embolism Syndrome
Decompression Sickness
1.
a.
b.
c.
d.
2.
3.
Pulmonary
hypertension
Right sided heart failure
Size of arteries involved
a.
Medium sized arteries
i. Pulmonary
heamorrhage
ii. No infarction
1.
Due to dual
arterial supply
of the lungs
b.
Small sized arteries
i. Presence of
infarcted area
Most of the cases are
assymptomatic
a.
1.
Amniotic Fluid
Embolism
Air Embolism
Massive fracture to long
bone
a. Microscopic fat globules
enter circulation thorugh
damaged marrow
sinusoid
2. Traumatic soft tissue injuries
a.
Ruptures of venules in
damaged tissue
Paradoxical embolism
a.
b.
1.
Fat Embolism
Air may accidentally
introduce to the circulation
through
a. Obstetric procedure
b. Venupuncture
c. Chest wall injury
d.
Sudden changes in
atmospheric pressure (gas
embolism)
Characterized by
Pulmonary insufficiency
i. Multiple pulmonary vessels
obstruction
Neurological symptoms
i. Occlusion in brain blood
vessels
Anemia
Thrombocytopenia
i. Massive utilization of platelet
during coagulation process
10% of all cases end up with
death
Aggravated by endothelial
injury
Platelet activation leads to
thrombogenesis
1.
Eventhough 90% pts with
severe skeletal injuries will
have fat embolism, but
only 10% presented with
symptoms
1.
2.
3.
People at risk
a.
Scuba diver
b.
Deep sea diver
c.
Underwater construction workers
When air being inhaled in high pressure, gas
will start to dissolve in the blood and tissue
a.
If diver ascends (depressurize) too
rapidly, gas will bubble up and form
gas embolism
b.
May occlude
i. Brain
ii. Heart
iii. Many other organs
The Bend
a.
4.
Due to rapid formation of gas bubbles
in the
i. Skeletal muscle
ii. Supporting tissue at the joints
The Choke
a.
2.
3.
Due to presence of gas bubbles in the
pulmonary vasculature
b.
Characterized by
i. Edema
ii. Heamorrhage
iii. Focal atelectasis
iv. Emphysema
v. Repiratory distress
More than 100ml of air needed to produce
clinical presentation
Smaller air bubbles may coalesce forming
frothy masses
a.
Sufficiently large to occlude major
vessels
Caisson Disease
a.
Chronic form of decompression
sikcness
b.
Persistance gas bubbles in the bone,
leading to
i.
Focal of ischeamic necrosis
ii.
Affect mostly at the
1.
Head of femur
2.
Tibias
3.
Humeri
1. Accidental entry of
amniotic fluid into
the maternal
circulation via
a. Tear of placental
membrane
b. Rupture of uterine
vessels
1.
Extremely fatal, but
very rare
2. Characterized by
a. Sudden severe
dypsnea
b. Cyanosis
c. Hypotensive shock
d. Seizures
e. Coma
3. If patient survive,
secondary
complication follows
a. Pulmonary edema
b.
Disseminated
Intravascular
Coagulation (DIC)
1.
Classically, the lung will
have
a. Pulmonary edema
b. Diffuse alveolar
damage
c. Pulmonary circulation
containing
i. Fetal squamous cells
skin
ii. Lanugo hair
iii. Vernix caseosa (fat)
iv. Mucin