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Li X, Wu J, Fang F, Liu Y, Jiang W, Li G, Song J. Isolated gastric varices associated with antiphospholipid syndrome and protein S deficiency: a case report and review of the literature. J Int Med Res 2024; 52:3000605241240579. [PMID: 38603605 PMCID: PMC11010754 DOI: 10.1177/03000605241240579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/02/2024] [Indexed: 04/13/2024] Open
Abstract
The mortality rate of gastric varices bleeding can reach 20% within 6 weeks. Isolated gastric varices (IGVs) refer to gastric varices without esophageal varices and typically arise as a common complication of left portal hypertension. Although IGVs commonly form in the setting of splenic vein occlusion, the combination of antiphospholipid syndrome and protein S deficiency leading to splenic vein occlusion is rare. We herein present a case of a 28-year-old woman with intermittent epigastric pain and melena. She was diagnosed with antiphospholipid syndrome based on the triad of pregnancy morbidity, unexplained venous occlusion, and positive lupus anticoagulant. Laparoscopic splenectomy and pericardial devascularization were performed for the treatment of IGVs. During the 6-month postoperative follow-up, repeated endoscopy and contrast-enhanced computed tomography revealed disappearance of the IGVs. This is the first description of splenic vein occlusion associated with both antiphospholipid syndrome and protein S deficiency. We also provide a review of the etiology, clinical manifestations, diagnosis, and treatment methods of IGVs.
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Affiliation(s)
- Xueyan Li
- Department of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jiandi Wu
- Department of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Feifei Fang
- Department of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ying Liu
- Department of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wewei Jiang
- Department of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Gangping Li
- Department of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Song
- Department of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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2
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Trifoi M, Levine M, Kim A, Eden B, Albert A. Inferior vena cava thrombosis extension into the right atrium: An unusual case report of renal cell carcinoma. SAGE Open Med Case Rep 2023; 11:2050313X231204768. [PMID: 37811349 PMCID: PMC10559693 DOI: 10.1177/2050313x231204768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
Inferior vena cava filling defects are common findings on computed tomography and magnetic resonance imaging, and accurate determination of pseudo, benign, or malignant thrombus is essential for clinical management. Inferior vena cava thrombosis involvement extending into the right atrium is a rare presentation of renal cell carcinoma. The degree of inferior vena cava and right atrium involvement is critical in determining management and prognosis of patients. Inferior vena cava thrombosis surgical thrombectomy is often a risky procedure due to the intraoperative determination of inferior vena cava thrombosis involvement. Accurate recognition of inferior vena cava thrombosis with right atrial involvement is critical in determining appropriate treatment options and preoperative level of involvement for surgical intervention. This case features a unique presentation of inferior vena cava thrombosis in renal cell carcinoma with right atrial involvement.
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Affiliation(s)
- Mara Trifoi
- Penn State College of Medicine, Hershey, PA, USA
| | - Marc Levine
- Penn State College of Medicine, Hershey, PA, USA
| | - Andrew Kim
- Penn State College of Medicine, Hershey, PA, USA
| | - Brandon Eden
- Penn State College of Medicine, Hershey, PA, USA
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3
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Biscetti L, De Vanna G, Cresta E, Corbelli I, Gaetani L, Cupini L, Calabresi P, Sarchielli P. Headache and immunological/autoimmune disorders: a comprehensive review of available epidemiological evidence with insights on potential underlying mechanisms. J Neuroinflammation 2021; 18:259. [PMID: 34749743 PMCID: PMC8573865 DOI: 10.1186/s12974-021-02229-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 12/31/2022] Open
Abstract
Several lines of evidence support a role of the immune system in headache pathogenesis, with particular regard to migraine. Firstly, alterations in cytokine profile and in lymphocyte subsets have been reported in headache patients. Secondly, several genetic and environmental pathogenic factors seem to be frequently shared by headache and immunological/autoimmune diseases. Accordingly, immunological alterations in primary headaches, in particular in migraine, have been suggested to predispose some patients to the development of immunological and autoimmune diseases. On the other hand, pathogenic mechanisms underlying autoimmune disorders, in some cases, seem to favour the onset of headache. Therefore, an association between headache and immunological/autoimmune disorders has been thoroughly investigated in the last years. The knowledge of this possible association may have relevant implications in the clinical practice when deciding diagnostic and therapeutic approaches. The present review summarizes findings to date regarding the plausible relationship between headache and immunological/autoimmune disorders, starting from a description of immunological alteration of primary headaches, and moving onward to the evidence supporting a potential link between headache and each specific autoimmune/immunological disease.
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Affiliation(s)
- Leonardo Biscetti
- Istituto Nazionale di Riposo e Cura dell'Anziano a carattere scientifico, IRCSS- INRCA, Ancona, Italy
| | - Gioacchino De Vanna
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Cresta
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ilenia Corbelli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Letizia Cupini
- Headache Center, UOC Neurologia-Stroke Unit, Emergency Department, Ospedale S. Eugenio, Rome, Italy
| | - Paolo Calabresi
- Department of Neuroscience, Università Cattolica Sacro Cuore, Rome, Italy
| | - Paola Sarchielli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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4
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Lin HY, Lin CY, Shen MC. Review article inferior vena cava thrombosis: a case series of patients observed in Taiwan and literature review. Thromb J 2021; 19:43. [PMID: 34158063 PMCID: PMC8218556 DOI: 10.1186/s12959-021-00296-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
Inferior vena cava thrombosis (IVCT) is rare and can be under-recognized. However, the associated complications and mortality may be severe. We report the first case series of IVCT observed in Taiwan with a brief literature review. Eight Taiwanese patients with IVCT between May 2012 and December 2019 were enrolled in this study. Deep venous thrombosis (DVT, 8/8) and pulmonary embolism (5/8) were reported. Various risk factors were identified, including an unretrieved inferior vena cava (IVC) filter, pregnancy, surgery, presence of lupus of anticoagulants, essential thrombocythemia, antithrombin deficiency, and hemoglobin H disease. Of note, four of our patients experienced complete IVC thrombosis with bilateral lower extremity swelling (due to DVT) and abdominal wall superficial venous dilatation, while four other patients presented with partial IVCT and unilateral DVT. The etiology, clinical characteristics, presentations, diagnosis, and treatment of IVCT were reviewed.
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Affiliation(s)
- Hsuan-Yu Lin
- Division of Hematology/Oncology, Changhua Christian Hospital, Nanshiao St 135, Changhua City, Changhua County, Taiwan
| | - Ching-Yeh Lin
- Division of Hematology/Oncology, Changhua Christian Hospital, Nanshiao St 135, Changhua City, Changhua County, Taiwan
| | - Ming-Ching Shen
- Division of Hematology/Oncology, Changhua Christian Hospital, Nanshiao St 135, Changhua City, Changhua County, Taiwan. .,Department of Laboratory Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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5
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Gelman R, Kharouf F, Ishay Y, Gural A. Cold Agglutinin-Mediated Autoimmune Hemolytic Anemia in Association with Antiphospholipid Syndrome. Acta Haematol 2021; 144:693-697. [PMID: 34000726 DOI: 10.1159/000516295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/29/2021] [Indexed: 01/15/2023]
Abstract
Antiphospholipid syndrome and cold agglutinin-mediated autoimmune hemolytic anemia are 2 distinct immune-mediated hematologic disorders. While no clear association exists between these 2 entities, complement activation is known to occur in both of them. Herein, we report a unique case of cold agglutinin hemolytic anemia in a patient with a known primary antiphospholipid syndrome.
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Affiliation(s)
- Ram Gelman
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Fadi Kharouf
- Rheumatology Unit, Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yuval Ishay
- Department of Gastroenterology and Liver Diseases, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Alexander Gural
- Department of Hematology and Transfusion Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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6
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Hamet B, Durot C, Djelouah M, Adlani I, Marchal A, Arrivé L, Hoeffel C. Involvement of small bowel in systemic disease: CT and MR imaging finding. Clin Imaging 2020; 67:74-85. [PMID: 32526662 DOI: 10.1016/j.clinimag.2020.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/19/2022]
Abstract
Computerized tomography (CT) and magnetic resonance imaging (MRI), particularly MR Enterography, are the standard cross-sectional imaging modalities used to study small bowel involvement in a context of multiorgan disease. Clinical symptoms are generally nonspecific in such cases. Moreover, imaging findings of the different conditions often overlap. However, analysis of the location, distribution of the lesions on the small bowel wall, as well as of the rest of the bowel and of distant organs, may help narrow the spectrum of diagnoses of multiorgan conditions involving both the small bowel and other organs. The purpose of this presentation is to review and illustrate the CT and MRI features of small bowel involvement in systemic disease. Based on the underlying mechanism, we will categorize them as follows: congenital/hereditary, immunologic, infiltrative, vascular, infectious and miscellaneous.
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Affiliation(s)
- Blandine Hamet
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France.
| | - Carole Durot
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France.
| | - Manel Djelouah
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France.
| | - Ibrahim Adlani
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France.
| | - Aude Marchal
- Department of Pathology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France.
| | - Lionel Arrivé
- Department of Radiology, Saint Antoine Hospital, Assistance Publique-Hopitaux de Paris, Sorbonne University, France.
| | - Christine Hoeffel
- Department of Radiology, Centre Hospitalo-Universitaire de Reims, Reims 51092, France; Université de Reims Champagne Ardenne, CReSTIC EA 3804, 51097 Reims, France.
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7
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A rare case of laparoscopy towards SLE with lupus mesenteric vasculitis induced ascites. BMC Surg 2019; 19:73. [PMID: 31266494 PMCID: PMC6604445 DOI: 10.1186/s12893-019-0533-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 06/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background Diagnosis and management of acute abdomen secondary to systematic lupus erythematosus (SLE) has always been a clinical challenge. Case presentation A 21-year-old lady, with BMI 17.7, presented to our department with acute abdomen. Laparoscopy was carried out to exclude surgical emergency when conservative regimen failed. The patient revealed a history of purpuric changes and lupus test was positive for SLE. Conclusion Based on our experience, early laparoscopy to alleviate acute abdomen has shown to improve the prognosis of the patient.
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8
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Kadoya Y, Zen K, Oda Y, Matoba S. Successful Endovascular Treatment for Aortic Thrombosis Due to Primary Antiphospholipid Syndrome: A Case Report and Literature Review. Vasc Endovascular Surg 2018; 53:51-57. [PMID: 30092725 DOI: 10.1177/1538574418791355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 60-year-old man with a history of Raynaud's phenomenon presented with bilateral intermittent claudication and an ulcer on his right toe. The ankle-brachial index of the right and left legs was 0.77 and 0.75, respectively. Laboratory data showed prolongation of the activated partial thromboplastin time and a positive result on the lupus anticoagulant test. Computed tomography angiography revealed isolated infrarenal aortic stenosis with irregular surface and noncalcified plaques. Intravascular ultrasonography examination demonstrated a noncalcified, irregular, and mobile plaque, suggestive of abdominal aortic thrombosis. In addition to anticoagulant and dual antiplatelet therapy, endovascular treatment was performed. A total of three 40-mm-long balloon-expandable stents were successfully implanted on a 15-mm balloon. The final angiography showed good results except for minimal plaque shifting in the terminal aorta. Three months later, the ulcer resolved and a final diagnosis of primary antiphospholipid syndrome (APS) was made. Clinicians should recognize that APS can affect the abdominal aorta, leading to aortic thrombosis. Endovascular treatment may be the one good treatment option for this rare condition.
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Affiliation(s)
- Yoshito Kadoya
- 1 Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,2 Department of Cardiovascular Medicine, Kyotango City Yasaka Hospital, Kyoto, Japan
| | - Kan Zen
- 1 Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yohei Oda
- 2 Department of Cardiovascular Medicine, Kyotango City Yasaka Hospital, Kyoto, Japan
| | - Satoaki Matoba
- 1 Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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9
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Melas N, Haji Younes A, Lindberg R, Magnusson P. A case of extreme weight loss due to mesenteric ischemia and antiphospholipid syndrome. Clin Case Rep 2018; 6:1055-1059. [PMID: 29881563 PMCID: PMC5986042 DOI: 10.1002/ccr3.1524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 01/07/2023] Open
Abstract
Mesenteric ischemia and antiphospholipid syndrome is a rare combination but should be suspected as a differential diagnosis. This may be presented as diffuse abdominal pain typically after food intake, diarrhea, and weight loss. Early recognition is warranted, and nutrition, stenting, and anticoagulant treatments are indicated.
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Affiliation(s)
- Nikolaos Melas
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSE‐ 801 87Sweden
| | - Amil Haji Younes
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSE‐ 801 87Sweden
| | - Robert Lindberg
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSE‐ 801 87Sweden
| | - Peter Magnusson
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSE‐ 801 87Sweden
- Cardiology Research UnitDepartment of MedicineKarolinska InstitutetStockholmSE‐171 76Sweden
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10
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Harifi G, Nour-Eldine W, Noureldine MHA, Berjaoui MB, Kallas R, Khoury R, Uthman I, Al-Saleh J, Khamashta MA. Arterial stenosis in antiphospholipid syndrome: Update on the unrevealed mechanisms of an endothelial disease. Autoimmun Rev 2018; 17:256-266. [PMID: 29339317 DOI: 10.1016/j.autrev.2017.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/29/2017] [Indexed: 12/20/2022]
Abstract
First described in 1983, antiphospholipid syndrome (APS) is an autoimmune condition characterized by the occurrence of recurrent arterial and/or venous thrombosis, and/or pregnancy morbidity, in the setting of persistent presence of antiphospholipid antibodies (aPL). While thrombosis is the most well-known pathogenic mechanism in this disorder, the relevance of some other mechanisms such as arterial stenosis is being increasingly recognized. Arterial stenosis has been first described in the renal arteries in patients with APS, however intracranial and coeliac arteries can also be involved with various and treatable clinical manifestations. The underlying pathophysiology of this stenotic arterial vasculopathy is not fully understood but some recent studies revealed new insights into the molecular mechanism behind this endothelial cell activation in APS. In this review, we discuss these newly discovered mechanisms and highlight the diagnostic and therapeutic modalities of the APS related arterial stenosis.
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Affiliation(s)
- Ghita Harifi
- Dr Humeira Badsha Rheumatology Center, Dubai, United Arab Emirates.
| | - Wared Nour-Eldine
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unit 970, Paris-Cardiovascular Research Center, Paris, France; Université Paris-Descartes, Paris, France
| | | | - Mohammad Baker Berjaoui
- Department of Internal Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Romy Kallas
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Rita Khoury
- Department of Internal Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jamal Al-Saleh
- Division of Rheumatology, Department of Internal Medicine, Dubai Hospital, United Arab Emirates
| | - Munther A Khamashta
- Division of Rheumatology, Department of Internal Medicine, Dubai Hospital, United Arab Emirates
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11
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Saponjski J, Stojanovich L, Saponjski J, Mirilovic M, Saponjski D. Abdominal pain in patient with antiphospholipid syndrome-the role of MDCT angiography on visceral blood vessels. Immunol Res 2017; 65:1150-1155. [PMID: 29134567 DOI: 10.1007/s12026-017-8968-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disease defined by accelerated atherosclerosis, arterial and venous thrombosis, fetal loss, and the presence of antiphospholipid antibodies (aPL) in the serum and which leads to the occurrence of various vascular events. Nonspecific abdominal pain can be one of the symptoms due to changes on visceral blood vessels. The goal of our work is to show the results we obtained in multidetector computed tomography (MDCT) angiography examination of visceral arteries, comparing patients with primary antiphospholipid syndrome (PAPS) and secondary antiphospholipid syndrome (SAPS) with control group. In this study, we analyzed 50 patients with primary PAPS and 50 patients, with secondary SAPS. The results were compared to 50 patients in the control group. The groups were compared in terms of age, gender, and the most common risk factors except for the lipid status, since controls had significantly higher levels of cholesterol and triglycerides. The study was conducted on 64-MDCT, on which we analyzed quantitative and morphological characteristics of the blood vessel lesions. Patients from the control group had statistically significant elevation of cholesterol and triglyceride levels compared to the patients with SAPS and PAPS (p < 0.001 and p < 0.05). The results showed that the frequency of changes is statistically (p < 0.05 and p < 0.001) more common in patients with PAPS and SAPS than in the control group. Statistically significant difference between the groups was found in superior and inferior mesentery arteries. Analyzing the number of lesions, there was statistically high difference between the patients with one and two lesions than in patients with four or more lesions (p < 0.001), lower difference compared to the patients with three lesions (p < 0.01), while there was low, but yet statistically important difference between the patients with three lesions and those with five or more blood vessel lesions (p < 0.05). Analyzing percentage of diameter stenosis, we established that the lesions in the groups of 0-30% diameter stenosis (DS) and 30-50% DS in patients with PAPS (n = 42) and SAPS (n = 44) are more common than in the control group (n = 18, p < 0.05). Analyzing the qualitative characteristics of plaques, we established significantly higher frequency of soft tissue and mixed lesions than calcified ones in patients with PAPS and SAPS (p < 0.001; p < 0.05). Our study showed that the subclinical manifestation of the changes on visceral arteries is more common in patients with APS. Patients with abdominal pain were those with two or more lesions, and according to our results, majority had PAPS. Because of its safety and accuracy, the method of choice is MDCT angiography in monitoring the progression of disease.
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Affiliation(s)
- Jovica Saponjski
- Institute of Cardio-Vascular Diseases, Clinical Center of Serbia, Belgrade, Serbia.
| | - Ljudmila Stojanovich
- Internal Medicine, "Bezanijska Kosa", University Medical Center, Belgrade, Serbia
| | - Jelena Saponjski
- Centar for Nuclear Medicine and PET, Clinical Center of Serbia, Belgrade, Serbia
| | - Milorad Mirilovic
- Head of Institute for Statistic, Faculty of Veterinary Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusan Saponjski
- Center for radiology and MR, Clinical Center of Serbia, Belgrade, Serbia.
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12
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The role of MSCT angiography in early detection of lower limb arterial lesions in patients with antiphospholipid syndrome. Immunol Res 2017; 65:482-486. [DOI: 10.1007/s12026-016-8887-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Catastrophic antiphospholipid antibody syndrome presenting as severe ischaemic colitis. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:684-687. [PMID: 27939948 DOI: 10.1016/j.gastrohep.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022]
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14
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Noureldine MHA, Haydar AA, Berjawi A, Elnawar R, Sweid A, Khamashta MA, Hughes GRV, Uthman I. Antiphospholipid syndrome (APS) revisited: Would migraine headaches be included in future classification criteria? Immunol Res 2016; 65:230-241. [DOI: 10.1007/s12026-016-8831-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Yang A, Nayeemuddin M, Prasad B. Takayasu's arteritis and primary antiphospholipid syndrome presenting as hypertensive urgency. BMJ Case Rep 2016; 2016:bcr-2015-211752. [PMID: 26783006 DOI: 10.1136/bcr-2015-211752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 33-year-old Caucasian man was admitted to the hospital with chest pain and hypertensive urgency. Physical examination revealed widespread arterial bruits and marked difference in blood pressure between the upper limbs. Vascular imaging showed widespread narrowing in multiple vascular territories. He met the established American College of Rheumatology criteria for Takayasu's arteritis. His resistant hypertension was considered to be a consequence of bilateral renal artery stenosis and he subsequently underwent sequential stenting of his renal arteries leading to improvement in blood pressure and reduction in the number of antihypertensive medications. Subsequent imaging revealed progression of aortic thrombus in the setting of an elevated erythrocyte sedimentation rate, and persistently elevated antiphospholipid antibodies fulfilling diagnostic criteria for primary antiphospholipid syndrome, requiring initiation of immunosuppression and anticoagulation.
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Affiliation(s)
- Andrew Yang
- University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Mohammed Nayeemuddin
- Department of Radiology, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
| | - Bhanu Prasad
- Department of Nephrology, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
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16
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Adler-Lazarovits C, Mazor M, Erez O. Autoimmunity, preeclampsia and splenic rupture: a case report and literature review. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Antiphospholipid antibody (APLA) syndrome is an autoimmune disease which is associated with preeclampsia and can cause thromboembolic events in several organs including the spleen. This report includes a case of post-partum splenic rupture in a woman with preeclampsia in the presence of APLA syndrome and a literature review of splenic rupture during the third trimester and puerperium. Unlike the prominent clinical manifestation of liver hematoma and rupture during preeclampsia, rupture of the spleen can be silent and mistakenly underdiagnosed.
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Affiliation(s)
- Chana Adler-Lazarovits
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Moshe Mazor
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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17
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Abstract
Antiphospholipid antibody syndrome (APS) or Hughes syndrome is a multisystem autoimmune disorder that is characterized by venous and arterial thrombosis and/or pregnancy complications (miscarriage and fetal death, preeclampsia, placental insufficiency, and fetal growth restriction), and positive serologic tests for anticardiolipin antibodies (aCL), lupus anticoagulant (LA), or antibodies against beta2-glycoprotein I (anti-ß2GPI) either of IgG or IgM isotype. APS is characterized by accelerated atherosclerosis that, together with an increased tendency toward thrombosis, leads to the occurrence of various vascular events. Timely diagnosis of vascular changes, preferably in the subclinical phase, is required both because of their severity and the high mortality rate. Detection of arterial and venous changes is performed by various invasive and noninvasive diagnostic methods. Computed tomographic angiography (CTA) seems to be the most precise method with low exposure time, giving clinicians an opportunity for early diagnosis and timely treatment of APS patients.
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Affiliation(s)
- L Stojanovich
- Internal Medicine, “Bezanijska Kosa,” University Medical Center, Belgrade, Serbia
| | - A Djokovic
- Internal Medicine, “Bezanijska Kosa,” University Medical Center, Belgrade, Serbia
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He X, Hu Y. Acute Total Occlusion of the Abdominal Aorta in an Elderly Patient with Atrial Fibrillation. AORTA (STAMFORD, CONN.) 2013; 1:255-256. [PMID: 26798702 PMCID: PMC4682769 DOI: 10.12945/j.aorta.2013.13-039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/21/2013] [Indexed: 06/05/2023]
Abstract
A 76-year-old man without regular anticoagulation therapy for his atrial fibrillation was found to have a complete occlusion of the abdominal aorta and bilateral iliac and femoral arteries, confirmed by multi-slice computed tomography angiography. Prompt diagnosis and immediate intervention are important to minimize complications and avoid fatal outcome whenever arterial occlusion is suspected or diagnosed.
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Affiliation(s)
| | - Yu Hu
- Corresponding author: Yu Hu, MD, Department of Geriatrics, The Affiliated Zhongshan Hospital of Fudan University, Fenglin Road 180, Shanghai 200032, China, Tel: +86 021 64041990, E-Mail:
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Lower Limb Ischemia: Aortoiliac Thrombosis Related to Antiphospholipid Syndrome (APS)-Case Report and Review of the Literature. Case Rep Surg 2013; 2013:536971. [PMID: 23984166 PMCID: PMC3745935 DOI: 10.1155/2013/536971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/24/2013] [Indexed: 11/24/2022] Open
Abstract
Antiphospholipid syndrome (APS) is recognized as one of the main determinants of hypercoagulable conditions. The literature reports the incidence of this syndrome in a third of patients who underwent surgery for peripheral revascularization. Antiphospholipid antibodies are divided into two categories in relation to specific diagnostic tests. The first group is called lupus anticoagulant and consists of immunoglobulins that inhibit the phospholipid dependent coagulation tests in vitro. The second group is defined by their ability to conduct the phospholipid in an ELISA test. The occurrence of thrombotic events in patients with systemic erythematosus lupus (SEL) and anticoagulant antibodies was described for the first time in 1963 by Bowie. The discovery of anti-cardiolipin antibodies in antiphospholipid syndrome is due to Harris et al. who described the syndrome. Primitive APS was consequently defined in the absence of further underlying illnesses. In this disease, arterial thrombosis occurs mainly in the brain. Peripheral arteries are affected less frequently. Thrombosis of the great vessels is reported as anecdotal.
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Multiple Thromboses in a Patient with Systemic Lupus Erythematosus after Splenectomy. Case Reports Immunol 2012; 2012:813629. [PMID: 25954554 PMCID: PMC4411889 DOI: 10.1155/2012/813629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/01/2012] [Indexed: 11/18/2022] Open
Abstract
Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history of fetal loss. Early diagnosis and adequate treatment is important to prevent multiple organ failures. Here, we described a woman with a two-year history of systemic lupus erythematosus with severe nephrotic syndrome, manifested multiple thrombi over the portal vein and the inferior vena cava, combined with acute renal infarction. The patient underwent splenectomy 10 months ago. Initially, she received anticoagulant treatment and low-dose glucocorticoid, but multiple organ failure progressed. After emergency plasma exchange followed by glucocorticoid pulse therapy, the patient recovered.
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Herscovici R, Szyper-Kravitz M, Altman A, Eshet Y, Nevo M, Agmon-Levin N, Shoenfeld Y. Superior vena cava syndrome – changing etiology in the third millennium. Lupus 2012; 21:93-96. [DOI: 10.1177/0961203311412412] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Superior vena cava syndrome (SVCS), is diagnosed following different degrees of central venous system obstruction, which traditionally was caused by infections, tumors or fibrosing mediastinitis. Recently the role of SVC thrombosis secondary to indwelling central venous devices or pacemaker leads as well as different hypercoagulable states have drawn much attention. In the current review we present a 58-year-old female patient who underwent recurrent pacemaker replacements due to recurrent infections. The patient was hospitalized with superior vena cava syndrome and multiple thrombi in the upper body circulation. Additionally the evaluation was conducted for thrombophilia, which revealed the presence of high titers of antiphospholipid antibodies, suggesting the concurrent diagnosis of the antiphospholipid syndrome (APS). This case reflects the changes in the etiology of SVCS, and the need for a comprehensive evaluation of patients, in the search for additional factors that may complicate a pacemaker insertion, such as the presence of antiphospholipid antibodies. We review the relevant literature and highlight the importance for an interdisciplinary approach in the treatment of SVCS nowadays.
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Affiliation(s)
- R Herscovici
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
| | - M Szyper-Kravitz
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - A Altman
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
| | - Y Eshet
- Imaging Department, Sheba Medical Center, Israel
| | - M Nevo
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
| | - N Agmon-Levin
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Y Shoenfeld
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Incumbent of the Laura Schwartz-Kipp Chair for Autoimmunity, Tel Aviv University, Israel
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23
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Geri G, Saadoun D, Cacoub P. Manifestations hépatiques des maladies systémiques. Rev Med Interne 2011; 32:486-93. [DOI: 10.1016/j.revmed.2010.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 04/24/2010] [Accepted: 07/19/2010] [Indexed: 12/20/2022]
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24
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Weng CT, Chung TJ, Liu MF, Weng MY, Lee CH, Chen JY, Wu AB, Lin BW, Luo CY, Hsu SC, Lee BF, Tsai HM, Chao SC, Wang JY, Chen TY, Chen CW, Chang HY, Wang CR. A retrospective study of pulmonary infarction in patients with systemic lupus erythematosus from southern Taiwan. Lupus 2011; 20:876-85. [PMID: 21693494 DOI: 10.1177/0961203311401458] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since large-scale reports of pulmonary infarction in systemic lupus erythematosus (SLE) are limited, a retrospective study was performed for this manifestation in 773 hospitalized patients in southern Taiwan from 1999 to 2009. Pulmonary infarction was defined as the presence of pulmonary embolism, persistent pulmonary infiltrates, and characteristic clinical symptoms. Demographic, clinical, laboratory, and radiological images data were analyzed. There were 12 patients with pulmonary embolism and 9 of them had antiphospholipid syndrome (APS). Six patients (19 to 53 years, average 38.2 ± 12.6) with 9 episodes of lung infarction were identified. All cases were APS and four episodes had coincidental venous thromboembolism. There were four episodes of bilateral infarction and seven episodes of larger central pulmonary artery embolism. Heparin therapy was routinely prescribed and thrombolytic agents were added in two episodes. Successful recovery was noted in all patients. In conclusion, there was a 0.8% incidence of pulmonary infarction in patients with SLE, all with the risk factor of APS. Differentiation between pulmonary infarction and pneumonia in lupus patients should be made; they have similar chest radiography with lung consolidation but require a different clinical approach in management. Although this report is a retrospective study with relatively small numbers of lupus patients with lung infarcts, our observation might provide beneficial information on the clinical features and radiological presentations during the disease evolution of pulmonary infarction in SLE with APS.
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Affiliation(s)
- CT Weng
- Section of Rheumatology and Immunology, Department of Internal Medicine, National Cheng Kung University Hospital and Dou-Liou Branch, Tainan, Taiwan–Republic of China
| | - TJ Chung
- Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - MF Liu
- Section of Rheumatology and Immunology, Department of Internal Medicine, National Cheng Kung University Hospital and Dou-Liou Branch, Tainan, Taiwan–Republic of China
| | - MY Weng
- Section of Rheumatology and Immunology, Department of Internal Medicine, National Cheng Kung University Hospital and Dou-Liou Branch, Tainan, Taiwan–Republic of China
| | - CH Lee
- Section of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - JY Chen
- Section of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - AB Wu
- Section of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - BW Lin
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - CY Luo
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - SC Hsu
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - BF Lee
- Department of Nuclear Medicine, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - HM Tsai
- Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - SC Chao
- Department of Dermatology, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - JY Wang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - TY Chen
- Section of Hemato-oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - CW Chen
- Section of Critical Care Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - HY Chang
- Section of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan–Republic of China
| | - CR Wang
- Section of Rheumatology and Immunology, Department of Internal Medicine, National Cheng Kung University Hospital and Dou-Liou Branch, Tainan, Taiwan–Republic of China
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25
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Cikrikcioglu MA, Hursitoglu M, Erkal H, Inan B, Ozturk T, Cakirca M, Canpolat F, Erkal S, Bahtiyar I, Cordan I, Tukek T. Splenomegaly in primary antiphospholipid syndrome without accompanying portal hypertension or comorbidity. PATHOPHYSIOLOGY OF HAEMOSTASIS AND THROMBOSIS 2011; 37:104-9. [PMID: 21555872 DOI: 10.1159/000327506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 03/16/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To demonstrate the presence of splenomegaly in primary antiphospholipid syndrome (PAPS) patients without accompanying portal hypertension or comorbidity. METHODS Twelve patients (7 women) aged 23-65 years followed upon the diagnosis of PAPS were enrolled in the study. We documented the identified causes of splenomegaly in patients with PAPS, and searched for the potential causes of splenomegaly in patients with spleen enlargement. PAPS patients with or without splenomegaly were evaluated in terms of demographic and clinical findings. RESULTS Splenomegaly was present in 6 of the 12 patients. In these patients, there were no infections, hematological disorders, portal hypertension or malignancy that might lead to splenomegaly. The long axis of spleen was found to be in the range of 137-155 mm in patients with splenomegaly. Splenomegaly was more frequently determined in female PAPS patients. The splenomegaly group had a longer duration of disease (median 5.5 vs. 0.75 years) and a higher number of thrombotic events (median 3 vs. 1.5). The splenomegaly group was especially composed of patients who never received any anticoagulant and acetylsalicylic acid, or who used these agents irregularly for very short periods. CONCLUSION Splenomegaly was observed in association with disease duration, frequency of thrombotic events and irregular antiaggregant or anticoagulant treatment in patients with PAPS, in the absence of comorbidity or portal hypertension.
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Affiliation(s)
- Mehmet Ali Cikrikcioglu
- Department of Internal Medicine, Vakif Gureba Training and Research Hospital, Istanbul, Turkey.
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Alchi B, Griffiths M, Jayne D. What nephrologists need to know about antiphospholipid syndrome. Nephrol Dial Transplant 2010; 25:3147-54. [PMID: 20587422 DOI: 10.1093/ndt/gfq356] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent arterial or venous thrombosis and/or pregnancy losses, in the presence of persistently elevated levels of anticardiolipin antibodies (aCL) and/or evidence of circulating lupus anticoagulant (LA). The kidney is a major target organ in both primary and secondary APS. With the expanding spectrum of renal diseases associated with APS, and the impact of APS in ESRD care, this subject is of increasing relevance to nephrologists. This review describes the various clinical manifestations and histological features of this syndrome, with reference to the kidney.
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Affiliation(s)
- Bassam Alchi
- Renal Unit, Addenbrooke's Hospital, Cambridge, UK
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27
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Ju JH, Min JK, Jung CK, Oh SN, Kwok SK, Kang KY, Park KS, Ko HJ, Yoon CH, Park SH, Cho CS, Kim HY. Lupus mesenteric vasculitis can cause acute abdominal pain in patients with SLE. Nat Rev Rheumatol 2009; 5:273-81. [PMID: 19412194 DOI: 10.1038/nrrheum.2009.53] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lupus mesenteric vasculitis (LMV) is a unique clinical entity found in patients who present with gastrointestinal manifestations of systemic lupus erythematosus, and is the main cause of acute abdominal pain in these patients. LMV usually presents as acute abdominal pain with sudden onset, severe intensity and diffuse localization. Other causes of abdominal pain, such as acute gastroenteritis, peptic ulcers, acute pancreatitis, peritonitis, and other reasons for abdominal surgery should be ruled out. Prompt and accurate diagnosis of LMV is critical to ensure implementation of appropriate immunosuppressive therapy and avoidance of unnecessary surgical intervention. The pathology of LMV comprises immune-complex deposition and complement activation, with subsequent submucosal edema, leukocytoclastic vasculitis and thrombus formation; most of these changes are confined to small mesenteric vessels. Abdominal CT is the most useful tool for diagnosing LMV, which is characterized by the presence of target signs, comb signs, and other associated findings. The presence of autoantibodies against phospholipids and endothelial cells might provide information about the likelihood of recurrence of LMV. Immediate, high-dose, intravenous steroid therapy can lead to a favorable outcome and prevent serious complications such as bowel ischemia, necrosis and perforation.
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Affiliation(s)
- Ji Hyeon Ju
- Rheumatology Division, College of Medicine, Catholic University of Korea, Seocho-Gu, Seoul, South Korea
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EHTUISH EF, MISHRA A. Multiple visceral aneurysms in antiphospholipid antibody syndrome — an unusual presentation. Br J Radiol 2008; 81:e184-7. [DOI: 10.1259/bjr/94135262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
LEARNING OBJECTIVES Learning objectives of this paper are to review and to summarize the pathogenesis of bowel ischemia and to describe its clinical, pathological, and radiological manifestations. BACKGROUND Bowel ischemia is a common disorder produced by several causes, and it shows various clinical presentations connected with an high mortality. With the increase in average life expectancy, bowel ischemia represents one of the most threatening abdominal conditions in elderly patients. In the last decade, computed tomography has tremendously altered the diagnostic approach to bowel ischemia also influencing the therapeutic approach in the current practice. IMAGING FINDINGS Computed tomographic imaging findings include bowel wall thickening, portal venous gas, intramural pneumatosis, engorgement of mesenteric veins, loss or increase of bowel wall enhancement, and infarction of other abdominal organs. CONCLUSIONS Bowel ischemia shows a broad spectrum of radiological manifestations, and regardless of the primary causes, it produces similar radiological features. Bowel ischemia may simulate cancer or inflammatory conditions; so it is a mandatory tight integration between radiological and clinical signs.
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Linnemann B, Schmidt H, Schindewolf M, Erbe M, Zgouras D, Grossmann R, Schambeck C, Lindhoff-Last E. Etiology and VTE risk factor distribution in patients with inferior vena cava thrombosis. Thromb Res 2008; 123:72-8. [PMID: 18295303 DOI: 10.1016/j.thromres.2008.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 11/30/2007] [Accepted: 01/05/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Inferior vena cava (IVC) thrombosis is a rare event and data detailing the underlying etiology are scarce. MATERIALS AND METHODS Therefore, we reviewed all available cases of IVC thrombosis consecutively registered in the MAISTHRO (MAin-ISar-THROmbosis) database and described the prevalence of VTE risk factors and other conditions contributing to IVC thrombosis development. RESULTS 53 patients (35 F, 18 M) with IVC thrombosis aged 12 to 79 years were identified. 40 patients (75.5%) developed thrombosis under the age of 45. Local problems, such as IVC anomalies or external venous compression, contributed to the development of thrombosis in 12 cases (22.6%). Lupus anticoagulants (10.9 vs. 2.3%, p=0.013) and malignoma (17.0 vs. 6.4%, p=0.023) were more prevalent in IVC thrombosis patients compared to 265 age and sex matched controls with isolated lower extremity DVT. No difference was identified with regard to inherited thrombophilia or other known VTE risk factors. Symptomatic pulmonary embolism (PE) occurred in 32.1% of IVC thrombosis patients compared to 15.2% of controls (p=0.005). CONCLUSIONS Local problems such as IVC anomalies and external venous compression, malignancy and the presence of lupus anticoagulants contribute to the risk of IVC thrombosis. The risk of symptomatic pulmonary embolism in the acute setting is high.
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Affiliation(s)
- Birgit Linnemann
- Division of Vascular Medicine, Department of Internal Medicine, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
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31
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Kishimoto M, Nasir A, Mor A, Belmont HM. Acute gastrointestinal distress syndrome in patients with systemic lupus erythematosus. Lupus 2007; 16:137-41. [PMID: 17402371 DOI: 10.1177/0961203306075739] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cases of mesenteric vasculitis in systemic lupus erythematosus (SLE) are well described, however, individual patient with recurrent mesenteric vasculopathy producing repeated episodes with each exacerbation similar in character and quality has not been reported previously in the literature. We describe two SLE patients whose condition was complicated by repeated stereotypic, CT confirmed, episodes of lupus enteritis characterized by dramatic intestinal wall edema. Moreover, each flare was accompanied by significant hypocomplementemia and was rapidly reversible suggesting an acute gastrointestinal distress syndrome (AGDS) as a result of leukoaggregation and a gut capillary leak syndrome.
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Affiliation(s)
- M Kishimoto
- Division of Rheumatology, NYU-Hospital for Joint Diseases, NYU School of Medicine, New York, NY 10003, USA
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32
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Cacciapaglia F, Vadacca M, Coppolino G, Buzzulini F, Rigon A, Zennaro D, Zardi E, Afeltra A. Spontaneous splenorenal shunt in a patient with antiphospholipid syndrome: the first case reported. Lupus 2007; 16:56-8. [PMID: 17283587 DOI: 10.1177/0961203306072390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The antiphospholipid syndrome (APS) is an autoimmune disorder, characterized by a wide spectrum of clinical manifestations. Thromboembolic events, with a greater involvement of extremities veins, are the most common features, and obstruction of abdominal vessels are sporadically reported. We present a singular case of a patient with primary APS (PAPS) that developed a spontaneous splenorenal shunt, secondary to a total portal, mesenteric and splenic vein thrombosis. Spontaneous splenorenal shunt, an uncommon circumstance reported in cirrhotic disease, to the best of our knowledge, has not been previously described in PAPS.
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Affiliation(s)
- F Cacciapaglia
- Department of Clinical Medicine, University "Campus Bio-Medico" of Rome, Rome, Italy
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Bilbao Jaureguízar JI, Vivas Pérez I, Cano Rafart D, Martínez de la Cuesta A. Imaging and Intervention in Gastrointestinal Hemorrhage and Ischemia. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cervera R, Espinosa G, Cordero A, Oltra MR, Unzurrunzaga A, Rossiñol T, Plaza J, Bucciarelli S, Ramos-Casals M, Ingelmo M, Asherson RA, Font J. Intestinal involvement secondary to the antiphospholipid syndrome (APS): clinical and immunologic characteristics of 97 patients: comparison of classic and catastrophic APS. Semin Arthritis Rheum 2007; 36:287-96. [PMID: 17207521 DOI: 10.1016/j.semarthrit.2006.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 09/08/2006] [Accepted: 09/25/2006] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze the clinical and laboratory characteristics of 97 patients with intestinal involvement secondary to the antiphospholipid syndrome (APS) (37 patients with classic APS and 60 with catastrophic APS). METHODS A computer-assisted (PubMed) search of the literature was performed to identify all cases of intestinal involvement associated with the APS from 1983 to December 2005. In addition, we analyzed the web-site-based international registry of patients with catastrophic APS ("CAPS Registry"). RESULTS There were no differences in distribution by gender, mean age, and previous clinical manifestations of APS between the 2 groups. The prevalence of abdominal pain as the presenting manifestation of intestinal ischemia was higher in patients with classic APS (76% versus 37%; P < 0.005). The main difference in histopathologic findings between the 2 groups was the higher rate of microthrombosis in patients with catastrophic APS (75% versus 4%; P < 0.0005). The mortality rate was higher in patients with catastrophic APS (55% versus 17%; P < 0.0005). Follow-up was available in 22 patients with classical APS: 17 of them were discharged on oral anticoagulation and with a mean follow-up of 13 months (range, 1 to 48); all were in good health without the development of new thrombotic events. CONCLUSIONS Intestinal involvement, although infrequent, is an important complication in patients with APS, especially in those with catastrophic APS. This would support the need for systematic screening for aPL in all cases of mesenteric thrombosis or ischemic colitis without clear underlying predisposing factors, and for systematic screening procedures in all classic APS patients complaining of abdominal pain.
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Affiliation(s)
- Ricard Cervera
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
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35
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Bachmeyer C, Barrier A, Frazier A, Fulgencio JP, Lecomte I, Grateau G, Callard P. Diffuse large and small bowel necrosis in catastrophic antiphospholipid syndrome. Eur J Gastroenterol Hepatol 2006; 18:1011-4. [PMID: 16894316 DOI: 10.1097/01.meg.0000230085.45674.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The catastrophic variant is an accelerated form of the antiphospholipid syndrome resulting in multiorgan failure because of multiple small vessel occlusions. We report a case of catastrophic antiphospholipid syndrome in a patient with subacute cutaneous lupus erythematosus and ischemic bowel, who presented with acute abdominal pain due to diffuse right colon and small bowel necrosis requiring large resection, associated with acute respiratory distress syndrome, thrombocytopenia and disseminated intravascular coagulation. Histopathological examination of resected tissues showed diffuse arteriolar and venous thrombosis but no vasculitis, and mesenteric artery lumen severely narrowed by intimal fibrosis. The patient died 15 days after admission despite treatment with anticoagulation, steroids, continuous hemofiltration and plasma exchange. Ischemic bowel and diffuse intestinal necrosis may be secondary to the antiphospholipid syndrome, and a high level of suspicion and an early diagnosis are required.
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Affiliation(s)
- Claude Bachmeyer
- Department of Internal Medicine, CHU Tenon (AP-HP), Paris, France.
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36
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Wunnava RV, Hunt TM. An unusual cause of acute abdominal pain - a case presentation. BMC HEMATOLOGY 2006; 6:1. [PMID: 16603067 PMCID: PMC1458326 DOI: 10.1186/1471-2326-6-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 04/07/2006] [Indexed: 11/15/2022]
Abstract
Background In 1983, Graham Hughes described a condition of Antiphospholipid Syndrome in which there was a danger of thrombosis. The condition is readily detectable by blood tests and, once diagnosed; the risk of further thrombosis can be significantly reduced by anticoagulation treatments. Affected groups of patients can be distinguished by a specific blood test – the detection of antiphospholipid antibody (Ref-1). Patients with Hughes syndrome have hypercoaguable state with a markedly increased risk of both arterial and venous thrombosis and there is temporal persistence of antibody positivity. Case presentation A 44-year-old woman was admitted under the acute surgical "take" with left sided abdominal pain radiating to her back. She had a history of borderline thyrotoxicosis in the early 1990s. She was on etonogestrel-releasing implants for contraception and there was no history of previous deep venous thrombosis. She was very tender, locally, over the left side of the abdomen. Investigations showed haemoglobin of 13.2 g/dl, white cell count of 19.9 10*9/L, and platelets 214 10*9/L with neutrophilia. Amylase and renal function tests were found to be normal. Liver function tests were deranged with Gamma GT 244 u/l (twice normal). An abdominal Ultrasound Scan suggested a possible splenic infarction, which was confirmed by a CT scan of her abdomen. Tests were carried out to investigate the possibility of a post thrombotic state. Coagulation risk factors for thrombosis were within the normal limits; Protein S 67 %(60–140), Protein C 103 % (72–146), Antithrombin 3 110 %(80–120) and Activated P C Resistance was 1.9(2.0–4.3). The Hams test was negative but the Anticardiolipin antibody test was positive. IgM level was 52 (normal is up to 10) and IgG was 18.8 (normal is up to 10). She also had border line APC Sensitivity 1.9 (2 to 4.3). Kaolin time 49 sec (70–120) Ktmix 64 sec (70–120), thyroid function test revealed TSH 0.32 mu/L, fT4 20.2 pmol/L (10–25). Subsequent determination of Anticardiolipin antibody was negative. Her symptoms were settled with the use of simple analgesia and she was discharged home with long-term anticoagulation medication. The INR target for long-term anticoagulation was aimed at >3. Conclusion This case presented to us as an acute abdominal pain. Subsequent investigations revealed the presence of splenic infarction. Coagulation risk factors for thrombosis proved negative. Haematological investigations revealed the presence of anticardiolipin antibodies at the first instance but subsequent determinations were negative. Hence, it mimicked Hughes syndrome initially but the criteria for temporal persistence of anticardiolipin antibody was not fulfilled. Unusual surgical presentation of a thrombotic abnormality as abdominal pain due to splenic infarction.
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Affiliation(s)
- Rao V Wunnava
- Department of Colorectal Surgery, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, UK
| | - Trevor M Hunt
- Department of Colorectal Surgery, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, UK
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Yotsueda H, Tsuruya K, Tokumoto M, Hirakata H, Iida M. Catastrophic antiphospholipid antibody syndrome following initiation of hemodialysis. Clin Exp Nephrol 2005; 9:335-339. [PMID: 16362163 DOI: 10.1007/s10157-005-0387-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Accepted: 09/05/2005] [Indexed: 11/29/2022]
Abstract
Antiphospholipid syndrome (APS) is associated with arterial and venous thrombosis, pregnancy morbidity, and thrombocytopenia. Some APS patients develop rapid and disseminated microthrombosis and are known as having catastrophic APS or CAPS. We document here a case of CAPS in a patient who presented with various clinical symptoms and serious abnormalities of blood coagulation following initiation of hemodialysis after bilateral nephrectomy due to renal cancer. The patient developed multiple organ symptoms, including melena, visual disturbances, skin eruptions, lymph node swelling, urinary tract bleeding, backache, arteriovenous fistula occlusion, and chest pain. Based on the clinical course and serological and histological examinations, a diagnosis of CAPS was established. The patient recovered by following intensive anticoagulation and steroid therapy. Although CAPS is rare, once symptoms develop the condition deteriorates rapidly. Because of the associated high mortality, early diagnosis and prompt treatment are necessary.
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Affiliation(s)
- Hideki Yotsueda
- Department of Medicine and Clinical Science, Graduate School of Medicine and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medicine and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masanori Tokumoto
- Department of Medicine and Clinical Science, Graduate School of Medicine and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hideki Hirakata
- Department of Medicine and Clinical Science, Graduate School of Medicine and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Mitsuo Iida
- Department of Medicine and Clinical Science, Graduate School of Medicine and Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Madroñero AB, Porcel JM, Pardina M, Gil M. [Not Available]. REUMATOLOGIA CLINICA 2005; 1:223-224. [PMID: 21794268 DOI: 10.1016/s1699-258x(05)72748-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 01/27/2005] [Indexed: 05/31/2023]
Affiliation(s)
- A B Madroñero
- Servicio de Medicina Interna. Hospital Universitario Arnau de Vilanova. Lleida. España
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Kaufman LB, Yeh BM, Breiman RS, Joe BN, Qayyum A, Coakley FV. Inferior Vena Cava Filling Defects on CT and MRI. AJR Am J Roentgenol 2005; 185:717-26. [PMID: 16120925 DOI: 10.2214/ajr.185.3.01850717] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the appearance and causes of inferior vena cava (IVC) filling defects, how such findings may be accurately characterized, and the clinical significance of IVC filling defects. Filling defects in the IVC observed at MDCT and MRI may be a result of flow artifacts, anatomic variants, or bland or malignant thrombus. CONCLUSION Familiarity with anatomy and flow effects is critical for distinguishing true from false filling defects in the IVC. Delayed imaging after administration of IV contrast material and dedicated MRI sequences may be helpful for further characterization of such findings. Once a true filling defect of the IVC is established, identification of the cause, whether benign or malignant, and extent will guide clinical treatment.
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Affiliation(s)
- Lauren B Kaufman
- Department of Radiology, University of California San Francisco, CA 94143-0628, USA
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Bhattacharya M, Yeh BM, Qayyum A, Coakley FV. Case 81: antiphospholipid antibody syndrome with adrenal hemorrhage and Budd-Chiari syndrome. Radiology 2005; 235:53-5. [PMID: 15798168 DOI: 10.1148/radiol.2351031848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mallar Bhattacharya
- Department of Radiology, University of California-San Francisco, Box 0628, M-372, 505 Parnassus Avenue, San Francisco, CA 94143-0628
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Mahnken AH, Brandenburg VM, Frank RD, Haage P, Günther RW. Hemolysis, hemorrhage, headache, and hidden abortion: imaging findings in antiphospholipid syndrome. Eur Radiol 2004; 13 Suppl 4:L83-6. [PMID: 15018171 DOI: 10.1007/s00330-003-1974-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Antiphospholipid antibodies are associated with arterial and venous thromboses, recurrent pregnancy loss, and organ infarction. Any vascular region can be affected. We present a 20-year-old woman suffering from secondary antiphospholipid syndrome with a unique combination of multifocal venous thromboses, pulmonary embolism, spontaneous abortion, and splenic infarction. Diversity of clinical symptoms and diagnostic imaging modalities are discussed with emphasis on cross-sectional imaging. The syndrome should be suspected in patients with thromboses and organ infarctions of otherwise undetermined etiology.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, University Hospital, University of Technology, Pauwelsstrasse 30, 52057 Aachen, Germany.
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Frauenfelder T, Wildermuth S, Marincek B, Boehm T. Nontraumatic Emergent Abdominal Vascular Conditions: Advantages of Multi–Detector Row CT and Three-Dimensional Imaging. Radiographics 2004; 24:481-96. [PMID: 15026595 DOI: 10.1148/rg.242025714] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the past decade, great strides have been made in the development of helical computed tomography (CT) that have led to shorter scanning time and higher spatial resolution. A wide range of traumatic and nontraumatic emergent conditions may be quickly and accurately diagnosed with multi-detector row CT. Multi-detector row CT angiography is the preferred method for imaging in emergent abdominal vascular conditions because it enables the acquisition of high-spatial-resolution volumetric image data during a single breath hold. Unlike catheter angiography, multi-detector row CT angiography not only depicts the vessels but also allows assessment of perfusion in adjacent organs. To make the most effective diagnostic use of multi-detector row CT angiography and three-dimensional image postprocessing, radiologists must be familiar with the optimal CT angiographic protocols and with the typical CT findings in various emergent vascular conditions. This article describes the protocols used in 11 patients with conditions including ruptured abdominal aortic aneurysm, secondary aortoduodenal fistula, splanchnic segmental arterial mediolysis, and Wegener-type vasculitis with visceral involvement. All of the diagnoses in these 11 cases were made in the emergency department, and the delay between imaging and diagnosis was decreased considerably by avoiding the transfer of patients for catheter angiography.
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Affiliation(s)
- Thomas Frauenfelder
- Institute of Diagnostic Radiology, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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André M, Delèvaux I, Amoura Z, Corbi P, Courthaliac C, Aumaître O, Piette JC. Ovarian vein thrombosis in the antiphospholipid syndrome. ACTA ACUST UNITED AC 2004; 50:183-6. [PMID: 14730615 DOI: 10.1002/art.11435] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Ovarian vein thrombosis (OVT) is an unusual condition mainly observed during the postpartum period. It has not been reported to date in the antiphospholipid syndrome. Two female patients with definite antiphospholipid syndrome, ages 33 years and 73 years, were diagnosed as having OVT by computed tomography (CT) scan, according to the radiologic criteria described by Zerhouni et al. In 1 of the women, the left vein was affected by OVT, while in the other woman, the right vein was affected. One of the patients had a pulmonary embolism; the diagnosis of OVT was established after she underwent a cesarean section and a right atrium thrombectomy. The other patient had no vascular manifestations. OVT was asymptomatic in both patients. Searches for associated thrombophilic states yielded negative results. With the continuation of anticoagulation therapy, the 2 patients have remained in good condition. Resolution of the OVT was observed in the patient who underwent a CT scan during followup. To our knowledge, this is the first report of OVT occurring in the antiphospholipid syndrome. Given that it may develop in the absence of pelvic clinical manifestations, this complication may be underdiagnosed.
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Affiliation(s)
- Marc André
- Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Jürgensen JS, Kettritz R, Schneider W, Koop H, Hildebrand TS, Frei U, Eckardt KU. Catastrophic antiphospholipid syndrome masquerading as ischaemic colitis. Rheumatol Int 2003; 23:204-6. [PMID: 12679877 DOI: 10.1007/s00296-003-0296-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2002] [Accepted: 01/03/2003] [Indexed: 11/24/2022]
Abstract
We describe a young woman whose initial presentation was dominated by acute diarrhoea. Life-threatening multiorgan failure rapidly ensued and necessitated mechanical ventilation and dialysis treatment. An initially elongated activated partial thromboplastin time prompted further coagulation tests that led to the detection of positive lupus anticoagulant, a highly elevated IgG-anticardiolipin (aCL) antibody titre, and prolonged dilute Russell's viper venom time. Histological examination of samples obtained during endoscopy revealed widespread intestinal thrombotic microangiopathy. In view of these serologic and histologic features, a diagnosis of the malignant variant of the antiphospholipid syndrome (APS), also termed 'catastrophic APS', was established. In spite of this syndrome's grim prognosis, the patient recovered following intensive anticoagulation and adjunct treatment with steroids and immunoglobulins.
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Affiliation(s)
- Jan Steffen Jürgensen
- Department of Nephrology and Medical Intensive Care, Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Abstract
Bowel ischemia may be caused by many conditions and manifest with typical or atypical and specific or nonspecific clinical, laboratory, and radiologic findings. It may mimic various intestinal diseases and be confused with certain nonischemic conditions clinically and at computed tomography (CT). Bowel ischemia severity ranges from mild (generally transient superficial changes of intestinal mucosa) to more dangerous and potentially life-threatening transmural bowel wall necrosis. Causes of critically reduced blood flow to the bowel are diverse, ranging from occlusions of mesenteric arteries or veins to complicated bowel obstruction and overdistention. CT can demonstrate changes in ischemic bowel segments accurately, is often helpful in determining the primary cause of ischemia, and can demonstrate important coexistent findings or complications. Unfortunately, common CT findings in bowel ischemia are not specific, and specific findings are rather uncommon. Therefore, it often is a combination of nonspecific clinical, laboratory, and radiologic findings-especially detailed knowledge about the pathogenesis of acute bowel ischemia in different conditions-that helps most in correct interpretation of CT findings. To improve understanding of this complex heterogeneous entity, this article provides an overview of the anatomy and physiology of mesenteric perfusion and discussions of causes and pathogenesis of acute bowel ischemia, CT findings in various types of acute bowel ischemia, and potential pitfalls of CT.
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Affiliation(s)
- Walter Wiesner
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
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