Nonthrombotic Pulmonary Embolism: New Insights – A Large Autopsy Study
Matthias S Dettmer, Niels Willi, Thore Thiesler, Peter Ochsner, Gieri Cathomas. Cantonal Hospital Liestal, Liestal, Switzerland
Background: Pulmonary bone marrow embolism (PBME) and pulmonary bone fragment embolism (PBFE) are two types of nonthrombotic pulmonary embolism (NTPE). While PBME can found consistently in autopsies, PBFE is a rarely observed event. Both these conditions have bone lesions as source of embolism and are not considered to be causative for death.
Design: A retrospective study of 1008 autopsies was performed and lung slides were reviewed for the existence of pulmonary embolism. Clinicopathological data were screened for osseous lesions considered as risk factors for PBME and PBFE.
Results: We found 29 cases of PBME and 5 cases of PBFE. Both the conditions were mutually exclusive of each other. While PBME showed significant association with costal fractures, PBFE showed significant association with osteomyelitis and a previously done osteosynthesis. There were between one and 346 bone emboli in PBFE with a density ranging from 0.74 – 30.5 emboli/cm2 with mean embolic diameter of 45.8±37.6 µm.
Conclusions: In this study, the incidence for PBME was 3% and PBFE was 0.5%. PBME was associated with costal fractures, while PBFE was associated with orthopedic procedures and osteomyelitis and can result in death. Both the conditions appeared exclusively, indicating that although they originate from osseous lesions, their underlying pathogenesis is probably different.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 7, Wednesday Morning