Postmortem Demonstration of the Source of Pulmonary Thromboembolism: The Importance of the Autopsy

Abstract

Periprostatic or paravaginal venous thromboses are rarely considered clinically as sites of clot origin in patients with pulmonary thromboembolism. The majority of emboli have been demonstrated to originate in the veins of the legs. This report raises awareness of pelvic vein thrombosis as a potential source of pulmonary embolism that is rarely considered or detected clinically, and which usually requires postmortem examination for recognition. It also reviews the possible routes emboli may take to reach the lungs.

Investigating the Source of Fatal Pulmonary Thromboembolism in a Coronial Postmortem Population

“…This is in line with recommendations in the forensic pathology literature that when a pulmonary thromboembolism is identified at autopsy, the embolus source should be established by a search for residual thrombosis 10–12 . However, dissection to examine the deep veins of the legs for thrombosis is not always routinely performed at postmortem examination 13 . Antemortem techniques, such as ultrasound or D-dimer assay, 1,14 for detection of thrombus in the deep veins of the legs are not applicable at postmortem examination.…”

“…[10][11][12] However, dissection to examine the deep veins of the legs for thrombosis is not always routinely performed at postmortem examination. 13 Antemortem techniques, such as ultrasound or D-dimer assay, 1,14 for detection of thrombus in the deep veins of the legs are not applicable at postmortem examination. It has been suggested that observation on a postmortem nonenhanced computed tomography scan of soft tissue edema of the leg may be a clue to the presence of deep vein thrombosis (DVT).…”

Periprostatic venous thrombosis

“…Periprostatic or paravaginal areas are rarely considered to be sites of clot origin in patients with PE 8 , 9. The majority of emboli have been demonstrated to originate in the veins of the legs.…”