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解剖实验室如何促进学习的整合:腹主动脉瘤合并巨大心内血栓的病例:一项罕见的尸体发现。

How the dissection laboratory facilitates integration of learning: presence of abdominal aortic aneurysm with a large intracardiac thrombus: a rare cadaver finding.

作者信息

Alyafi Motaz M, Alamodi Abdulhadi A, Juurlink Bernhard H J, Ganguly Paul

机构信息

College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.

出版信息

Int J Angiol. 2012 Jun;21(2):77-80. doi: 10.1055/s-0032-1315625.

Abstract

There is a debate among medical education experts on the application of dissection or prosection for learning anatomy. However, the literature reveals that the majority of published articles are in favor of dissection. In this article, we present a case of an abdominal aortic aneurysm (AAA) with intracardiac thrombus in a cadaver on routine dissection. We will discuss possible explanations for such finding and provide some insight into how this finding can support the significance of the cadaver-based teaching of anatomy of the medical students. Initially, the abdomen was dissected and exposed to study the abdominal structures in an anatomy class and later the thoracic region was dissected and all the clinical abnormalities were examined and documented. Autopsy of the clot was obtained for histopathology analysis. The intracardiac thrombus was present in the right atrium characterized by its projection into the superior vena cava, inferior vena cava, and the right ventricle. The AAA was extensive and inferior to the renal arteries constricting the entire inferior vena cava. Moreover, associated findings included presence of numerous collaterals in the thoracic region near the superior vena cava; histological examination of the clot showed extensive population of leukocytes. There were enlarged mediastinal lymph nodes. Our cadaver showed an excellent model for integrating between clinical anatomy and pathology by triggering medical students to think of normal and abnormal structures: often called "thinking outside the box." Such an effort might help them in developing their thought processes and future medical careers.

摘要

医学教育专家们就是否应用解剖或局部解剖来学习解剖学存在争议。然而,文献表明,大多数已发表的文章支持解剖。在本文中,我们展示了一例在常规解剖尸体时发现的腹主动脉瘤(AAA)合并心内血栓的病例。我们将讨论对此发现的可能解释,并深入探讨这一发现如何能够支持以尸体为基础的医学生解剖学教学的重要性。最初,在解剖课上解剖腹部并暴露以研究腹部结构,随后解剖胸部区域并检查和记录所有临床异常情况。获取血栓进行组织病理学分析。心内血栓存在于右心房,其特征是延伸至上腔静脉、下腔静脉和右心室。腹主动脉瘤范围广泛,位于肾动脉下方,压迫整个下腔静脉。此外,相关发现包括上腔静脉附近胸部区域存在大量侧支;血栓的组织学检查显示有大量白细胞。纵隔淋巴结肿大。我们的尸体展示了一个将临床解剖学与病理学相结合的优秀模型,促使医学生思考正常和异常结构:这通常被称为“跳出框框思考”。这样的努力可能有助于他们发展思维过程和未来的医学职业生涯。

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