ST elevation myocardial infarction case study five

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Case 5: Mural Thrombus

Clinical Summary

A 67-year-old female was transferred to the hospital from a nursing home in a comatose state.

Physical findings on examination were compatible with brain stem infarction.

On the fourth hospital day, an electrocardiogram revealed changes compatible with anterior myocardial infarction.

The patient remained comatose with quadriplegia and died on the 16th day of hospital stay.

Autopsy Findings

Examination of the brain revealed extensive infarction involving the midbrain and cerebellum with complete occlusion of the upper one-half of the basilar artery; there was also extensive coronary artery atherosclerosis.

A large aneurysm of the left ventricle was present; this was filled with mural thrombus.

Extensive infarction of the lateral and posterior portions of the left ventricular wall toward the base of the heart was also found.

Histopathological Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

This is a gross photograph of the heart from this case demonstrating the well-formed thrombus (arrow) tightly attached to the myocardium near the apex of the left ventricle.

This is a low-power photomicrograph of the thrombus (1) attached to the myocardium (2).

This higher-power photomicrograph shows the border between the thrombus on the right (1) and the endocardium on the left (2). There is a line of inflammatory cells at this interface (arrow).

This is a high-power photomicrograph of the border zone between the thrombus (1) and the endocardium (2). In this region there is less inflammation at the border zone.

This photomicrograph illustrates the layered effect of the thrombus.

This is a higher-power photomicrograph of the thrombus. Note the pale regions which contain primarily platelets (degranulated platelets) with some fibrin (1), and the red areas which contain RBCs, some leukocytes, and fibrin(2).

This high-power photomicrograph of thrombus demonstrates more clearly the components of the layers--the pale regions which contain primarily platelets (degranulated platelets) with some fibrin (1), and the red areas which contain RBCs, some leukocytes, and fibrin (2).