INSTRUCTORS ONLY

Cardiovascular Laboratory 2
THROMBOSIS, EMBOLISM, INFARCTION

Areas of Concentration

• Thrombosis

• Myocardial, pulmonary, and renal infarction

In particular:

1. Recognize the pathologic features of myocardial infarction.

2. Understand the common features of infarction seen in different organs.

3. Describe the pathogenesis of arterial and venous thrombosis.

4. Recognize the histologic features of thromboemboli as they undergo formation and subsequent organization/resolution..

5. Be familiar with the pathogenesis of pulmonary and systemic thromboembolism.

PC USERS: Drive mapping is no long needed. Use the ImageScope links.

Slide 54 [WebScope] [ImageScope]

A 57-year-old man complaining of chest tightness and indigestion was admitted to the hospital. An evaluation led to the diagnosis of myocardial infarction, primarily involving the left ventricle. One day after admission, the patient developed cardiac failure and pulmonary edema. Despite aggressive management, adequate cardiac function could not be maintained and the patient died 3 days after admission. An autopsy was performed and Slide 54 was prepared from his heart.

1. What has happened to the myocardium?

2. How old is the myocardial lesion? How does the character of the cellular infiltrate enable you to estimate the age of the lesion?

3. If the patient had survived, what would the affected areas have looked like three weeks later? Three years later?

4. What clinical chemistry tests would have been helpful in establishing the diagnosis of myocardial infarct?

5. What are some of the clinical complications of this myocardial disorder and how are they related to the pathologic features of this disorder?

6. For what reasons might such patients die during their convalescence?

Slide 35 [WebScope] [ImageScope] and Slide 36 [WebScope] [ImageScope]

Soon after completing a 4,000-mile airline trip, a 54-year-old male presented to the E.R. because of severe shortness of breath and chest pain, both of several hours duration. He had previously been well and had never had any medical problems. Although his past medical history was essentially unremarkable, his social history disclosed a complete lack of exercise and a sedentary job. His physical exam revealed obesity, tachycardia, and a pleural friction rub. Following his evaluation, he was admitted to the hospital where he expired approximately 10 days later.

These slides were prepared from his autopsy: Slide 35 was prepared from his inferior vena cava; Slide 36 was prepared from his lung.

1. What pathologic findings do you identify in the vena cava and lung?

2. What other physical or laboratory findings might have been observed during the patient’s evaluation?

3. With regard to the partially organized thrombus in the vena cava, how does a thrombus differ from a postmortem clot?

4. What factors contribute to venous thrombosis? To arterial thrombosis? What is the difference between an embolus and a thrombus, and how can you grossly tell them apart?

5. What is meant by the term “organization,” as applied to a thromboembolus? What morphologic evidence of organization is present in Slide 35?

6. What clinical settings predispose to pulmonary infarcts?

7. What is the gross appearance of a pulmonary infarct?

Slide 5 [WebScope] [ImageScope]

An elderly man underwent repair of an abdominal aortic aneurysm. He developed a postoperative infection and died from generalized sepsis. At autopsy, part of the cortical surface of a kidney was pale and outlined by a hyperemic border. The histologic section was prepared from this cortical lesion.

1. Describe the histologic findings.

2. Based on the pathologic features (gross and histologic), what is your diagnosis?

3. What pathologic lesions can serve as sources of emboli that produce this renal lesion?

The answers to the path lab questions will be posted approximately 48-72 hours after the lab sessions. These are abbreviated answers, not a full discussion of the topics. You can find them in the M2 CTools site resources. In the folder for each sequence the will be a folder called 'Path Lab Resources'