Cpc 1
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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
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
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