An embolus is a detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its

point of origin

 In more than 95% of cases, PEs originate from leg

deep vein thromboses (DVTs)

Most pulmonary emboli (60% to 80%) are

clinically silent because they are small

Sudden death, right heart failure (cor pulmonale),

or cardiovascular collapse occurs when emboli obstruct 60% or more of the pulmonary circulation

 Embolic obstruction of medium-sized arteries

with subsequent vascular rupture can result in pulmonary hemorrhage but usually does not cause pulmonary infarction
Embolic obstruction of small end-arteriolar

pulmonary branches usually does result in hemorrhage or infarction

 Emboli in the arterial circulation.

Most (80%) arise from intracardiac mural thrombi

2/3 of which are associated with left ventricular

wall infarcts 1/4 with left atrial dilation and fibrillation The remainder originate from aortic aneurysms, thrombi on ulcerated atherosclerotic plaques, or fragmentation of a valvular vegetation

 Arterial emboli can travel to a wide variety of sites

Major sites :
lower extremities (75%) brain (10%) intestines, kidneys, spleen, and upper extremities

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 The consequences of embolization in a tissue

depend on:
its vulnerability to ischemia, the caliber of the occluded vessel, collateral blood supply

In general, arterial emboli cause infarction of the affected tissues

 after fractures of long

bones (which have fatty marrow) rarely in the setting of soft tissue trauma and burns characterized by pulmonary insufficiency, neurologic symptoms, anemia, and thrombocytopenia

 Gas bubbles within the circulation can coalesce to

form frothy masses that obstruct vascular flow (and cause distal ischemic injury).
Decompression sickness, occurs when individuals

experience sudden decreases in atmospheric pressure

Chronic form of decompression sickness is called

caisson disease

An infarct is an area of ischemic necrosis caused by occlusion of either the arterial supply or the venous drainage

 Myocardial infarction

Cerebral infarction
Pulmonary infarction Diabetic (gangrenous infarction)

 Thrombotic or embolic arterial occlusion

Other mechanism:
Local vasospasm Extrinsic vessel compression (eg.tumor)

Torsion of vessel (infark testis)

Vascular trauma Edema (compartment syndrome)

 Red infarcts
(1) with venous occlusions (e.g., ovary),
(2) in loose tissues (e.g., lung) (3) in tissues with dual circulations (4) in tissues previously congested by sluggish

venous outflow, (5) when flow is re-established to a site of previous arterial occlusion and necrosis (e.g., following angioplasty of an arterial obstruction).

 White infarcts
arterial occlusions in solid organs with end-arterial

circulation (e.g., heart, spleen, and kidney) where tissue density limits the seepage of blood from adjoining capillary beds into the necrotic area.

1) the nature of the vascular supply,

2) the rate at which an occlusion

develops, 3) vulnerability to hypoxia 4) the oxygen content of the blood.