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Objective To investigate the incidence of in situ thrombosis of small pulmonary arteries and arterioles during the exacerbation stage of chronic cor pulmonale.Methods 49 autopsy cases died from the exacerbation of chronic cor pulmonale were chosen as the study group, while 103 other autopsy cases without chronic cor pulmonale and disseminated intravascular coagulation (DIC) as control group. Morphologic and morphometric studies were taken on lung tissues and other organs with focus on the thrombi in small pulmonary arteries and arterioles.Results 44 cases of the study group had multiple thrombi in small pulmonary arteries and arterioles, the incidence is 89.8%, and in 9 of them, thrombi in proximal pulmonary arteries co-existed, the incidence is 18.4%. 80% of the thrombi existed in pulmonary arterioles. In the control group, only 3 cases had thrombi in small pulmonary arteries and arterioles, the incidence is 2.9%. All thrombi adhered to endangium, implying that they were in situ thrombi. No intravascular thrombosis was found in other organs. X2 test showed that the incidence of thrombosis and the number of thrombi in small pulmonary arteries and arterioles in cases with chronic cor pulmonale were significantly higher than those of the control group (P<0.01).Conclusions Multiple in situ thrombosis in small pulmonary arteries and arterioles is a prominent and common pathological change during the exacerbation stage of chronic cor pulmonale. The study suggests a new diagnostic and therapeutic concept and gives a morphological and theoretical basis for the clinical application of anticoagulants or even the thrombolytic agents for the cases of chronic cor pulmonale in the exacerbation stage.