Knot in a pulmonary thromboembolus

Aim To describe an unusual morphological appearance of a pulmonary thromboembolus. Case report An adult male was admitted following a collapse at home and certified dead soon after. There was no past history of thromboembolic predisposition, risk or phenomena apart from a BMI of 34, cigarette smoking and recent discharge from hospital following a chest infection. Postmortem findings were those of death due a pulmonary thromboembolus complicating deep (calf) vein thrombosis. Unusually and unexpectedly, a knot was found in the leading (head) portion of this thromboembolus. Conclusion We describe the first reported case of a knot in a thromboembolus and speculate that this could only have occurred in the larger veins or during its course through the right side of the heart.