Pathology of Coronary Artery Embolism Derived From Mural Thrombus of Left Ventricle

An 88-year-old man was admitted due to acute myocardial infarction. Coronary angiography showed occlusion of the left anterior descending coronary artery (Figure A), and aspiration of thrombus improved blood flow to TIMI3 (Figure B). Electrocardiogram showed ST-T elevation with abnormal Q-wave sinus rhythm in chest leads. Aspirated material contained white thrombus (Figure C) and histology confirmed mixed fibrin and platelet thrombus without necrotic debris (Figure D). The patient died of cardiogenic shock and an autopsy was performed. The coronary artery was found to have adhesion of embolic material (Figure E–H). Multiple fresh and organized thromboemboli in the peripheral arteries were identified (Figure I). Gross heart analysis indicated old infarction in the septum (Figure J) with mural thrombus (Figure K). Aspirated material was histologically identical to the superficial septal thrombus. Repeated thromboembolism derived from cardiac cavity was suggested. Latent advanced gastric adenocarcinoma was identified (Figure L) and it was speculated that the complication of cancer accelerated the thrombus formation. Although rare, coronary embolism may be the first manifestation of underlying disease and, occasionally lethal.

Figure.

(A) Coronary angiography showing total occlusion of the left anterior descending artery. (B) Aspiration improved blood flow to TIMI3. (C) Aspirated material contains white thrombus, and (D) histology confirms fresh thrombus. (E–H) Coronary arteries demonstrate adhesion of organized thrombus in the lumen (arrows). (I) Multiple thromboemboli are identified in the peripheral coronary arteries (arrow). (J) Transverse section of the heart demonstrates old infarction in the septum (arrows); and mural thrombus is apparent (arrowheads). (K) Superficial thrombus of septum is identical to the aspirated material. (L) Latent gastric adenocarcinoma (arrows) was identified. (E–I,K) Masson’s trichrome. sep, septum; th, thrombus. Scale bars: D,E,G, 500 μm; I, 50 μm; K, 2,000 μm.

Disclosures

No conflicts of interest.