Path Lab

Name: Onyedika Egbujo

No: #671
Topic: Saddle Embolism

Identify the Tissue with reason


It is called saddle embolus because sometimes
the blood clot takes the shape of the curved
conjunction of the right and
left pulmonary arteries.


Describe gross morphology changes Real thrombi formed in a rapidly flowing
bloodstream are usually dry, friable gray masses
composed of almost regularly arranged layers of
platelets and fibrin, irregularly mixed with small
amounts of darker red coagulated blood. The
resulting laminations are the lines of Zhan. Clots
like this are also adherent to the vessel walls, post
mortem clots are not. Post mortem clots are
also referred to as current jelly or chicken fat. Post
mortem clots occur when the components of
blood are evenly distributed throughout the clot.
Describe histopathology changes Sections of the thrombi should be taken for
microscopic analysis. The lines of Zahn should also
be seen microscopically.
List possible etiology/ risk factors 1) prolonged bedrest (particularly with
immobilization of the legs);
(2) surgery, especially orthopedic surgery, of knee
and hip;
(3) severe trauma (including burns or multiple
fractures);
(4) congestive heart failure;
(5) in women, the period around parturition or
oral contraception using birth control pills with
high estrogen content;
(6) disseminated cancer; and
(7) primary disorders of hypercoagulability (e.g.,
factor V Leiden)


Describe the pathogenic mechanism
An embolus is something that can float through
blood and then plugs the flow. It's usually a blood
clot or air. A pulmonary infarct occurs when the
embolus goes to a pulmonary artery and the lung
down stream dies from lack of oxygen. A saddle
embolis is a clot bridging the main arteries to both
the right and left lungs.
A saddle pulmonary embolus is a relatively large
clot that becomes lodged within the main
pulmonary artery and straddles (extends into)
both right and left pulmonary arteries. The clot is
believed to come from deep veins of the leg.
What is the pathology or diagnosis The pathophysiologic consequences of
thromboembolism in the lung depend largely on
the size of the embolus, which in turn dictates the
size of the occluded pulmonary artery, and on the
cardiopulmonary status of the patient. There are
two important consequences of embolic
pulmonary arterial occlusion:
(1) an increase in pulmonary artery pressure from
blockage of flow and, possibly, vasospasm caused
by neurogenic mechanisms and/or release of
mediators (e.g., thromboxane A
2
, serotonin); and
(2) ischemia of the downstream pulmonary
parenchyma. Thus, occlusion of a major
vessel results in a sudden increase in pulmonary
artery pressure, diminished cardiac output, right-
sided heart failure (acute cor pulmonale), or even
death. Usually hypoxemia also develops, as a
result of multiple mechanisms:
Perfusion of lung zones that have become
atelectatic. The alveolar collapse occurs in
the ischemic areas because of a reduction
in surfactant production and because pain
associated with embolism leads to
reduced movement of the chest wall; in
addition, some of the pulmonary blood
flow is redirected through areas of the
lung that normally are hypoventilated.
The decrease in cardiac output causes
a widening of the difference in arterial-
venous oxygen saturation.
Right-to-left shunting of blood may occur
through a patent foramen ovale, present
in 30% of normal persons.
If smaller vessels are occluded, the result is
less catastrophic, and the event may even


be clinically silent.


Massive pulmonary embolism is one of the few
causes of literally instantaneous death, even
before the person experiences chest pain or
dyspnea.
List symptoms/signs Death usually follows so suddenly from hypoxia or
acute failure of the right side of the heart (acute
cor pulmonale) that there is no time for symptoms
and signs to develop in the lung.
List other systems affected/complications Acute cor pulmonale, hypoxia to the brain and
death
List relevant/additional info N/A
Write a clinical vignette A 35-year-old woman is noted to have a 2-day
history of a swollen and tender right leg. Doppler
ultrasound studies confirm a deep venous
thrombosis. She has had two previous episodes of
venous thrombosis and also has a history of losing
three pregnancies in the past 6 years. What will be
the worst case scenario if the condition is left
untreated.
A. Saddle embolism
B. Pulmonary edema
C. Pulmonary embolism
D. Thromboembolim
The prognosis for a patient with a saddle embolus:
A. excellent; full recovery is expected
B. fair; recovery with some lasting damage
C. guarded; patient may not recover
D. poor; recovery is not expected

List 3 important features that might be tested Location of the embolus, origin of the embolus and
ultimate consequence of the condition.