Pulmonary anatomopathologic analysis and clinical manifestations related to different diseases in patients with pulmonary thromboembolism. An autopsy study

Abstract

Purpose: Patients who died due to pulmonary thromboembolism (PTE), may present different clinical manifestations and symptoms depending on their underlying diseases. The anatomopathological findings are still unknown in literature. The objective of this study was describing demographic and etiologic data, anatomic pathological findings and in-vivo manifestations (Acute Respiratory Failure [ARF], Hemodynamic Instability [HI] or Sudden Death) associated to the variety of diagnosis extracted from autopsy reports of PTE patients. Methods: From 2,000 to 2,008, were reviewed 291 autopsies of patients whose cause of death was PTE. The following data were obtained: age, sex, clinical in-vivo manifestations, post-mortem pathological patterns and main associated underlying diseases. The pulmonary histopathological changes were categorized in: diffuse alveolar damage (DAD), pulmonary edema (PE), alveolar hemorrhage (AH) and lympho/plasmacytic interstitial pneumonia (LPIP). Odds ratios of certain associated diseases developing a specific clinical manifestation and/or a specific pulmonary histological finding were determined by logistic regression. Moreover, the relation between certain clinical manifestation and a specific anatomic pathologic pattern was analysed too. Odds ratio was considered significative when p < 0,05. Results: A total of 127 (43,6%) men were studied. The median age was 64 years. Neoplasies were present in 49.1% of cases and 31.2% of patients developed PTE in postsurgical period, mainly from abdominal and neurosurgery.The most common clinical manifestation was ARF (28,9%), followed by PCR (27,5%) and HI (26,8%). The most prevalent pulmonary finding was PE (26.8%). Chronic Obstructive Pulmonary Disease was positively correlated to LPIP (p = 0,04). Linking in-vivo manifestations to pulmonary changes were found significative relations between: ARF and PE (OR, 2,99; 95% IC, 1,25 – 7,21; p = 0,014); ARF and AH (OR, 2,70; 95% IC, 1,02 – 7,20; p = 0,04); ARF and DAD (OR, 8,79; 95% IC, 1,11 – 69,42; p = 0,039); HI and HA (OR, 3,38; 95% IC, 1,27 – 8,99; p = 0,015) and HI and DAD (OR, 11,43; 95% IC, 1,46 – 89,46; p = 0,02). The multivariated analysis didn’t exhibited significant association between different clinical manifestations and specific diseases. Conclusions: In autopsies of patients with PTE, the most prevalent disease was neoplasy. The most associated histological finding was PE. The most frequent clinical manifestation was ARF. We noticed important relation between COPD an LPIP. ARF was positively related to PE, AH and DAD; as well HI to AH and DAD.