Affiliation:
1. Institute of Fundamental Medicine and Biology; Kazan (Volga Region) Federal University
2. Kazan (Volga Region) Federal University; Kazan State Medical Academy – Branch Campus of the Russian Medical Academy of Continuous Professional Education
Abstract
Many aspects of pulmonary embolism pathogenesis are still unclear: for example, what is the probability of pulmonary embolization in venous thrombosis and thrombi formation in the pulmonary artery in situ. The origin and timing of thromboemboli formation in the pulmonary artery are of great clinical importance for effective treatment and prognosis of pulmonary embolism outcome. The aim of the study was as part of clinical observation to compare the results of shear wave ultrasound elastography of a venous thrombus and the histological structure of blood clots in the lower extremity and the pulmonary artery obtained during a pathoanatomical examination. Research results. Patient Sh., 67 years old, was hospitalized with a diagnosis of pulmonary embolism. Ultrasound imaging visualized heterogeneous, predominantly hypoechoic non-occlusive thrombotic masses in the lumen of the posterior tibial vein of the left lower limb, extending into the lumen of the popliteal vein for 2 cm with an uneven "ragged" contour of the proximal part of the thrombus, without clear signs of flotation. Shear wave ultrasound elastography determined stiffness of the proximal part of the venous thrombus with an average Young's modulus of 8.5 kPa, which corresponds to the acute stage of thrombosis. Negative dynamics was observed after thrombolytic therapy. Computed tomography angiography of the cerebral vessels revealed signs of intracerebral hemorrhage. On the third day, the patient was pronounced dead. The pathological examination was supplemented with histological data from a fragment of a venous thrombus of the pulmonary artery and lower leg veins. The morphological characteristics of blood clots from the veins of the lower extremities and the pulmonary artery coincided, indicating their common origin and the time of formation (acute stage). Conclusion. A comparative analysis of ultrasound and pathoanatomical data of the clinical case give us the opportunity to recommend shear wave ultrasound elastography of venous thrombi of the lower extremities to assess the state of thromboembolism in the pulmonary artery.
Publisher
I.N. Ulianov Chuvash State University
Reference7 articles.
1. Sazhin A.V., Lebedev I.S., Gavrilov S.G. et al. Istochniki tromboembolii legochnykh arterii po dannym patologoanatomicheskogo i klinicheskogo issledovanii [Causes of pulmonary embolism according to autopsies and clinical examination]. Flebologiya, 2019, no. 13(3), pp. 202–210. DOI: 10.17116/flebo201913031202.
2. Porembskaya O.Ya., Lobastov K.V., Kravchuk V.N. et al. Legochnaya emboliya – razroznennye chasti nesobrannoi mozaiki [Pulmonary embolism – scattered parts of an unassembled mosaic]. Flebologiya, 2021, no. 15(3), pp. 188–198. DOI: 17116/flebo202115031188.
3. Kapustina E.P., Akramova E.G., Khamzina F.T., Lukanikhin V.A. Sposob ul’trazvukovoi diagnostiki vozrasta venoznogo tromba elastografiei sdvigovoi volnoi [Method for ultrasonic diagnosis of the age of a venous thrombus by shear wave elastography]. Patent RF, no 2022105158, 2022.
4. Seliverstov E.I., Lobastov K.V., Ilyukhin E.A. et al. Profilaktika, diagnostika i lechenie tromboza glubokikh ven. Rekomendatsii rossiiskikh ekspertov [Prevention, Diagnostics and Treatment of Deep Vein Thrombosis. Russian Experts Consensus]. Flebologiya, 2023, no. 17(3), pp. 152–296. DOI: 10.17116/flebo202317031152.
5. Chernysh I.N., Nagaswami C., Kosolapova S. et al. The distinctive structure and composition of arterial and venous thrombi and pulmonary emboli. Sci Rep., 2020, vol. 10(1), 5112. DOI: 10.1038/s41598-020-59526-x.