Atherosclerosis Case Studies


CASE 4:


Clinical History:

Several months following a myocardial infarction, a 30-year-old man with familial hypercholesterolemia (total serum cholesterol 550 mg/dL) noted left upper quadrant pain. He had recovered from the MI, but subsequently had markedly decreased exercise tolerance.

Images 18 and 19 demonstrate the wall of the left ventricle, which is thin following the infarction and scar formation. Grossly, this wall bulged out (forming an aneurysm) and was essentially just fibrous scar following healing from the myocardial infarction. Thrombus of various ages is present in this aneurysm.

  1. Describe and name the lesion present in the spleen.

    2. The spleen shows areas of ischemic necrosis (pale red areas with loss of nuclear detail) that represent recent infarction.

  2. What would cause such a lesion?

    3. An embolus could do this. Some sections actually show an embolus in a small artery next to the infarct.

  3. How does this relate to the myocardial infarction with subsequent aneurysm?

    4. An aneurysm represents non-functional heart wall with abnormal blood flow and stasis that promotes formation of mural (on the wall) thrombus. Portions of such a thrombus can break off and embolize out the arterial circulation.

  4. What are potential complications?

    5. The complications would include embolization with infarction of spleen, kidney, brain, or possibly other organs.