Let's talk about massive blood clots (today's news)

General Questions
#1

There’s a video on the CNN website that shows a massive blood clot being pulled out of a man’s chest (Tim Henderson is the name of *lucky soul).

Apparently, the belief is the clot probably formed in his leg after he broke it and had to keep it immobilized to heal.

It traveled to his lung, and caused a PE.

The questions:

It seems unlikely that the clot started that big in his leg, and snaked its way to his lung. I’m going to assume that it was much smaller, and somehow it grew by accretion once it hit the lung. Is that plausible?

The doctor is shown pulling the clot out in one piece. I never imagined a blood clot to be of a consistency that it could be pulled out like that. Do clots become that “sturdy” for lack of a better word.

I don’t have a direct link to the video, but it will likely be readily available for several days.

*Lucky that he survived that monster, that is.

#2

Not having seen the video, I can’t comment on the size, but we get clotted blood in the lab all the time, and it gets downright chunky and keeps clogging up the pipette tips. So, yeah.

#3

Sounds like pure unadulterated BS!

A link to a general site is usually totally useless. Noting to be found there via exhaustive searching.

#4

Um. Spingears, just click the Health tab, then look at “Free Video”. (Disclaimer: I am not a doctor, just a student of web usability.)

#5

Not having the proper Windows Player (although I do…stupid website!) I can’t view the video. Instead, I’ll have to regale you with a TMI story of my own.

Back in my early days of studying herbal medicine, my husband started getting frequent and fairly severe nosebleeds. A couple of times a day. They were pretty alarming, but begging, nagging, cajoling and generally being a pain in the ass could not persuade him to go to the doctor. So he’d spend 10 or 20 minutes bent over the toilet, nose running blood in a stream. Finally, he asked me for herbal help (but still wouldn’t go to the doctor.)

I was faced with a limited supply of herbals at home, not to mention a limited knowledge of said herbals. Knowing that yarrow is good at helping blood clot (but it’s usually used externally, for scraped knees and the like), I made an infusion of dried yarrow flowers, let it cool a bit, strained it and soaked a handkerchief in the liquid. I then told him to shove it up his nostril. He did.

Two minutes later, he made a very odd face. He pulled out the handkerchief, along with a SEVEN INCH LONG BLOOD CLOT the shape of his nasal passages. It was like a piece of raw liver, it was that firm! :eek:

So yes, they can be quite firm and easily handled.

#6

I clicked on video, then in the search box, typed ‘clot’. First result.

#7

"HEALTH
• Man survives massive blood clot (1:45)
• Suit: Burned by sunscreen labels? (7:31)
• Health Minute: Fruit (1:09) "

RESULT of clicking on “Man survice massive blood clot (1:45)” link:

"404 Error
The page you requested cannot be found. The page you are looking for might have been removed, had its name changed, or is temporarily unavailable.

Please try the following:
• If you typed the page address in the Address bar, make sure that it is spelled correctly.
• Open the www.cnn.com home page and look for links to the information you want.
• Use the navigation bar on the left to find the link you are looking for.
• Click the Back button to try another link.
• Enter a term in the search form below to look for information on CNN sites or the Internet."

OK
So now what?

#8

I saw the video clip; it was apparently taken using the surgeon’s cell phone during the operation. The reporter stated that the clot began behind the man’s knee before breaking loose. It is possible that it lodged in one or more other places before going to his pulmonary arteries; in the femoral or pelvic veins or the inferior vena cava, for example. The clot could have expanded anywhere along its course to the lung; there was no doubt a constant process of simultaneous formation and breakdown. It is unusual for surgery to be needed to remove a PE; normally the PE is either small enough to be treated with blood thinners, or it is so large as to be rapidly fatal. In only a small number of patients is the clot so severe that medical therapy can’t be given time to work, and the patient is still stable enough to make it to the operating room.

The clot that is seen in the video clip is pretty damn big, no doubt about it. The consistency looks right, too; the tangled proteins in a blood clot give it the consistency of jello or softboiled egg. Clots become more organized with the passage of time; the cellular portions can break down and leave a mature clot enriched in protein - a ‘pale’ clot. I’m sure that gabriela could comment on the gross appearance of clots of different ages.

Spingears, on what do you base your impression that this is pure unadulterated BS?

#9

Nope, wrong answer, spingears.

Huge clots can form in the deep venous systems of the lower extremities and break free to travel to the lungs. It happens a lot. It’s fatal a lot, too.

#10

Because the video seems to be missing, can you expound on “pretty damn big”? An inch long? Five? 10? Bigger than a bread box?

#11

Hell, I’ve pulled an 8 inch long clot out of a guy’s nose before. It was about a quarter to a third of an inch in diameter. And I’ve seen clots the size of grapefruit get removed from abdomens during surgery.

Maybe gabriela will tell us more about the clots of the dead! :slight_smile:

#12

I think gabriela could make a fortune setting up a site about her experiences. Can’t find a medical thread without someone calling her. :stuck_out_tongue:

As for the the topic at hand…let’s just say most women have experienced the expelling of a massive blood clot at some point during their cycle.

#13

I thought of that at first, too. But the fluid expelled during menses isn’t exactly blood. It’s actually liquified endometrial tissue, only some of which is actual blood. We just call it “blood” 'cause it’s easier.

#14

Try here for the clip from the local news station.

If that doesn’t work: the clot was about as big around as an index finger and maybe 12-14 inches long. Not world-class in terms of absolute size (avulsed spleen, anyone? Perhaps a leaking AAA?), but very impressive for being pulled out of the pulmonary artery (and heart? and cava?) of a living human being.

#15

You’d have to tie me down to do that. I’ve had nasal surgery, and I’m getting a big case of heebie-jeebies from the memories of having big things (splints and sponges) pulled out of my nose.

#16

The patient found it rather refreshing, actually. Not only was the sensation of fullness relieved, but removing the clot (which was chewing up the blood’s coagulation factors) allowed his nosebleed to finally stop.

#17

Here’s the CNN clip

#18

I am a Cardiovascular Technologist, and spend much of my day looking for DVT (Deep Vein Thrombosis or Blood Clots) in various places of my patients.

They usually form in the lower leg as a result of injury, altered blood chemistry, or lack of mobility.

There are a few primary (deep) veins that run the length of the leg and can completely fill with thrombus (clot). It is conceivable that a clot could form in one of these “deep” veins in the leg and grow to fill the vein throughout the leg. For that matter, it could extend into the Inferior Vena Cava (large vein in the abdomen).

They usually start off as a very soft spongy texture. The longer they stay in the bloodstream the more rigid they become. Finally, if undisturbed, they will form a hard plaque like consistency that is firmly attached to the wall of the vein.

DVT’s are most dangerous when they are in their early stages of development. At this time they are very soft and poorly attached to the vessels. The biggest risk is for the DVT to dislodge and travel to the lungs and heart.

TL
RDCS, RVT

#19

Here is a link to an .html page for those having problems with the video.

Apparently the clot was more than a foot long and was lodged in his right pulmonary artery. I would assume it wasn’t in the pulmonary trunk and that is why he is still alive.

To the doctors on the board, is this likely to be due to a hereditary thrombotic disorder, or just sporadic? Will they likely test him for deficiencies of anticoagulant factors, or will he just be given heparin and only tested if this recurs?

#20

From Wikipedia, (Redirected from Deep venous thrombosis)

"Many factors are involved in the formation of a thrombus (clot). Virchow’s triad is a group of 3 factors that are known to affect clot formation: rate of flow, the consistency (thickness) of the blood, and qualities of the vessel wall. Among the many risk factors, immobilisation, female gender, use of oral contraceptives, tobacco usage and air travel (“economy class syndrome”, a combination of immobility and relative dehydration) are some of the better-known causes. Thrombophilia (tendency to develop thrombosis) often expresses itself with recurrent thromboses.

It is recognised that thrombi usually develop first in the calf veins, “growing” in the direction of flow of the vein. DVTs are distinguished as being above or below the popliteal vein. Very extensive DVTs can extend into the iliac veins or the inferior vena cava. The risk of pulmonary embolism is higher in the presence of more extensive clots."