Embolism
Embolus
Emboli
? Embolus from left heart cavity or
arterial system
? Embolus from right heart cavity or
venous system
? Embolus from portal veins
? Paradoxical embolism
? Retrograde ethrombus
Motional pathway of embolus:
? Fig 5-16
THROMBOEMBOLISM
?Instantaneous death (>60%).
?Cardiovascular collapse.
?Hemodynamic compromise.
Pulmonary
1.Large emboli (5%):
2.Small emboli (60-80%):
?Clinical silent in patients without
cardiovascular failure.
?Infarctions in those with compromised
pulmonary circulation (10-15%).
3,Between the extremes of large and
small emboli (10-15%):
Pulmonary hemorrhage.
4,Multiple overt or covert small emboli:
Pulmonary hypertension and vascular
sclerosis.
Systemic embolism
I,80-85% from heart,secondary to myocardial infarction.
II,5-10% from auricular thrombi associated with rheumatic
heart disease and atrial fibrillation.
III,5% from the dilated cardiac chamber of myocarditis /
cardiomyopathy.
VI,Less common sources,Debris from ulcerative atheromata,
or thrombi in aneurysms,infectious endocarditis,
prosthetic valves,paradoxical emboli.
V,Unknown.
Etiology:
Fractures of long bones
Soft tissue trauma
Burns
Fat embolism
90% of individuals with severe skeletal
injuries
10% with clinical findings
Pulmonary insufficiency
Neurologic symptoms 9-20 g
Fat embolism
? Fig 5-17
Etiology:
Intravenous therapeutic procedures
Obstetric procedures
Chest wall injury
Decompression sickness (nitrogen)
Air embolism
Clinical effect,>100 cc
Bends,focal ischemia
Atelectasis and emphysema (choke)
Caisson disease(a more chronic form):
Multiple foci of ischemic necrosis in
skeletal system(femurs,tibia,humor)
Air embolism
AMNIOTIC FLUID INFUSION
Incidence,1/50 000 deliveries
Mortality rate,80%
Clinical onset,Sudden severe dyspnea,
cyanosis,hypotensive shock,
seisuresand coma.
AMNIOTIC FLUID INFUSION
? Embolization of the pulmonary
microcirculation of the particulate debris
in amniotic fluid.
? Release of vasoconstrictor agents,e.g.,PG
reducing pulmonary blood flow.
? Intercurrence of DIC.
Embolus
Emboli
? Embolus from left heart cavity or
arterial system
? Embolus from right heart cavity or
venous system
? Embolus from portal veins
? Paradoxical embolism
? Retrograde ethrombus
Motional pathway of embolus:
? Fig 5-16
THROMBOEMBOLISM
?Instantaneous death (>60%).
?Cardiovascular collapse.
?Hemodynamic compromise.
Pulmonary
1.Large emboli (5%):
2.Small emboli (60-80%):
?Clinical silent in patients without
cardiovascular failure.
?Infarctions in those with compromised
pulmonary circulation (10-15%).
3,Between the extremes of large and
small emboli (10-15%):
Pulmonary hemorrhage.
4,Multiple overt or covert small emboli:
Pulmonary hypertension and vascular
sclerosis.
Systemic embolism
I,80-85% from heart,secondary to myocardial infarction.
II,5-10% from auricular thrombi associated with rheumatic
heart disease and atrial fibrillation.
III,5% from the dilated cardiac chamber of myocarditis /
cardiomyopathy.
VI,Less common sources,Debris from ulcerative atheromata,
or thrombi in aneurysms,infectious endocarditis,
prosthetic valves,paradoxical emboli.
V,Unknown.
Etiology:
Fractures of long bones
Soft tissue trauma
Burns
Fat embolism
90% of individuals with severe skeletal
injuries
10% with clinical findings
Pulmonary insufficiency
Neurologic symptoms 9-20 g
Fat embolism
? Fig 5-17
Etiology:
Intravenous therapeutic procedures
Obstetric procedures
Chest wall injury
Decompression sickness (nitrogen)
Air embolism
Clinical effect,>100 cc
Bends,focal ischemia
Atelectasis and emphysema (choke)
Caisson disease(a more chronic form):
Multiple foci of ischemic necrosis in
skeletal system(femurs,tibia,humor)
Air embolism
AMNIOTIC FLUID INFUSION
Incidence,1/50 000 deliveries
Mortality rate,80%
Clinical onset,Sudden severe dyspnea,
cyanosis,hypotensive shock,
seisuresand coma.
AMNIOTIC FLUID INFUSION
? Embolization of the pulmonary
microcirculation of the particulate debris
in amniotic fluid.
? Release of vasoconstrictor agents,e.g.,PG
reducing pulmonary blood flow.
? Intercurrence of DIC.
