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EMBOLISM -1
Embolism occurs when a solid, liquid, or gaseous mass travels through the bloodstream and lodges in a blood vessel distant from the site of origin. Embolisms are classified based on direction of travel and composition. Pulmonary embolisms involve the lungs while systemic embolisms affect other organs. Common causes of embolism include blood clots, fat droplets, air bubbles, and infectious materials. Symptoms vary depending on the size and location of the embolism but may include dyspnea, chest pain, and coughing. Diagnosis involves blood tests, imaging, and scans. Consequences depend on factors like vessel size and collateral blood flow.
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Overview of embolism; definition of embolus as a mass carried by blood to distant sites.
Categorization of embolism based on movement, types (thrombotic, fat, etc.), and composition.
Details on pulmonary embolism, its prevalence, risk factors, symptoms, and potential severity.Description of saddle pulmonary embolus and acute cor pulmonale as serious outcomes of PE.
Methods for diagnosing pulmonary embolism including blood tests and imaging techniques.
Effects of systemic thromboembolism on organs, including common sites and causes of emboli.
Discussion on non-thrombotic emboli, specifically air embolism and its causes.
Causes and morphology of air embolism, including decompression disease and iatrogenic causes.
Complications and severe outcomes of amniotic fluid embolism during labor.
Fat embolism occurrences post-injury, with statistics and potential complications highlighted.
Details on fat embolism syndrome, including symptoms that develop after specific timeframes.
Septic embolism explained, including causes and complications associated with infective endocarditis.
Embarkation of foreign body embolism, potential sources, and effects on the body.
General symptoms of embolism; concluding remarks from the presentation.
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EMBOLISM -1
- 1. Embolism DR. ROOPAM JAIN PROFESSOR& HEAD HOD DEPT. OF PATHOLOGY & BLOOD BANK
- 2. Introduction • An embolusis intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from its point of the origin.
- 3. Classification of embolism •1. Based on the direction of movement of the embolus • 2. Pulmonary or systemic embolism • 3. Composition of the emboli
- 4. • Orthograde embolism(direct embolism)- embolus is carried in the direction of normal blood flow • Retrograde embolism - the emboli move in a direction opposite from the direction of blood flow; this is usually significant only in blood vessels with low pressure (veins) or with heavy emboli. • Paradoxical embolism (<2%) - embolus that is carried from venous side to the arterial side (or vice versa). Example: septal defects in the heart (ASD, VSD..), patent foramen ovale.
- 5. Composition of theemboli: 1. Thrombotic emboli 2. Fat droplets 3. Amniotic fluid emboli 4. Aterosclerotic emboli 5. Septic emboli 6. Air emboli
- 6. Pulmonary embolism • 200,000deaths per year in the USA • In 95% of cases, venous emboli originate from deep leg veins proximal to popliteal fossa • It is the most common among hospitalized patients • Their range in manifestations can be from mild to lethal. • Predisposing risk factors: – prolonged bed rest, cancer, estrogen-based medication, obesity, pregnancy, surgery, genetic factors increasing blood clotting susceptibility...
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- 10. Symptoms and signs •Symptoms and signs vary depending on the diameter and number of blood vessels that are occluded, part of the lungs that is affected and other comorbidities – Dyspnea – Tachypnea – Chest pain – Cough – Hemoptysis – Tachycardia PE is difficult to diagnose because symptoms are non-specific and clinical presentation of patients with suspected PE varies widely from patients who are asymptomatic to those in cardiogenic shock
- 11. • Most pulmonaryemboli are small and clinically silent. If they are organized, they can cause pulmonary hypertension • Large embolus can cause death
- 13. Saddle pulmonary embolus Grossdescription of large pulmonary emboli
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- 15. Cause of death: •Acute cor pulmonale – form of acute right heart failure produced by a sudden increase in resistance to blood flow in the pulmonary circulation, and dilatation of right side of the heart due to massive (>60% of pulmonary circulation) or large emboli in the pulmonary circulation.
- 16. Obstruction of thesmaller blood vessels causes pulmonary infarcts (if there is passive hiperemia previously)
- 17. Diagnosing pulmonary embolism •Blood test to look for a protein called D-dimer. • CT pulmonary angiography (CTPA) • ventilation-perfusion scan, also called a V/Q scan or isotope lung scanning • leg vein ultrasound
- 18. Systemic thromboembolism • Itwill always lead to infarction in the organs • Common arterial embolization: – Lower extremities (75%), – central nervous system (10%), – intestines, kidneys, spleen...
- 19. Systemic thromboembolism • Causes: –80% arise from intracardiac mural thrombi (left ventricular infarcts, or dilated left atria), aortic aneurysm, thrombi overlying ulcerated atherosclerotic plaques, fragmented valvular vegetations...
- 20. • Consequences ofembolization depend on: – the caliber of the occluded vessel – The collateral supply – The affected tissue’s susceptibility of oxygen deprivation
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- 22. Air embolism • Oneor more air bubbles enter into vein or artery and block them.
- 23. Causes • Decompression disease: –Acute: scuba divers -- when dissolved nitrogen forms bubbles in body tissues and fluids causing joint pain, weakness... – Chronic: Caisson disease-pain in the bones due to ishemic necrosis, neurologic and cardiovascular deficits
- 24. • Iatrogenic: Injections andsurgical procedures (example: brain surgeries and venous embolism..) • Suicid
- 25. Morphology of airembolism • Can be proved only at the autopsies • There are bubles in blood vessels • Air embolism can lead to acute cor pulmonale • Heart and pulmonary vessels should be opened under the water at the autopsy
- 26. Amniotic fluid embolism •Complication of the labor • Important cause of death among women in labor (86%) • Damage of placental membranes and rupture of the uterine veins with entrance of squamous epithelial cells of the skin into the blood
- 27. • Dyspnea, disseminatedintravascular coagulation, convulsion, coma • Diagnosis is made when all other causes are excluded
- 28. Fat embolism • Developsafter skeletal trauma, trauma of soft tissue, burns • Presence of fat globules in lung circulation and peripheral circulation • Usually occurs 72 hours after skeletal trauma • Prevalence of fat embolism is 1% to 3.5% of patients with fracture of tibia and femur
- 29. • Fat droppletswill travel through venous circulation to the lungs and there they can move to systemic circulation. Oil red O, histochemical stain
- 30. • Fat particlesenter the circulation and cause damage to capillary beds. While the pulmonary system is most frequently affected, fat embolism can occur in the microcirculation of the brain, skin, eyes, and heart can be involved.
- 31. Fat embolism afterblunt trauma 10.1007/s12024-018-0053-0
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- 34. Fat embolism • 1.Mechanical theory • 2. Biochemical theory (FFA toxic effects on the endothelium)
- 35. Fat embolism syndrome •1% of patients with fat embolism can develop this syndrome • 24-72 hours after the injury • Neurologic symptoms • Heart and lung failure (ARDS) • Anemia and thrombocytopenia
- 36. Septic embolism • Obstructionof a blood vessel by embolus that is infected from a distant infectious source. • They lead to inflammation and abscessus formation.
- 37. Septic embolism • Septicemboli are a common complication of infective endocarditis. • Septic emboli could affect multiple organs and cause variable insults. • Blood cultures are usually positive in patients with septic emboli. • Septic emboli cause tissue injury by two different mechanisms: ischemia and infection. • The prognosis of septic emboli usually depends on source control of the underlying infection.
- 39. Embolism with foreignbodies • Talc in drug users • Silicone embolism • Contaminated injections • Endovascular procedures such as coiling, catheterization, and thrombolysis may contribute to lesion formation • It can lead to granulomatous reaction
- 40. Histopathology of foreignbody embolism
- 41. Signs and symptoms •Asymptomatic • Tiredness • Weakness • Pulmonary infarction, secondary infection
- 42. • Thank youfor your attention