Pulmonary thromboembolism: retrospective study of necropsies performed over 24 years in a university hospital in Brazil

Abstract

CONTEXT: Pulmonary thromboembolism is the third most frequent cause of morbidity and mortality among acute cardiovascular diseases. The incidence of pulmonary embolism in necropsies has remained unchanged over the last few decades. Cardiac diseases, neoplasia, trauma, recent surgery and systemic diseases are important predisposing clinical conditions. The relationship between male and female sexes is estimated at 1.24. Various studies have shown an increase in morbidity in spring and autumn. There is great difficulty in precise anatomopathological diagnosis in relation to the localization of the emboli in the pulmonary vessels, although they are preferentially located in the right lung and lower lobes. OBJECTIVE: To study the incidence of lethal and non-lethal pulmonary thromboembolism in relation to epidemiological and anatomical variables. DESIGN: Retrospective study performed via reports on the necropsy findings. SETTING: University hospital providing tertiary-level attendance. SAMPLE: 16,466 consecutive necropsies performed from January 1972 to December 1995. MAIN MEASUREMENTS: Frequency of lethal and non-lethal pulmonary thromboembolism, predisposing diseases, occurrence in relation to the seasons of the year, and location where the embolus is lodged. RESULTS: Pulmonary thromboembolism was found in 4.7% of all the necropsies performed. There was a predominance of lethal cases (68.2%). There was no difference in relation to sex or seasons of the year for the occurrence of this disease. Cardiovascular diseases were more frequently associated with thromboembolic phenomena. With regard to the location where the embolus was lodged, various lung segments showed greater incidence of being bilaterally compromised. CONCLUSION: Over the period of this study, it was observed that there was a reduction in the incidence of pulmonary thromboembolism, which was probably due to the increase in prophylactic measures over the last few decades. Nonetheless, lethal thromboembolism predominated in frequency, probably because of the abrupt onset of a condition of attack across a large area of the lung, lack of clinical suspicions and consequently a lack of early diagnosis, and delay in instituting fibrinolytic therapy in the cases with hemodynamic repercussions or a large number of lung segments affected.

Pulmonary embolism and sudden–unexpected death: Prospective study on 2477 forensic autopsies performed at the Institute of Legal Medicine in Seville

“…This percentage is within the previously reported range of 0.8%, obtained at the Office of the Chief Medical Examiner of New York 8 , and 2.5% referred to by the Department of Legal Medicine of the University of Kitasato. 19 Studies carried out on series of hospital autopsies indicate a greater percentage of PE (between 3.9% and 5.8%) 13,14,20 than that obtained in forensic autopsies. This difference is logical since hospital autopsies are performed on admitted patients who have more risk factors for the development of PE than the general population on which the forensic autopsies are performed.…”

“…25,26,7,13 This fact is explained by the influence of cold weather on vasoconstriction and the fibrinolytic system, along with a diminution in physical activity. 22 The source of PE was identified in 72% of cases; most of them (96%) were localized in the deep venous system of the lower limbs, mainly in calves, and in only one case (4%) in a thrombus lodged in the right ventricle.…”

“…doi:10.1016/j.jflm.2008.08.015 patients. 13,14 However, most previous series are retrospective; on the contrary, the main strength of our study is that it has been conducted prospectively, in a consecutive series of forensic autopsies.…”

Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos

“…3 Autopsy data show incidence similar to that seen in international literature, ranging from 4 to 19 percent, and being the cause of death from 3.7 to 5 percent of cases. [4][5][6][7][8] Deep vein thrombosis (DVT) of the lower limbs, the primary source of pulmonary emboli, is found at rates of 0.2 to 0.7 cases per 1000 inhabitants per year in the general population; 9 estimates put its incidence at 0.6 cases per 1000 inhabitants per year in Brazil. 10 A later, non-deadly complication from DVT, though still a cause of major socioeconomic problems, is chronic venous insufficiency (CVI), in this case also known as post-thrombotic syndrome (PTS), which affects 20 to 50 percent of DVT patients treated with anticoagulants.…”

Tromboembolismo pulmonar en pacientes hospitalizados entre 1994-2000: serie de autopsia

“…Muchos de ellos presentaban varios de estos factores simultáneamente. Datos similares han sido publicados en estudios recientes (11)(12)(13). El TEP continúa siendo de difícil diagnóstico a pesar de constituir una de las causas más frecuentes de muerte en pacientes hospitalizados (1,10,12,23).…”