Imagine you are working on a team caring for a patient who is
recovering from a stroke she had two days prior. This stroke was
caused by an embolism that became lodged in the right anterior
cerebral artery. Using ultrasonography, it was discovered the embolism
likely originated from a deep vein thrombosis in the right popliteal vein.
This is perplexing, because you were taught that deep vein thromboses
in the lower extremities become lodged in pulmonary arterioles or
capillaries (they are not typically small enough to fit through those
vessels). What is a possible explanation for this finding? Please list the
route of flow and all the structures the embolism would pass through in
order to travel from the right popliteal vein to the right cerebral artery.
My patient's embolism is defined as an obstruction of an artery by a clot of
blood. It is caused by blood clots that travel to the lungs from deep veins in the
legs or other parts of the body. In this case the clot is in the brain (right anterior
cerebral artery) of my patient. Ultrasonography is a procedure that uses high-
energy sound waves to look at tissues and organs inside the body. This
imagining talked about Popliteal vein thrombosis where the clot originated from,
this happens when a blood clot blocks one of the blood vessels behind your
knees. I think a possible explanation for a clot in the right popliteal vein to travel
all the way up the right anterior cerebral artery is that the clot was brown down,
or a piece broke off. In the knee in the right popliteal vein the clot had a piece
break off from the pressure of blood or other causes. This tiny piece of clot
traveled from the right popliteal vein to the
Right femoral vein
Right external iliac vein
Right common iliac vein deoxygenated blood
Inferior vena cava
To the heart :
Right atrium
Tricuspids valve
Right ventricle
Pulmonary valve
Pulmonary trunk
Pulmonary arteries into lungs now oxygenated blood
Pulmonary vein
Left atrium
Mitral valve
Left ventricle
Aortic valve
Aortic arch
Right common carotid artery
Right internal carotid artery
And finally ending in the Right anterior cerebral artery. This tiny piece of blood
clot that traveled all the way up finally got stuck. Normally I would think the clot
would get stuck in the lungs that's why this is so unusual. I think the only way this
would be possible is if it broke into tiny, very tiny pieces and then reclotted in the
brain.
References
Deep vein thrombosis (DVT); symptoms, causes, treatment & prevention.
Cleveland Clinic. (n.d.).
Mayo Foundation for Medical Education and Research. (2020, June 13).
Pulmonary embolism. Mayo Clinic.
NCI Dictionary of Cancer terms. National Cancer Institute. (n.d.).
