Histological criteria for age determination of fatal venous thromboembolism

• Published in: International journal of legal medicine Vol. 132; no. 3; pp. 775 - 780
• Main Authors: Maffeis, Valeria, Nicolè, Lorenzo, Rago, Claudio, Fassina, Ambrogio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2018; Springer Nature B.V
• Subjects: Age; Antigens, CD - metabolism; Antigens, Differentiation, Myelomonocytic - metabolism; Autopsies; Blood clots; Case Report; Chronology; Criteria; Female; Forensic Medicine; Forensic pathology; Forensic Pathology - methods; Health risk assessment; Hemosiderin - metabolism; Histology; Humans; Immunohistochemistry; Macrophages - metabolism; Medical Law; Medicine & Public Health; Middle Aged; Neutrophils - metabolism; Peroxidase - metabolism; Postmortem Changes; Pulmonary Embolism - pathology; Pulmonary embolisms; Risk analysis; Thromboembolism; Thrombosis; Time Factors; Venous Thromboembolism - pathology; Venous Thrombosis - pathology; Pulmonary embolism; Thrombus age determination; Forensic pathology; Venous thromboembolism
• ISSN: 0937-9827; 1437-1596
• DOI: 10.1007/s00414-017-1705-4

In clinical and forensic practice, fatal thromboembolism is a major problem, particularly in a patient with no pre-existing risk factors. Out of a recent case, we discuss here the criteria for age determination of venous thrombi in a 46-year-old female with concomitant deep vein thrombosis in the common femoral left vein and in the right heart and fatal pulmonary embolism. At autopsy, histopathology and immunohistochemistry evidenced the different composition of thrombi in different sites and permitted to define the different timing. We discuss and review the histopathological criteria for age estimation of venous thrombi starting from the case and in relation to the acquired and inherited thrombophilic risk factors. The appropriateness of clinical management is also discussed.