ABRAR ALRAMYAN ALYA2 AL NAJAR ABRAR ALOMAR DALAL

ALABDILLHADI FATMA BAQERI HAWRAA AL HASHIMI SHAYMAA

AL BLUSHI
History
35-yr old engineer, admitted with a swollen right leg. The patient
was just back from USA, which was a 16-hour flight.

Family history
Irrelevant except that she had an elder brother who died suddenly
at the age of 42.

Examination
Good condition, afebrile (without fever).
Chest, heart & abdomen : normal
Left leg and thigh were swollen (10 cm difference in diameter).
Color Doppler Ultrasound
Lt
Venography
(popliteal vein)
To perform
venography, there
must be additional of
radiolucent material
(e.g. contrast dye in
the veins)

Occlu
polite
veins
 Venography
What was the result
of radiological tests?
This patient has one
continuous venous
thrombus that has
occluded the Lt
common iliac vein
 What is the diagnosis of the patient
at presentation ?

 DVT: deep vein

thrombosis
 In your opinion, what might have
precipitated this condition?

▪ Prolonged immobilization ( 16 hours flight) stasis

▪ Inherited hypercoagulability (sibling death) due to
deficiency of anticoagulant factor including:
▪ Antithrombin III
▪ Protein C/S
▪ Factor V- Leiden
 What sort of therapy do you think
the patient received and how do
you monitor such therapy?
1- Anticoagulants
▪ Heparin (I.V or SC) →((Monitored
by APTT))
▪ Warfarin or coumadin (orally)
→((Monitored
by PT))
 Do you suggest any further tests to reveal the
underlying cause for his condition?

 Screening & analysis to find:

 Genetics predisposition of inherited
thrombophilia
 Level of anticoagulant present in the
blood like protein C & S, plasmin,
antithrombin
 lupus anticoagulant associated with
aquired hypercoagubility
Two days later, the doctor on call was called urgently
because the patient started to have difficulty in
breathing.

Arterial Blood Gas Analysis:

pH : 7.50 (7.35-7.45)
[HCO3] : 17mmol/L (22-30)
pCO2 : 3.0Kp (4.5-6)
pO2 : 13Kp (12-15) N
 What do the results of the arterial blood
gas analysis show?

 A case of “ Respiratory Alkalosis

“ due to hyper-ventilation. That it
compensated by renal excretion
of HCO3
 Ventilation scan
▪ Is used evaluate the ability of air to reach all
portions of the lungs.
▪ Inhale gas with radioactive materials.

Normal ventilation
 Perfusion scan
▪ Measures the blood supply through the lungs
▪ Inject radioactive material intravenously

Decreased uptake of the radio-isotope in the upper portion

of the RT lung indicating poor perfusion
 What do results of ventilation/perfusion
scan show?

Normal ventilation low perfusion

“ ventilation/perfusion mismatch”
In spite of active therapy (thrombolytic therapy) , the patient
passed away the next day.

▪ Why did the patient’s condition

deteriorate?
hemodynamic instability
Due to the major pulmonary embolism which blocks the major
pulmonary artery → Rt ventricular obstruction → low blood
goes to Lt ventricle → low perfusion cardiogenic →
shock → death
▪ Describe the macro (gross) post-mortem findings of this case.

The macroscopic postmortem examination reveals the

presence of an embolus blocking the pulmonary artery
▪ Describe the microscopic post-mortem findings of this case.

Red venous thrombus

The End