病理学见习课课件：病理见习案例2.ppt

Problem based learning ? 2010 College of American Pathologists. All rights reserved. College of American Pathologists ? 2010 College of American Pathologists. All rights reserved. ? 2010 College of American Pathologists. All rights reserved. ? 2010 College of American Pathologists. All rights reserved. ? 2010 College of American Pathologists. All rights reserved. ? 2010 College of American Pathologists. All rights reserved. CASE 2 2013 case-2 Clinical Summary A 70-year-old woman presented to the emergency department with back and right knee pain after falling at a local mall. No fracture was identified. She was treated for minor abrasions and discharged. After the accident, she became less mobile due to pain and swelling in her right knee. Her pain progressed, and two weeks after her initial fall she presented to the emergency department with acute shortness of breath and chest pain aggravated by coughing. Her physical exam revealed an increased leg circumference of her right leg and positive Homans sign. Her initial workup showed a D-dimer of 12.3 mg/L (reference range: 0.22-0.44 mg/L). Her prothrombin time was 13.7 sec (INR of 1.0) and PTT 105.5 sec (reference range: 23.5-36.9 sec). Cardiac studies revealed a troponin of less than 0.05 ng/mL (reference range: 0.0-0.05 ng/mL), myoglobin of 152 ng/mL (reference range: 0-106 ng/mL), and CK-MB of 4.1 ng/mL (reference range: 0.0-4 ng/mL). A ventilation-perfusion scan showed a high probability of a pulmonary embolus and a Doppler study showed a deep vein thrombosis. The patient was started on heparin and transferred to the intensive care unit. She developed progressive right heart failure, became unresponsive and could not be resuscitated. Autopsy Findings The left pleural cavity contained 100 mL of serosanguineous fluid. The left lung weighed 499 grams and the right 540 grams. They were both edematous and congested. The myocardium was red-brown, firm and without obvious ischemic changes or scarring. 2013