During a medico-legal autopsy, a pathologist incises the heart chambers and finds a dark red mass attached to the endocardium. On sectioning, the mass has a rough, laminated surface and is firmly attached to the endocardium. The most likely diagnosis is:
- A Postmortem clot
- B Red currant jelly clot
- C Thrombus ✓
- D Vegetation
Correct answer: C. Thrombus
Explanation
A postmortem clot is smooth, rubbery, and unattached, often resembling red currant jelly (dark, moist, homogeneous) or chicken fat (pale, dry, layered). An antemortem thrombus, however, is dry, firm, rough, and laminated with lines of Zahn, and it is firmly attached to the endocardium or vessel wall due to endothelial injury and activation of the coagulation cascade before death. The rough, laminated, firmly attached nature described is pathognomonic for a thrombus. A red currant jelly clot (B) is a type of postmortem clot that is smooth and unattached.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.