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.