Medial hypertrophy in patients with pulmonary embolism: anatomopathological study.
OBJECTIVE
To compare the arterial response of cases of acute and chronic embolism, seeking to associate ischemic pulmonary remodeling with progression to chronicity.


METHODS
Retrospective analysis of 61 necropsies of patients who died in the Instituto do Coração (31 cases of pulmonary embolism and 30 cases of acute myocardial infarction). Slides of pulmonary tissue were obtained from all cases and analyzed qualitative and quantitatively (medial thickness measurement).


RESULTS
Qualitative analysis enabled the differentiation between cases of embolism and the control group, thus characterizing the two groups and defining the adequate choice of the control group. The alterations predominated in patients with embolism (alveolar inflammation and edema, infarction, vasoconstriction, concentric intimal proliferation, presence of thrombus). Quantitative analysis demonstrated higher percent medial thickness in the cases of embolism than in the control group; among the cases of embolism, no differences in intra (acute--19.74 and chronic--20.04) and pre-acinar (acute--18.85 and chronic--18.68) arteries were observed.


CONCLUSIONS
The lack of difference among the groups with embolism and the higher values of percent medial thickness in the peripheral arteries allow the conclusion that the vascular response is more intense and starts in these arteries.
Instituto do Coração, Hospital das Clínicas, FM, USP, São Paulo, SP, Brasil. rarnoni@uol.com.br
Renato Tambellini
RT
Arnoni
Fábio Biscegli
FB
Jatene
Wanderley Marques
WM
Bernardo
Vera Demarchi
VD
Aiello
Tanas
T
Jatene
Rosângela
R
Monteiro
Lea Maria Macruz
LM
Demarchi
D000208:Acute Disease; D001344:Autopsy; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000209:etiology; D018450:Disease Progression; D004487:Edema / Q000209:etiology; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D007249:Inflammation / Q000209:etiology; D008168:Lung / Q000473:pathology*; D009203:Myocardial Infarction / Q000473:pathology*; D011651:Pulmonary Artery / Q000033:anatomy & histology / Q000648:ultrastructure*; D011655:Pulmonary Embolism / Q000150:complications / Q000473:pathology*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D017539:Tunica Intima / Q000473:pathology*