VENOUS THROMBOSIS AND PULMONARY-EMBOLISM - A STUDY OF 5039 AUTOPSIES

The frequency and the localisation pattern of venous thrombosis and subsequent pulmonary embolism detected postmortem was studied by reviewing 5039 autopsy records from 1975 through 1980 and from 1987/88 of two university hospitals. The autopsy procedure was identical in both study periods. Thrombosis was documented overall in 34.2% with a slight increase from the first to the second series. Taking in account the cases of pulmonary embolism without detected source, the thrombosis rate was 42.6%. The rate of cases with thrombi in the vena cava superior system almost doubled (1975: 9.2%, 1987/88: 17.0%; p < 0.05). Regarding the list of thrombus localisations the right internal jugular vein (16.9%) was second only to the left femoral vein (17.8%) in 1987/88. Pulmonary emboli were seen in 1500 of 5039 autopsies (29.8%); in 59.4% the source was found in the lower venous tree, in 12.6% in the upper venous tree. In 28.0% no source could be detected. In these cases we supposed a complete detachment of thrombi from the lower venous tree to be the most likely reason. In 628 of the 1500 cases (42.5%) pulmonary embolism was classified as fatal. Both rates, for total pulmonary embolism and for fatal thrombembolism showed a small, but significant decrease during the study period. In 8.3% (52/628) the source of fatal pulmonary emboli was situated in the upper venous tree including the right heart. This means that 10.2% (52/512) of all cases with isolated thrombosis in the vena cava superior system were associated with fatal pulmonary embolism. Venous thrombosis and pulmonary embolism are still frequent findings at autopsy. In the past thrombembolism originating from upper vein thrombosis has not been thought to be an important complication. Our data provide evidence that it though rarely occurs, probably due to the widespread use of central venous catheters.