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Pulmonary infarction, myocardial infarction, and acute disseminated intravascular coagulation
F J Thomson1, E W Benbow, R F McMahon
1Department of Medicine for the Elderly, Manchester Royal Infirmary.
Insights
Pulmonary embolism can cause severe disseminated intravascular coagulation (DIC), leading to fatal outcomes in elderly patients. Early diagnosis of pulmonary embolism is crucial to prevent irreversible DIC progression.
Area of Science:
- Cardiology
- Pulmonology
- Hematology
Background:
- Disseminated intravascular coagulation (DIC) is typically a consequence, not a cause, of organ damage.
- Pulmonary and myocardial damage are recognized manifestations of DIC.
Observation:
- Three elderly patients presented with severe DIC.
- The underlying cause of DIC in these cases was pulmonary and myocardial infarction.
- Necropsy revealed extensive pulmonary emboli, pulmonary infarcts, and ventricular aneurysms with thrombus.
Findings:
- Severe DIC can be directly caused by pulmonary and myocardial infarction.
- Pulmonary embolism is a critical underlying pathology in such cases.
- Outcomes were fatal in all reported cases.
Implications:
- Clinicians must maintain a high index of suspicion for pulmonary embolism in elderly patients with severe DIC.
- Prompt diagnosis and treatment of pulmonary embolism may prevent irreversible DIC.
- This highlights a rare but critical etiology for DIC in geriatric patients.
Abstract:
Pulmonary and myocardial damage are frequently cited as manifestations of disseminated intravascular coagulation (DIC), but rarely as causes. Three elderly cases of severe DIC due to pulmonary and myocardial infarction are reported. All three patients died. Necropsy showed extensive pulmonary emboli in each case with large pulmonary infarcts in cases 1 and 2 and a ventricular aneurysm containing thrombus in cases 2 and 3. Early diagnosis and treatment of pulmonary embolism requires a high degree of clinical suspicion but may prevent progression to the irreversible stage of severe DIC.