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  • Title: [Autopsy-proven cases of fatal saddle thromboembolism in the pulmonary artery].
    Author: Ishikawa K, Fujino T, Shinozaki Y, Mukai M.
    Journal: Nihon Kyobu Shikkan Gakkai Zasshi; 1993 Nov; 31(11):1416-21. PubMed ID: 8277612.
    Abstract:
    In 544 autopsy cases during the period from 1984 through 1990 at National Okura Hospital, there were 7 cases of fatal saddle pulmonary thromboembolism (1.3%). Pulmonary thromboembolism was included in the differential diagnosis, but not as a primary consideration. Therefore, no case was diagnosed antemortem. Saddle thromboembolus is defined here as a thromboembolus which impacted in the main pulmonary artery or lodged astride the bifurcation. The cases were 5 females and 2 males ranging in age from 53 to 76 years. During the clinical course of the initial disease, sudden symptoms including dyspnea, chest pain or tachypnea developed, and death occurred within one hour or in a relatively short period of time. In case 6, sudden death followed removal of a central venous catheter inserted in the inferior vena cava one week previously. In cases 2, 3, and 5, deep vein thromboemboli were detected at postmortem examination. In cases 3 and 4, the patients were 3- and 5-days postoperative, respectively. Laboratory data obtained before death showed no abnormalities of hematologic and coagulation profiles. At autopsy, the pulmonary artery trunk was completely occluded by embolus, and thromboemboli were detected in the femoral and iliac veins in 3 cases. These thromboemboli were composed of fibrin and red cells enmeshed with platelets. On microscopic examination, endothelial disruption was not observed at the levels of the large and smaller pulmonary vessels, which underlies thrombosis in situ or creates a procoagulant environment. Proximal pulmonary thromboemboli were demonstrated in only one out of seven cases (Case 1). Saddle thromboembolism, in our limited observation, resulted from the impact of large floating embolus, emanating from elsewhere, against the large pulmonary artery, rather than the propagation of a smaller pulmonary embolus originating in a peripheral artery.
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