Pathology cases: Bilateral pulmonary thromboemboli following an airplane flight

A middle-aged man flew from Australia to the US.  He complained of leg pain for a week and then suffered a witnessed collapse.  At autopsy, bilateral occlusive thromboemboli were found in both main pulmonary arteries.

Here are some pics from the gross exam:

The poplieal fossae were explored, and both the greater and lesser saphenous veins *and* the popliteal veins had significant clots bilaterally.

Here’s a low power view of the right main pulmonary artery.  It’s hard to get a good section if you are cutting the tissue fresh.  The clot will tend to pop out and the pulmonary artery is not real stable under the knife. If you want a really good demonstrative histologic section, it’s better to fix the tissue first.  Unfortunately, we all know what the workload issues are, and I really didn’t have the time to wait.  So, this is from a fresh section.  On gross examination, as you can see above, there was complete occlusion, even though on histology it’s only about 50%.

Here’s a close up of the clot, showing the layers of fibrin with inflammatory cells and red cells, forming the classic “Lines of Zahn.”

If the clot’s been there for awhile, you will see organization moving in from the vascular wall.  In this case there was only a hint of early reaction.

CPR had been attempted, and there were a couple of broken ribs.  I’ve shown pictures of lipid emboli in the lungs before, and there were a couple here as well:

Something a little different, though, were innumerable small vacuoles in other organs as well — the kidney, the liver, and the brain.  Here’s an example from the liver.  That’s a little unusual for me.  Maybe it’s due to altered circulation due to blockage of most flow to the lungs…

As always, images are free to use with or without attribution, though attribution is appreciated.  If higher resolution images are required, send me an email.