Cystic Adventitial Disease of the Common Femoral Vein Presenting with Lower Limb Swelling: A Case Report

Cystic adventitial disease (CAD) is a rare vascular disorder predominantly seen in adults without cardiovascular risk factors. We report a case of CAD involving the common femoral vein in a 38-year-old female presented with right lower extremity swelling that was initially misdiagnosed as deep vein thrombosis (DVT). A computed tomography revealed a cystic structure that compressed the right common femoral vein with resultant severe stenosis of the vascular lumen. Complete evacuation of the cyst with excision of the cyst wall was performed, and the patient remained symptom-free at 3 year follow-up. This case highlighted that the rare venous CAD should be incorporated in the differential diagnosis of unilateral lower extremity swelling suspicious for a DVT. Complete evacuation and surgical excision of the cyst often conferred favorable clinical outcome.

Constrictive pericarditis: portal, splenic, and femoral venous Doppler pulsatility: a case series

PURPOSE

Pulsatile flow of the portal vein has been implicated as an indicator of right ventricular dysfunction in cardiac patients. In patients with significantly elevated right atrial pressure, pulsatile venous flow may be transmitted to the portal, splenic, renal, and femoral veins. We describe the evolution of these echocardiographic findings in four patients with constrictive pericarditis (CP) undergoing pericardiectomy with simultaneous hemodynamic waveform and cerebral oximetry monitoring in the operating room and in the intensive care unit.

CLINICAL FEATURES

Patient 1 presented classic signs of CP, including equalization of left and right diastolic pressures, a "square root" sign on the diastolic portion of the right ventricular pressure curve, and elevated right atrial pressure. Preoperative transesophageal echocardiography showed a hyperdynamic left ventricle and dilated right ventricle with abnormal pulsatile waveforms in the portal and splenic veins. Surgical decompression of the pericardium gradually normalized the Doppler waveforms. Increased venous return following pericardiectomy during surgery in patients 2 and 3 and during the postoperative period in patient 4 resulted in right ventricular (RV) failure due to significantly increased preload. Venous pulsatility was also observed in the portal, splenic, and femoral veins.

CONCLUSION

In patients with CP, changes in hemodynamic and echocardiographic signs of RV dysfunction are rapidly reflected by changes in peripheral venous velocities. Identifying signs of splanchnic and peripheral vascular venous congestion could help identify patients at higher risk of developing postoperative complications following pericardiectomy.

Doppler Interrogation of the Femoral Vein in the Critically Ill Patient: The Fastest Potential Acoustic Window to Diagnose Right Ventricular Dysfunction?

Objectives

To report the use of common femoral vein Doppler interrogation as a simple technique to diagnose right ventricular dysfunction.

Design

Case report.

Setting

Cardiac surgical ICU.

Patients

Postoperative cardiac surgical patients.

Interventions

Common femoral pulsed-wave and color Doppler examination associated with hepatic, portal, and renal venous Doppler measurement were obtained in both patients and before and after treatment in patient number 1. In addition, right ventricular pressure waveform examination was obtained in patient number 2.

Measurements and Main Results

The technique to obtain common femoral venous Doppler is described. Two cases of patients presenting with right ventricular dysfunction and fluid overload with portal and renal venous congestion in the perioperative period undergoing complex multivalvular cardiac surgery are presented. Hemodynamic waveform monitoring was performed alongside echocardiographic, hepatic, and renal venous flow Doppler assessment, and spectral Doppler profiles of the common femoral veins were examined. Those findings were useful in confirming our diagnosis and guiding our response to treatment. An algorithm was developed and tested on two additional hemodynamically unstable patients.

Conclusions

Doppler examination of the common femoral vein is a simple, fast, and noninvasive technique that could be useful to rule in the presence of right ventricular dysfunction with venous congestion and help guide the management of such patients.

Effects of ankle pump exercise frequency on venous hemodynamics of the lower limb

PURPOSE

The purpose of this study was (1) to compare the effects of ankle pump exercise(APE) frequency on hemodynamics of the common femoral vein(CFV) and (2) to analyse the relationship between APE duration and lower limb fatigue.

METHODS

Twenty-seven males and thirty-three females performed APE. Among them, there were thirty participants with non-lower limb fracture (N-LLF) and thirty participants with lower limb fracture (LLF).The colour doppler ultrasound was used to record the time-averaged mean velocity (TAMV) of common femoral venous flow when the participants at rest and move at different frequencies of 6 times/min, 10 times/min, 30 times/min, 60 times/min. The ratings of perceived exertion (RPE) was used to assess the lower limb fatigue of the participants when performing APE at the frequency of 60 times/min after 1 min, 2 mins, 3 mins, 4 mins and 5 mins.

RESULTS

With the increase of frequency, TAMV increased significantly in both the participants with N-LLF and LLF (p < 0.01). The TAMV were 19.82±3.86, 33.78±8.76, 37.06±8.67, 43.82±10.40, 52.18±10.53, respectively in the participants with N-LLF and 16.98±3.01, 22.20±4.96, 24.01±5.78, 29.20±7.05, 35.75±9.28, respectively in the injured limb of patients with LLF when at rest and moving at the frequency of 6 times/min, 10 times/min, 30 times/min, 60 times/min. There was a positive correlation (p < 0.01) between lower limb fatigue and exercise duration.When the RPE was 16 points (the corresponding fatigue degree is "tired"), the exercise duration of the participants with N-LLF was 3 mins and that of the injured limb of patients with LLF was 2 mins.

CONCLUSIONS

Both fast and slow-frequency APE can promote venous blood return in the lower limb. Despite of the equivalent APE duration, fast-frequency APE can promote venous blood return more effectively. When the frequency of APE was 60 times/min, participants with N-LLF can exercise for 3 mins, and the injured limb of patients with LLF can exercise for 2 mins.

Cystic adventitial disease of the common femoral vein: A case report

OBJECTIVES

Cystic adventitial disease is an extremely rare vascular disorder and is often misdiagnosed. In order to improve the knowledge and treatment of this disease, a case of venous cystic adventitial disease was reported.

METHODS

The whole processes about the diagnosis and treatment of one patient with venous cystic adventitial disease was retrospectively studied.

RESULTS

This case of venous cystic adventitial disease was diagnosed accurately by contrast-enhanced computed tomography and treated successfully by surgical resection. No complications were detected after one-year post-operative follow-up.

CONCLUSIONS

Surgical resection is a safe and effective method for the treatment of venous CAD.

Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis: A case report

RATIONALE

Primary leiomyosarcoma (LMS) of the vein is a rare tumor that arises from the smooth muscle cells of the vessel wall and has an extremely poor prognosis. This tumor can occur in vessels such as the inferior vena cava, great saphenous vein, femoral vein, iliac vein, popliteal vein, and renal vein; the inferior vena cava is the most common site. LMS of the femoral vein can result in edema and pain in the lower extremity; therefore, it is not easy to be differentiated from deep vein thrombosis (DVT). Moreover, virtually no studies have described the ultrasonographic features of LMS of the vein in detail.

PATIENT CONCERNS

We present a case of a 55-year-old woman with LMS of the left femoral vein that was misdiagnosed as having deep vein thrombosis (DVT) on initial ultrasonographic examination. The patient began to experience edema and pain in her left leg seven months previously. She was diagnosed as having DVT on initial ultrasonographic examination, but the DVT treatment that she had received for 7 months failed to improve the status of her left lower limb.

DIAGNOSES

She subsequently underwent re-examination by means of a multimodal ultrasonographic imaging approach (regular B-mode imaging, color Doppler imaging, pulsed-wave Doppler imaging, contrast-enhanced ultrasonography), which confirmed a diagnosis of LMS.

INTERVENTIONS

This patient was treated successfully with surgery.

OUTCOMES

This case demonstrates that use of multiple ultrasonographic imaging techniques can be helpful to diagnose LMS accurately. Detection of vasculature in a dilated vein filled with a heterogeneous hypoechoic substance on ultrasonography is a sign of a tumor.

LESSONS

The pitfall of misdiagnosing this tumor as DVT is a useful reminder.

Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients

Background:

Deep venous thrombosis (DVT) contributes significantly to the morbidity and mortality of neurosurgical patients; however, no data regarding lower extremity DVT in postoperative Chinese neurosurgical patients have been reported.

Materials and Methods:

From January 2012 to December 2013, 196 patients without preoperative DVT who underwent neurosurgical operations were evaluated by color Doppler ultrasonography and D-dimer level measurements on the 3^rd, 7^th, and 14^th days after surgery. Follow-up clinical data were recorded to determine the incidence of lower extremity DVT in postoperative neurosurgical patients and to analyze related clinical features. First, a single factor analysis, Chi-square test, was used to select statistically significant factors. Then, a multivariate analysis, binary logistic regression analysis, was used to determine risk factors for lower extremity DVT in postoperative neurosurgical patients.

Results:

Lower extremity DVT occurred in 61 patients, and the incidence of DVT was 31.1% in the enrolled Chinese neurosurgical patients. The common symptoms of DVT were limb swelling and lower extremity pain as well as increased soft tissue tension. The common sites of venous involvement were the calf muscle and peroneal and posterior tibial veins. The single factor analysis showed statistically significant differences in DVT risk factors, including age, hypertension, smoking status, operation time, a bedridden or paralyzed state, the presence of a tumor, postoperative dehydration, and glucocorticoid treatment, between the two groups (P < 0.05). The binary logistic regression analysis showed that an age greater than 50 years, hypertension, a bedridden or paralyzed state, the presence of a tumor, and postoperative dehydration were risk factors for lower extremity DVT in postoperative neurosurgical patients.

Conclusions:

Lower extremity DVT was a common complication following craniotomy in the enrolled Chinese neurosurgical patients. Multiple factors were identified as predictive of DVT in neurosurgical patients, including the presence of a tumor, an age greater than 50 years, hypertension, and immobility.