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Aper T, Simanowski J. Diagnostic and surgical treatment of the thrombophlebitis in the saphenofemoral junction. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2009; 30:180-184. [PMID: 19340728 DOI: 10.1055/s-0028-1109308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE This retrospective study reports on the diagnostic and surgical treatment of 10 patients with ascending thrombophlebitis in the proximal great saphenous vein with free-floating thrombi reaching into the common femoral vein. MATERIALS AND METHODS 10 patients were operated in our clinic for thrombophlebitis with free-floating thrombi in the saphenofemoral junction. Diagnosis of free-floating thrombi was made by B-mode and color-coded duplex ultrasound examination. Surgical thrombectomy was performed immediately. RESULTS No operative complications were observed, while 5 of 10 patients sustained preoperative pulmonary embolism. After successful thrombectomy and perioperative systemic heparinization, patients who had no PE and no thrombophilic disorders were discharged without any further anticoagulant therapy. CONCLUSION The results of our retrospective study show that patients with an ascending thrombophlebitis should undergo ultrasound examination to detect free-floating thrombi reaching into the deep venous system. In case of free-floating thrombi, immediate surgical thrombectomy, which is safe and provides rapid recovery from symptoms, is indicated.
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77
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Selishchev VV, Hardubeĭ II, Svyrydov VO, Vatsuro MF. [Active radical surgical tactics in acute varicothrombophlebitis of the lower extremities]. KLINICHNA KHIRURHIIA 2009:30-31. [PMID: 19957731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The experience of surgical treatment of 170 patients for an acute varicothrombophlebitis of the lower extremities subcutaneous veins was summarized. There was proved the efficacy and safety of application of an acute radical surgical tactics for prophylaxis of the pulmonary artery thromboembolism and for radical treatment of varicose disease as well.
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78
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Mohsin N, Budruddin M, Amitabh J, Ehab M, Abbas P. Fatal acute purulent pericarditis in a patient with renal transplant: a case report. EXP CLIN TRANSPLANT 2009; 7:62-65. [PMID: 19364316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Acute purulent pericarditis is a lifethreatening disease, although it is becoming uncommon in the era of antibiotics. MATERIALS AND METHODS We present a case of fatal acute massive purulent pericarditis in a kidney transplant recipient. RESULTS A 46-year-old woman had an unrelated commercial renal transplant in 2003. She had a history of diabetes mellitus and hepatitis C infection. Kaposi sarcoma developed in the posttransplant period. Her last admission was prompted by the development of acute rejection confirmed by transplant biopsy, and she was treated with intravenous methylprednisolone. Three days before her death, thrombophlebitis of the right forearm was noted. We postulate that this could have been the source of the fulminant purulent pericarditis, as the organism in the pericardial fluid was Staphylococcus aureus, a common pathogen in thrombophlebitis. She was initially resuscitated after cardiac arrest but died shortly after. CONCLUSIONS Severe purulent pericarditis in the immunocompromised patient can occur abruptly. The source of infection may show minimal signs and symptoms. Thrombophlebitis and other apparently minor infections should not be overlooked in such patients.
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79
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Herity NA, Dalzell GW. Venous thrombosis causing arterial embolization to the same limb through a patent foramen ovale. Clin Cardiol 2009; 20:893-6. [PMID: 9377829 PMCID: PMC6655789 DOI: 10.1002/clc.4960201020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We describe a patient who presented with acute ischemia affecting the left lower limb. Because a transthoracic echocardiogram was abnormal, a transesophageal study was arranged. This demonstrated an atrial septal aneurysm and right-to-left shunting of contrast, raising the possibility of paradoxical embolism. The diagnosis was confirmed by contrast venography, which showed extensive thrombosis in the deep veins of the left thigh, and a ventilation-perfusion scan which was consistent with multiple pulmonary emboli. Among the lessons from this case was the finding that in patients with arterial embolism the likely origin of the embolus should be considered and, in the absence of common risk factors (atrial fibrillation, rheumatic heart disease, left ventricular dilatation, widespread atheroma), occult venous thrombosis and a right-to-left shunt should be sought. In this select group of patients, transesophageal echocardiography is significantly more sensitive than transthoracic study and should be the investigation of choice. Second, in the patient described in this report the clinical signs of deep venous thrombosis (DVT) were masked by the more prominent features of acute arterial ischemia. Without the incidental echocardiographic abnormality, it is likely that the important diagnoses of DVT, pulmonary embolism, and paradoxical embolism would not have been made.
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80
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Jerkic Z, Karic A, Karic A. Clinically silent deep vein thrombosis in patients with superficial thrombophlebitis and varicose veins at legs. MEDICINSKI ARHIV 2009; 63:284-287. [PMID: 20380131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although superficial thrombophlebitis is a common disorder until recently it was considered as benign disorder. Also it is associated with varicose vein at legs and it was treated effectively with conservative methods, walking and non-steroid anti-inflammatory drugs. Aims of our investigation were: determine frequency of clinically silent deep vein thrombosis at legs in patient with and without superficial thrombophlebitis, determine correlation between superficial thrombophlebitis and deep vein thrombosis regardless of localization of superficial thrombophlebitis in superficial veins of legs and determine adequacy and safety vein phlebography in early diagnosis clinically silent deep vein thrombosis in patients with superficial thrombophlebitis. Using flebography in prospective study was evaluated incidence of clinically silent deep vein thrombosis in 92 patients with varicose veins at legs. By phlebograpy in patients with varicose veins at legs and superficial thrombophlebitis at legs and without clinical signs of DVT at legs of the 49 patients we detected DVT in 12 patients (24, 48%), in three male and nine female. We detected localization of DVT in ilijacofemoral junction in 4,08% patients, although localization of DVT in femoropopliteal region was observed in 6, 12% patients and localization in crural region was in 14.28% patients. Localization of DVT at legs was detected in iliac vein in 16.66% patients, in femoral vein in 25% patients, popliteal vein 8.33% patients, anterior tibial vein 16.66%, posterior tibial vein in 25% and crural veins 8.33% patients. Also we deduced significant difference between two group of patients (chi2 = 10, 76). Such result proves thesis that in most patients with superficial thrombophlebitis and varicose veins is possibility of developing of DVT.
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81
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Tuma J. [Pain in the right lower leg -- CME-Ultrasonography 25]. PRAXIS 2008; 97:1331. [PMID: 19085843 DOI: 10.1024/1661-8157.97.25.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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82
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Chalazonitis AN, Condilis N, Tzovara J, Ptohis N, Laspas F, Neofytou I, Feida E, Tzannetaki A. Lower limb veins color and spectral Doppler ultrasonography examination. An examination protocol. Ann Ital Chir 2008; 79:273-280. [PMID: 19093630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Lower extremity's venous pathology was traditionally investigated by intravenous venography. Nowadays Color Doppler flow imaging is widely accepted as a well established, noninvasive method for the evaluation of deep pelvic and lower extremity's venous system. The vast majority of authors conclude that the method can safely replace diagnostic venography in all patients with venous thrombosis, thrombophlebitis and valve or communicating veins insuffciency. Optimal performance of Color Doppler flow imaging as a diagnostic tool for the whole lower limb veins requires: Proper equipment specifications and settings. Knowledge of regional venous anatomy. Established examination protocols. Evaluation of morphological and functional findings. Documentation of the findings. All these steps are described as a sequence of guidelines, photographs and multiple ultrasonographic images. Our paper can be useful to all physicians or sonographers involved with color Doppler studies for the evaluation of lower limb venous diseases and abnormalities.
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83
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Nair V, Mohapatro AK, Sreedhar M, Indrajeet IK, Tewari AK, Anand AC, Mathew OP. A case of hereditary protein S deficiency presenting with cerebral sinus venous thrombosis and deep vein thrombosis at high altitude. Acta Haematol 2008; 119:158-61. [PMID: 18434709 DOI: 10.1159/000126200] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 01/28/2008] [Indexed: 11/19/2022]
Abstract
A 35-year-old healthy male with no history of any past medical illness developed severe headache, vomiting and drowsiness while at high altitude (4,572 m) in the eastern Himalayan ranges. He was evacuated to a tertiary-care hospital where he was diagnosed to have cerebral sinus venous thrombosis (CSVT) on magnetic resonance imaging, with deep vein thrombosis (DVT) of his right popliteo-femoral vein on color Doppler study. Investigation for thrombophilia revealed protein S (PS) deficiency in this patient. Family screening revealed low levels of PS in two elder brothers. One brother had a history of 'stroke in young' at the age of 20 years with the other being asymptomatic. This established the hereditary nature of PS deficiency. We are not aware of any previously published report on hereditary PS deficiency combined with CSVT and DVT occurring at high altitude. However, 1 case of protein C deficiency with CSVT has been reported previously.
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84
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Rauschning W. [Report on 16 ruptures of popliteal cysts mimicking deep venous thrombosis (12 observations during one year) (author's transl)]. ZEITSCHRIFT FUR ORTHOPADIE UND IHRE GRENZGEBIETE 2008; 118:324-30. [PMID: 7415426 DOI: 10.1055/s-2008-1053513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The clinical symptoms and signs of 16 patients presenting with swelling and tenderness of the calf indicative of deep venous thrombosis are reported. Phlebography disclosed no venous obstruction in any case. Arthrography revealed dissecting or ruptured popliteal cysts in all patients. The differential diagnosis and the underlying disorders of the knee joint are discussed.
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85
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Evanchuk DM, Von Gehr A, Zehnder JL. Superficial venous thrombosis associated with congenital absence of the inferior vena cava and previous episode of deep venous thrombosis. Am J Hematol 2008; 83:250-2. [PMID: 17918250 DOI: 10.1002/ajh.21089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Congenital malformations of the inferior vena cava (IVC) are uncommon and may be associated with an increased risk of venous thrombosis. We report the case of a man with congenital absence of the IVC and remote history of deep venous thrombosis who now presents with severe abdominal wall superficial thrombophlebitis. To our knowledge, this is the first report of a patient with IVC absence who has developed both deep and superficial venous thromboses.
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86
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Sukovatykh BS, Belikov LN, Zaĭtsev VI, Sukovatykh MB. [Sclerotherapy of sapheno-femoral reflux of blood in patients with initial stages of varicose disease of the lower extremity veins]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 2008; 167:22-26. [PMID: 18411662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The results of ultrasonic investigation and the following phlebosclerosing treatment of an incompetent saphenofemoral anastomosis were analyzed in two groups of patients with initial stages of varicose disease of the lower extremity veins. The first group included 48 patients treated by injection-sclerosing therapy by the technology of "empty vein". The second group consisted of 82 patients treated by catheter sclerotherapy of the sapheno-femoral anastomosis. In the first group the treatment was effective in 73.1%, in the second group - in 91.5%. The terminal hemodynamic criteria of performing the injectional and catheter sclerotherapy were determined in elimination of high sapheno-femoral reflux of blood.
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Minaeva NK. [Diseases of veins in the elderly: stepwise treatment and rehabilitation]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 2008; 167:82-84. [PMID: 18411677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A specially developed card including 147 parameters was used in examination of 118 elderly phlebological patients. Pathology of the veins occurs in the elderly 5.4 times more often than in subjects younger than 60. A six-step system was developed for treatment of such patients: primary step, day hospital, specialized vascular and surgical unit, rehabilitation center, health resort treatment, dispensary examinations. Laboratory investigation of thrombophilic conditions, ultrasonic angioscanning and using minimally invasive methods of operative treatment should be introduced in the laboratory practice for the improvement of quality of life and prevention of complications.
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88
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Juárez Escalona I, Díaz Carandell A, Aboul-Hons Centenero S, Monner Diéguez A, Marí Roig A, Arranz Obispo C, Piulachs Clapera P, Lluch Salas JM, Cuscó Albors S, Sieira Gil R. Lemierre Syndrome associated with dental infections. Report of one case and review of the literature. Med Oral Patol Oral Cir Bucal 2007; 12:E394-6. [PMID: 17767106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The first publication on Lemierre Syndrome appears in 1936 by Lemierre. It is defined as an "oropharynx bacterial infection characterized by the thrombophlebitis in the internal jugular vein, derived in a systemic septic embolism". In 81% of the cases, the Fusobacterium necrophorum is the most frequent etiologic agent. Fever is the most common symptom, but it can depending on the primary infection, tonsillitis, mastoiditis or odontogenic infection. According to the literature the mortality is very low, but with a significant morbidity, that is why the diagnosis and early treatment is very important. The diagnosis it's clinical, even though the CT scan and other diagnosis methods (echography, MRI) help to determine the extent of the infection. It's necessary to administer the antibiotics endovenous at high dose, (keeping in mind that the most frequent micro organism is anaerobic), and vital support measures if necessary. We present a case report of Lemierre Syndrome associated to an odonthogenic infection caused by the 4.8 molar.
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89
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Garcia J, Aboujaoude R, Apuzzio J, Alvarez JR. Septic pelvic thrombophlebitis: diagnosis and management. Infect Dis Obstet Gynecol 2007; 2006:15614. [PMID: 17485796 PMCID: PMC1581461 DOI: 10.1155/idog/2006/15614] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Septic pelvic thrombophlebitis (SPT) was initially diagnosed and
described in the late 1800's. The entity had a high incidence and
mortality during this period of time, and a surgical therapeutic
approach was the treatment of choice. Since then, the diagnosis,
incidence, and management of the entity evolved. This evolution
followed the development of newer diagnostic tools such as
computed tomography (CT), magnetic resonance imaging (MRI), and a
better understanding of the pathophysiology of the disease. The
treatment of SPT has had significant changes as well, from a
surgical approach at the end of the 19th century to a
medical approach after the 1960's. By using an adequate
broad-spectrum antibiotic therapy, mortality has decreased.
However, controversy in the management of this entity remains
even till today.
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Nouira K, Bedioui H, Azaiez O, Belhiba H, Messaoud MB, Ksantini R, Jouini M, Menif E. Percutaneous Drainage of Suppurative Pylephlebitis Complicating Acute Pancreatitis. Cardiovasc Intervent Radiol 2007; 30:1242-4. [PMID: 17587080 DOI: 10.1007/s00270-007-9102-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Suppurative pylephlebitis is a rare condition with a significant mortality rate, ranging from 50% to 80%. We report a case of suppurative pylephlebitis complicating acute pancreatitis treated by percutaneous drainage in a 40-year-old woman. The patient had an uneventful recovery.
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91
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Kim BK, Lee SK. [A case of thrombophlebitis in superior mesenteric vein due to appendicitis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2007; 49:267-9. [PMID: 17525513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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92
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93
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Fain O, Rouaghe S, Stirnemann J. [Lemierre syndrome]. LA REVUE DU PRATICIEN 2007; 57:827. [PMID: 17633598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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94
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Ballesteros García MM, Gil Pons E, Medina Monzón C, Baquero Cano M, Martínez Gutiérrez A, Osé Palomares J. [Lemierre's syndrome]. An Pediatr (Barc) 2007; 66:417-8. [PMID: 17430721 DOI: 10.1157/13101249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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95
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Gillet JL, Ffrench P, Hanss M, Allaert FA, Chleir F. Valeur des D-dimères lors des thromboses veineuses superficielles des membres inférieurs. ACTA ACUST UNITED AC 2007; 32:90-5. [PMID: 17379463 DOI: 10.1016/j.jmv.2007.01.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 01/17/2007] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The negative predictive value of D-dimer (DD) assay in patients with venous thromboembolic disease is well established for deep vein thrombosis and pulmonary embolism. Little is known about the value of DD assay in patients with superficial thrombophlebitis (ST). The purpose of this study was to assess the value of DD assay in patients with ST of the lower limb. METHOD The study group was composed of 100 consecutive patients, irrespective of age. Patients with clinical manifestations suggestive of ST of the lower limbs with positive duplex color Doppler evidence confirming the diagnosis and DD assay results (Vidas D-Dimer Exclusion) within 24 hours were included in the study. Patients with thrombosis in another site in addition to the superficial vein of the lower limb, those taking anticoagulants for more than 48 hours, and those with a condition known to potentially elevate DD levels were excluded. The volume of the thrombus was determined echographically and reported as mean diameter and length. RESULTS Sixty-two women and 38 men were included. Mean age (+/- 5) was 58 years +/- 13.48 (range 18-90; median: 57). The ST involved the Great saphenous (n=74), the small saphenous (n=11) or another vein (n=15). Mean thrombus volume was 4453 mm(3) +/- 7101 (range 94-38484; median: 1751). Mean DD level was 829 ng/ml +/- 516.72 (range 100-2567; median: 715.5). DD assay was negative (<500 ng/ml) in 32 patients (32%) and positive in 68 (68%). For these three items, there was no significant difference between ST with and without varicose veins. DD assay was always positive (>or=500 ng/ml) in all patients aged over 70 years (n=22). In patients aged less than 70 years (n=78), DD assay was positive in 46 (59%) and negative in 32 (41%). DD level was positively correlated with thrombus volume in patients aged less than 70 years (P<0.0001). ROC analysis, sensitivity as a function of specificity by thrombus volume for the entire population, determined the usefulness of a negative DD assay. Considering the critical threshold at 5914 mm(3), sensitivity was 1.0 (95CI 0.89-1.0), with 0.29 specificity (95CI 0.19-0.42), 1.00 negative predictive value and 0.75 positive predictive value. However, the thrombus volume was less than this threshold value in three of the nine cases of ST with extension to the terminal portion of the saphenous. CONCLUSION A positive DD assay was observed in 68% of patients with ST, with no significant difference with or without varicose veins. The test was positive in all patients aged over 70 years and in 59% of those aged under 70 years. There was a correlation between DD level and thrombus volume, yielding a threshold volume (5914 m(3)) above which all DD tests were positive. Nevertheless, this threshold volume was too great to include all ST extending to the terminal portion of the saphenous. Measurement of DD level is thus not contributive to the diagnosis of ST.
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Jiménez D, Gómez M, Herrero R, Lapresa E, Díaz G, Lanzara L, Escobar C, Vicente A, Gaudó J, Máiz L, Sueiro A. [Thromboembolic events in patients after a negative computed tomography pulmonary angiogram: A retrospective study of 165 patients]. Arch Bronconeumol 2007; 42:344-8. [PMID: 16945265 DOI: 10.1016/s1579-2129(06)60544-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the value of computed tomography (CT) angiography of the chest as a diagnostic test to exclude pulmonary embolism and to assess compliance with diagnostic protocols for thromboembolic disease. PATIENTS AND METHODS We retrospectively studied patients who underwent CT angiography of the chest because of suspected pulmonary embolism in 2004. All the patients were followed for 3 months. The percentage of patients diagnosed with a thromboembolic event based on an objective test during the follow-up period was determined. We analyzed the percentage of patients with a negative CT angiogram on whom additional diagnostic tests (ultrasound of the lower limbs and/or ventilation-perfusion lung scintigraphy) were performed. RESULTS One hundred sixty-five patients underwent CT angiography of the chest because of suspected pulmonary embolism in 2004. Four of the patients were excluded from the study because they were on chronic anticoagulation therapy and a further 2 were excluded because they had a life expectancy of under 3 months. Of the remaining 159 patients, 60 had CT angiograms that were interpreted as high probability for pulmonary embolism (prevalence of 38%). Thirty-nine of the 99 patients with a negative CT angiogram experienced an objectively confirmed thromboembolic event (63% sensitivity; 95% confidence interval, 53%-73%). Other diagnostic tests were not performed in 46% of the cases. CONCLUSIONS In our setting, a negative single-detector helical CT angiogram was not sensitive enough to exclude the diagnosis of pulmonary embolism. Furthermore, compliance with internationally accepted diagnostic protocols was far from optimal.
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Páramo JA, de Gaona ER, García R, Rodríguez P, Lecumberri R. [Diagnosis and management of deep venous thrombosis]. REVISTA DE MEDICINA DE LA UNIVERSIDAD DE NAVARRA 2007; 51:13-7. [PMID: 17555115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. Currently, an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasonography imaging allows for safe and convenient estimation of suspected lower-limb thrombosis. The mainstay of treatment is anticoagulation therapy. The use of low-molecular-weight heparin or pentasaccharide (fondaparinux) allows for outpatient management of most patients with DVT. The duration of anticoagulation depends on whether the primary event was idiopathic or secondary to a transient risk factor. Interventions such as thrombolysis and placement of inferior vena cava filter are reserved for special situations.
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99
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Perrin MA, Jankowski A, Righini C, Boubagra K, Coulomb M, Ferretti G. Syndrome de Lemierre : apport de l’imagerie. ACTA ACUST UNITED AC 2007; 88:65-8. [PMID: 17299369 DOI: 10.1016/s0221-0363(07)89791-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lemierre syndrome is a septic thrombosis of the internal jugular vein with pulmonary abscesses secondary to untreated pharyngotonsillitis due to anaerobic bacteria. It occurs in young, previously healthy patients and leads to life-threatening consequences if not treated. We illustrate the value of imaging and particularly cervical and thoracic CT in a report of three recent cases.
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100
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Singaporewalla RM, Clarke MJ, Krishnan PU, Tan DEL. Is this a variant of Lemierre's syndrome? Singapore Med J 2006; 47:1092-5. [PMID: 17139410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Lemierre's syndrome is an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein (IJV). It is classically anaerobic in origin and Fusobacterium necrophorum is the commonest pathogen. We report an unusual variant of this condition in a 68-year-man with uncontrolled diabetes mellitus who presented with extensive cellulitis of the left neck. No primary oropharyngeal sepsis was detected. Neck radiographs revealed soft tissue gas and computed tomography confirmed neck space infection with gas formation and complete thrombosis of the left IJV. Klebsiella pneumoniae was isolated from the fluid, tissue and blood samples. Repeated debridement was required until complete healing. Computed tomography of the neck at six months showed resolution of infection, although the vein remained thrombosed. Although the radiological features resemble Lemierre's syndrome, this case differs from it in the absence of oropharyngeal sepsis and presence of background diabetes mellitus. The isolation of Klebsiella pneumoniae as a cause has not been previously described.
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