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Ruffer N, Krusche M, Holl-Ulrich K, Lötscher F, Kötter I. [Hughes-Stovin syndrome: a life-threatening manifestation of Behçet's syndrome]. Z Rheumatol 2024; 83:327-333. [PMID: 37280333 PMCID: PMC11058631 DOI: 10.1007/s00393-023-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/08/2023]
Abstract
Hughes-Stovin syndrome (HSS) is a systemic inflammatory condition of unknown origin that is considered to be part of the Behçet's syndrome (BS) spectrum. Recurrent venous thrombosis and superficial thrombophlebitis in combination with bilateral pulmonary artery aneurysms (PAA) represent the hallmark of HSS. The diagnostic evaluation includes computed tomography pulmonary angiography to detect signs of pulmonary vasculitis. The management of HSS is based on the European Alliance of Associations for Rheumatology (EULAR) recommendations for BS and mainly comprises immunosuppressive therapy with glucocorticoids and cyclophosphamide. In addition to drug therapy, PAA should be evaluated for interventional treatment. Spontaneous PAA rupture due to fragile vessel architecture can occur even in cases of remission and/or PAA regression.
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Affiliation(s)
- Nikolas Ruffer
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin Krusche
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Konstanze Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Labor Lademannbogen MVZ GmbH, Hamburg, Deutschland
| | - Fabian Lötscher
- Universitätsklinik für Rheumatologie und Immunologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
| | - Ina Kötter
- III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
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2
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Scarano M, D'Arrigo S, De Letteriis S, Grasso S, Pittiruti M, Scoppettuolo G. Risk of thrombophlebitis associated with continuous peripheral infusion of vancomycin: The effect of dilution. J Vasc Access 2024; 25:107-112. [PMID: 35608270 DOI: 10.1177/11297298221095778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Although several guidelines recommend that prolonged administration of vancomycin should be preferably carried out by a central venous access, vancomycin is often given peripherally. Whether such risk may be affected by different modalities of administration in terms of dilution and time of infusion, it is a matter of controversy. METHODS This single-center prospective study enrolled all consecutive patients requiring prolonged intravenous infusion of vancomycin (1 g/day) using long peripheral cannula "mini-midline." Patients were randomized in study group (4 mg/ml) and control group (20 mg/ml). All patients were systematically evaluated every 24 h by the Visual Exit-Site Score and a daily ultrasound scan of the veins of the arm. RESULTS The daily ultrasound evaluation showed venous thrombosis at the distal tip of the cannula in all patients, in both groups. After this finding in the first 14 patients, the study was interrupted. All thromboses were completely asymptomatic and occurred in absence of any sign of catheter malfunction. The onset of thrombosis was significantly earlier in the control group (ranging from 24 to 48 h) than in the study group (ranging from 48 to 96 h), with an average of 30 ± 11 versus 68 ± 16 h (p < 0.001). CONCLUSION Continuous intravenous infusion of vancomycin should be preferably delivered by a central venous access, as largely recommended by current guidelines, since peripheral infusion is inevitably associated with venous thrombosis, independently from the type of peripheral venous access device adopted (short peripheral cannula vs long peripheral cannula) and from the extent of dilution.
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Affiliation(s)
- Marianna Scarano
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Sonia D'Arrigo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Sestilio De Letteriis
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Salvatore Grasso
- Department of Anesthesia and Intensive Care 2 "A. Brienza," A.O.U. Policlinico "Giovanni XXIII," Bari, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giancarlo Scoppettuolo
- Department of Infective Diseases, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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3
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Dasgupta R, Singha A. Mondor's disease: an overlooked clinical entity. QJM 2023; 116:1027-1028. [PMID: 37410150 DOI: 10.1093/qjmed/hcad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Indexed: 07/07/2023] Open
Affiliation(s)
- R Dasgupta
- Newcastle University, Newcastle upon Tyne, UK
| | - A Singha
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata 20, India
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Dharia S, Shah S, Kissinger M, Sanders A, Singh G. Group A Streptococcal Endometritis and Toxic Shock causing Septic Pelvic Thrombophlebitis and Septic Pulmonary Emboli. BMJ Case Rep 2023; 16:e255455. [PMID: 37996149 PMCID: PMC10668199 DOI: 10.1136/bcr-2023-255455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Group A Streptococcus (GAS) in the setting of postpartum endometritis can have severe and life-threatening complications. We report a rare case of septic pulmonary emboli that we surmised to have originated from septic pelvic thrombosis in the setting of GAS toxic shock syndrome (TSS) secondary to postpartum endometritis and intrauterine demise. Although the patient had source control with hysterectomy, she continued to have new septic emboli to the lungs seen on CT scans. CT scan of the pelvis demonstrated several filling defects in the renal and pelvic veins. The patient eventually responded well to anticoagulation in addition to antibiotics, which is similar to cases of Lemierre's syndrome. Additionally, we would like to bring attention to how important radiological findings can be missed if there is lack of interspecialty communication about the patient's clinical situation.
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Affiliation(s)
- Sunny Dharia
- Albany Medical Center Hospital, Albany, New York, USA
| | - Sapan Shah
- Albany Medical Center Hospital, Albany, New York, USA
| | | | - Alan Sanders
- Albany Medical Center Hospital, Albany, New York, USA
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Cai J, Xu W, Meng T, Pang Y, Chen H. Acute Appendicitis Complicated by Septic Thrombophlebitis of the Portal Vein Shown by 18 F-FDG and 68 Ga-FAPI-46 PET/CT. Clin Nucl Med 2023; 48:997-999. [PMID: 37796180 DOI: 10.1097/rlu.0000000000004830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
ABSTRACT Septic thrombophlebitis of the portal vein is a serious infectious disorder and is difficult to be diagnosed at an early stage. In this case, we presented 18 F-FDG and 68 Ga-FAPI-46 PET/CT findings in a 45-year-old man with acute appendicitis complicated by septic thrombophlebitis of the portal vein. 68 Ga-FAPI-46 PET/CT showed intense radiotracer uptake in the thrombosis of the portal vein, with higher SUV max and larger disease extent than 18 F-FDG PET/CT. This case demonstrated that 68 Ga-FAPI PET/CT may be a useful imaging modality for the diagnosis of this infectious condition.
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Affiliation(s)
- Jiayu Cai
- From the Department of Nuclear Medicine and Minnan PET Center, Xiamen Key Laboratory of Radiopharmaceuticals, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Burt JN, Hirsh JD, Panchal RM, Endler GT, Devalla RN, Mitchell ME, Villalobos MA. Inferior Vena Cava Filter Occlusion Causing Phlegmasia Alba Dolens. Am Surg 2023; 89:3915-3916. [PMID: 37204767 DOI: 10.1177/00031348231177929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Phlegmasia alba dolens is a rare sequela of acute extensive venothrombus of the iliofemoral segments. Rarely, phlegmasia alba dolens can also result from clotted inferior vena cava filter. A 39-year-old with protein S deficiency, and prior inferior vena cava filter placement after remote trauma presented to the emergency department with progressive bilateral lower extremity pain and swelling. Venous duplex revealed extensive bilateral deep vein thromboses from the external iliac veins to popliteal veins, as well as thrombophlebitis of the left great saphenous vein. Venography confirmed patency of the suprarenal vena cava with abrupt occlusion of the infrarenal segment at the level of the inferior vena cava filter. The filter was removed followed by endovascular thrombectomy and adjunctive venoplasty. The patient progressed well and discharged on therapeutic anticoagulation. This case illustrates that a staged endovascular approach may be utilized for acute on chronic caval thrombosis and filter removal.
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Affiliation(s)
- Jeremy N Burt
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Joshua D Hirsh
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Ramola M Panchal
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Graham T Endler
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Raviteja N Devalla
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
| | - Marc E Mitchell
- Department of Surgery, University of Mississippi Medical Center Jackson, MS, USA
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7
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Condell LJ, McMonagle MP. Phlegmasia Cerulea Dolens in Pregnancy. Eur J Vasc Endovasc Surg 2023; 66:166. [PMID: 37225055 DOI: 10.1016/j.ejvs.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Affiliation(s)
| | - Morgan Peter McMonagle
- Department of Vascular Surgery, University Hospital Waterford, Ireland; Department of Trauma Surgery, St. Mary's Hospital, Praed St, London, W2 1NY, UK. https://twitter.com/McmonagleMorgan
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8
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Georgiades F, Najem M. Beware of Superficial Thrombophlebitis Mimicking a Foreign Body. Eur J Vasc Endovasc Surg 2023; 65:849. [PMID: 36958481 DOI: 10.1016/j.ejvs.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Fanourios Georgiades
- Department of Surgery, University of Cambridge, Cambridge, UK; Vascular Surgery Unit, Bedford Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
| | - Mojahid Najem
- Vascular Surgery Unit, Bedford Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
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Shah A, Moake MM. Diagnosis of Internal Jugular Vein Septic Thrombophlebitis by Point-of-Care Ultrasound. Pediatr Emerg Care 2022; 38:568-571. [PMID: 35477931 DOI: 10.1097/pec.0000000000002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Septic thrombophlebitis represents a rare but serious collection of diseases, which carry a high risk of morbidity and mortality requiring prompt and aggressive treatment. Diagnosis centers on identification of thrombus along with clinical and microbiologic data. We present a case where point-of-care ultrasound was used to diagnose septic thrombophlebitis of the internal jugular vein and expedite appropriate therapy. We further review the technique and literature for ultrasound diagnosis of venous thrombosis and associated thrombophlebitis.
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Affiliation(s)
- Aalap Shah
- From the Departments of Emergency Medicine
| | - Matthew M Moake
- Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC
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10
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Dike CM, Enemuo VC. Exercise-Induced Mondor's Disease of the Chest Wall in a Nigerian Man: A Case Report. West Afr J Med 2022; 39:425-428. [PMID: 35490435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mondor's disease (MD) is a rare cause of chest pain, characterized by thrombophlebitis of the subcutaneous veins of the anterolateral thoracoabdominal wall. It is a benign, self-limiting condition that is often underdiagnosed due to lack of knowledge of the condition. Although the exact aetiology is unclear, several predisposing factors, including excessive physical activity have been postulated. To the best of our knowledge, there is no previous published report of MD of the chest wall in an adult Nigerian man. OBJECTIVE To describe the association between muscular strain and the development of MD. CASE PRESENTATION A 40-year-old Nigerian man presented with a one-month history of dull, aching right-sided chest pain. He gave a history of engaging in intense thoracoabdominal exercises for 6 weeks prior to onset of symptoms. Physical examination revealed a tender, subcutaneous cord-like swelling extending from below the right anterior axillary fold to the right hypochondrium and accentuated by overhead abduction of the right arm. Ultrasonography revealed a hypoechoic, noncompressible right thoracoepigastric vein with no flow on Doppler interrogation, in keeping with superficial venous thrombosis. He was treated with nonsteroidal anti-inflammatory agents and paracetamol. The pain and lesion resolved completely within two weeks after presentation and there was no recurrence over the subsequent four months of follow-up. CONCLUSION MD is an uncommon cause of chest pain that is often underdiagnosed and underreported due to lack of awareness. It can suddenly appear in persons performing extreme thoracoabdominal exercises. Treatment is essentially symptomatic. Prompt diagnosis of this self-limiting condition is essential in distinguishing it from malignant diseases.
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Affiliation(s)
- C M Dike
- Department of Family Medicine, Niger Foundation Hospital, 5, Presidential Close, Independence Layout, Enugu State, Nigeria
| | - V C Enemuo
- Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
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11
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Yoshikawa S, Ueda T, Fujiwara T. Use of intravascular hypo- and hyper-attenuation on non-contrast-enhanced computed tomography in diagnosing acute septic thrombophlebitis. J Radiol Case Rep 2022; 16:1-14. [PMID: 35529424 PMCID: PMC9063837 DOI: 10.3941/jrcr.v16i3.4364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Septic thrombi, such as those observed in pylephlebitis and Lemierre's syndrome, are characterized by portal vein thrombosis and venous thrombosis with bacterial infection. Although radiographic findings of septic thrombus on contrast-enhanced computed tomography have been well described, no report has described the characteristics of non-contrast-enhanced computed tomography. We describe a case series of septic thrombophlebitis exhibiting intravascular hypo- and hyper-attenuation on non-contrast-enhanced computed tomography. These radiographic features reflect the pathophysiology of septic thrombus, and therefore, it is important and useful to evaluate thrombus attenuation on non-contrast-enhanced computed tomography.
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Affiliation(s)
- Satoshi Yoshikawa
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Takeshi Ueda
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Takuya Fujiwara
- Department of Radiology, National Hospital Organization/Osaka National Hospital, Osaka, Japan
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12
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Affiliation(s)
- Edward T Qian
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine
| | - Robert J Lentz
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
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13
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Valerio L, Pleming W, Barco S. Re: Internal Jugular Vein and Cerebral Venous Sinus Infective Thrombophlebitis Detected With 99mTc-HMPAO White Blood Cell Scintigraphy. Clin Nucl Med 2021; 46:858-859. [PMID: 33630791 DOI: 10.1097/rlu.0000000000003536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - William Pleming
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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14
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Shiomi Y, Fujiwara S, Morihisa Y, Katakami T, Kawamoto M, Kohara N. [Bacterial Meningitis and Suppurative Thrombophlebitis after Trigger Point Injections: A Case Report]. Brain Nerve 2021; 73:737-740. [PMID: 34127570 DOI: 10.11477/mf.1416201824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 73-year-old woman with untreated diabetes mellitus visited our emergency department with a 4-day history of progressive headache, fever, and chills. She received trigger point injections (TPI) into the right sternocleidomastoid for exercise-induced ipsilateral shoulder pain, 13 days before admission and into the right trapezius, 6 days before admission. Cerebrospinal fluid (CSF) evaluation revealed pleocytosis with a predominance of neutrophils, as well as elevated protein and reduced glucose levels. Magnetic resonance imaging of the cervical spine revealed inflammatory changes of the right-sided posterior cervical muscles and the right vertebral arch of the C5-C6 vertebrae without contrast enhancement of the right posterior cervical veins. She was diagnosed with bacterial meningitis and suppurative thrombophlebitis, and empiric broad-spectrum antibiotic therapy was administered intravenously. The initial blood culture yielded Streptococcus intermedius; however, CSF culture showed no growth. She recovered completely after a 4-week course of intravenously administered ampicillin and was discharged with oral clindamycin to complete a total 6-week antibiotic course. TPI are widely used as a safe therapeutic strategy associated with few complications, and serious infections are rare. However, clinicians must remain mindful of the possibility of these complications in immunocompromised patients, such as those with diabetes mellitus who undergo TPI. (Received September 18, 2020; Accepted December 21, 2020; Published June 1, 2021).
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Affiliation(s)
- Yuma Shiomi
- Department of Neurology, Kobe City Medical Center General Hospital
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Abstract
BACKGROUND Mondor's disease of the breast (MDB) is a rare and benign disorder of the breast. It is characterized by thrombophlebitis of the superficial veins of the chest wall. Clinically, it manifests as a cord-like induration of the breast area. MDB resolves spontaneously without sequela. CASE PRESENTATION We report cases of three Caucasian African patients aged 29, 40 and 34, respectively. One patient was under progestative contraception. All the patients had a cord-like induration on the chest wall. Ultrasonography was performed in all patients and was normal in two cases and showed a thrombotic vein in one case. All the patients had symptomatic treatment with total resolution of symptoms within 1 to 4 weeks. No relapse was observed. CONCLUSION MDB is benign in most cases. However, it is not to be taken lightly, because it can be the manifestation of an underlying disease such as breast cancer. The diagnosis is based on clinical findings; ultrasonography can be helpful for the diagnosis. Treatment is based on analgesic and anti-inflammatory drugs.
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Affiliation(s)
- K. Ben Hamida
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - M. Ghalleb
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - A. Triki
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - I. Jebir
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - R. Makhlouf
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - H. Touinsi
- Surgery Department, Mohamed Taher El Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis, Tunisia
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Abstract
Granulicatella adiacens, which occurs as part of the oral microflora, is an uncommon cause of infection. However, it can cause serious bloodstream infections including infective endocarditis. Although oral bacteria, most commonly the Fusobacterium spp, can cause internal jugular vein (IJV) thrombophlebitis, there are no reported cases of IJV thrombosis caused by G. adiacens Here we report a patient with septic IJV thrombosis with G. adiacens bacteraemia. A middle-aged man presented to our hospital with fever and altered mental status. Blood cultures were positive for G. adiacens, and pan-scan CT with contrast showed left IJV thrombosis, pulmonary embolism and abscesses in the gluteal muscles. The patient was successfully treated with antibiotics. When confronted with G. adiacens bacteraemia in patients with poor oral hygiene, it is necessary to be cautious of the fact that this organism can cause IJV thrombophlebitis.
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Affiliation(s)
- Honami Kawai
- Department of General Internal Medicine, Kokuho Asahi Chuo Hospital, Asahi, Chiba, Japan
| | - Toshiaki Shiojiri
- Department of General Internal Medicine, Kokuho Asahi Chuo Hospital, Asahi, Chiba, Japan
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Llerena S, Piezny D, Ríos F, Arias C, Sagardía J. [Phlegmasia cerulea dolens. Treatment with systemic fibrinolysis]. Medicina (B Aires) 2021; 81:454-457. [PMID: 34137708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Phlegmasia cerulea dolens (FCD) is a rare complication of deep vein thrombosis. Its cause is unknown. The main predisposing factors for the disease are neoformative processes, hypercoagulable states, congestive heart failure, pregnancy, prolonged immobilization, and surgeries on the affected limb. FCD is characterized by massive edema, severe pain, and cyanosis. The diagnosis is clinical. It is associated in most cases with pulmonary embolism and can lead to loss of the compromised limb if not treated in time. So far there is no consensus on its treatment. In clinical practice the use of anticoagulation with heparin, local thrombolysis, systemic fibrinolysis, surgical thrombectomy, fasciotomy, and inferior vena cava filter are described. In irreversible cases amputation is required. We present the case of a patient with FCD, the treatment performed and the evolution.
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Affiliation(s)
- Sofía Llerena
- Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina. E-mail:
| | - Damián Piezny
- Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
| | - Fernando Ríos
- Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
| | - Constanza Arias
- Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
| | - Judith Sagardía
- Hospital Nacional Profesor Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
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Lim EYT, Taneja R. Thrombophlebitis of abdominal veins as an unusual cause for acute abdomen: avoiding the diagnostic pitfalls. Emerg Radiol 2020; 28:187-192. [PMID: 32583089 DOI: 10.1007/s10140-020-01811-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/19/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this pictorial essay is to review the imaging appearances of the spectrum of thrombophlebitis of abdominal veins on computed tomography (CT) scans. Thrombophlebitis of abdominal veins is rare but mimics other more common conditions presenting with acute abdomen. Due to non-specific presenting symptoms, signs and laboratory findings, diagnosis is largely reliant on imaging, particularly CT which is readily available in the emergency setting.
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Affiliation(s)
| | - Ranu Taneja
- Department of Radiology, Changi General Hospital, Singapore, Singapore
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19
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Fei Z, Peng A, Wang L, Zhang L. Pulmonary embolism caused by postpartum ovarian vein thrombophlebitis after vaginal delivery: Case report and brief review of the literature. J Clin Ultrasound 2020; 48:291-293. [PMID: 31930727 DOI: 10.1002/jcu.22814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
Puerperal ovarian vein thrombophlebitis is a rare pathology. We present the case of a 23-year-old female who presented with fever and cough that occurred after vaginal delivery and persisted after several courses of antibiotics between the 2nd and 20th day postpartum. CT pulmonary angiography revealed right subsegmental pulmonary embolism. An abdominal ultrasonographic examination led to the diagnosis of ovarian vein thrombosis. She was treated with warfarin for 2 weeks with a good response. Our case highlights the importance of prompt ultrasonographic diagnosis and clinical treatment of ovarian vein thrombosis to prevent morbidity and mortality.
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Affiliation(s)
- Zhengdong Fei
- Department of Ultrasound, Shuyang People's Hospital, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, Jiangsu, China
| | - Aiqin Peng
- Department of Radiology, Shuyang People's Hospital, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, Jiangsu, China
| | - Lei Wang
- Department of Ultrasound, Shuyang People's Hospital, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, Jiangsu, China
| | - Lu Zhang
- Department of Ultrasound, Shuyang People's Hospital, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, Jiangsu, China
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Affiliation(s)
| | - Anwar Ahmed
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Shahab Abid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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21
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Affiliation(s)
| | - John Embil
- University of Manitoba, Winnipeg, MB, Canada
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22
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Weiss D, Yaakobovitch H, Tal S, Nyska A, Rotman OM. Novel short peripheral catheter design for prevention of thrombophlebitis. J Thromb Haemost 2019; 17:39-51. [PMID: 30506866 DOI: 10.1111/jth.14350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 12/01/2022]
Abstract
Essentials Phlebitis is one of the most frequent complications related to short peripheral catheters (SPC). A new SPC design, aimed for minimizing mechanical phlebitis, was tested in vivo in swine. MRI analysis revealed 40% less inflammation with the new SPC design compared to commercial SPC. The results confirm that our SPC biomechanical design approach can minimize phlebitis rates. SUMMARY: Background Short peripheral catheters (SPCs) are the most common intravenous device in today's medical practice. Short peripheral catheter thrombophlebitis (SPCT) occurs in up to 80% of hospitalized patients. Symptoms appear on average 3 days after catheter insertion and can lead to extended hospitalization and increased related costs. Here we introduce a novel SPC, named very short peripheral catheter (VSPC), that was designed to minimize biomechanical irritation and improve blood flow. Objective The goal was to test the performance of the novel catheter in vivo for reduction of thrombophlebitis. Methods Very short peripheral catheter prototypes were inserted into swine ear veins (n = 12). Verification of the catheter conformation in situ and blood perfusion was performed using Echo-Doppler. The SPCT development rate was measured using magnetic resonance imaging (MRI), 4 and 12 days after catheter insertion, and analyzed by means of edema and inflammation intensities. Blind histopathology analysis was performed on the veins postmortem. Clinically available SPC was used as a reference. Results Operation of the VSPC devices did not require any special skills over those used for the clinically available SPC. Echo-Doppler imaging confirmed that in contrast to the traditional SPC, the VSPC avoided contact with the vein wall and allowed better blood perfusion. The MRI analysis revealed 2-fold inflammation and edema rates (~80%) in the veins cannulated with the commercial SPC, whereas rates of only ~40% were seen with the novel VSPC. A similar trend was noticed in the histopathology analysis. Conclusions The results indicate that the novel catheter design significantly reduced SPCT rates and demonstrated proof of concept for our biomechanical approach.
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Affiliation(s)
- D Weiss
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - H Yaakobovitch
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - S Tal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- MRI and Neuroradiology Section, Assaf Harofeh Medical Center, Tel Aviv, Israel
| | - A Nyska
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Consultant in Toxicologic Pathology, Timrat, Israel
| | - O M Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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23
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Martín Guerra JM, Asenjo MM, Dueñas Gutiérrez CJ, Gil González I. Synchronous Cardiopulmonary Consequences of the Hypercoagulable State Associated With Cancer. Arch Bronconeumol 2018; 55:330-332. [PMID: 30337138 DOI: 10.1016/j.arbres.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | - Miguel Martín Asenjo
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | - Inmacualda Gil González
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
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24
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Robinson C, Miller D, Will M, Dhaun N, Walker W. Hughes-Stovin syndrome: the diagnostic and therapeutic challenges of peripheral pulmonary artery aneurysms. QJM 2018; 111:729-730. [PMID: 29860510 DOI: 10.1093/qjmed/hcy110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D Miller
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Will
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - N Dhaun
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - W Walker
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Kostrzewa O, Kołodziej P, Majdan M, Zwolak R, Górak A, Bar K. [Mondor's disease or systemic sclerosis - diagnostic and therapeutic dilemmas]. Wiad Lek 2018; 71:93-95. [PMID: 29558359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this article we have presented a case of 31-year-old male with thickening of the skin and tender cord of superficial veins of the penis and laboratory findings of the high titer of PM/Scl-100 antibodies in the serum. The patient was referred to the Rheumatology Department due to suspected systemic sclerosis. The HRCT scan of his lungs revealed fibrous degeneration and ground-glass opacity in the lower lobes. Capillaroscopy showed abnormalities, which were not typical for systemic sclerosis. In Doppler ultrasound examination of penis, superficial dorsal and circumflex veins thrombosis and inflammatory infiltration were observed. Taking into account the entire clinical picture, the patient was diagnosed with rare penile Mondor's disease and was under surveillance for systemic sclerosis.
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Affiliation(s)
- Olga Kostrzewa
- Studenci Wydziału Lekarskiego Uniwersytet Medyczny w Lublinie, Lublin, Polska
| | - Paweł Kołodziej
- Studenci Wydziału Lekarskiego Uniwersytet Medyczny w Lublinie, Lublin, Polska
| | - Maria Majdan
- Katedra i Klinika Reumatologii i Układowych Chorób Tkanki Łącznej Uniwersytet Medyczny w Lublinie, Lublin, Polska
| | - Robert Zwolak
- Katedra i Klinika Reumatologii i Układowych Chorób Tkanki Łącznej Uniwersytet Medyczny w Lublinie, Lublin, Polska
| | - Anna Górak
- Katedra i Klinika Reumatologii i Układowych Chorób Tkanki Łącznej Uniwersytet Medyczny w Lublinie, Lublin, Polska
| | - Krzysztof Bar
- Katedra i Klinika Urologii i Onkologii Urologicznej Uniwersytet Medyczny w Lublinie, Lublin, Polska
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Abstract
Spontaneous septic thrombophlebitis is a rare complication of Staphylococcus aureus bacteraemia. Its true incidence is unknown as septic thrombus is not often considered as a source in the typical 'screen' of tests used to find the source of a bacteraemia.Positron emission tomography computerised tomography (PET-CT) is becoming increasingly available to physicians, is highly sensitive and yields specific anatomical information regarding abnormal metabolically active sites in infection, inflammation and neoplasia.In this case, PET-CT enabled the identification of the source of a septic thrombus and enabled focused management. PET-CT should be considered as part of the raft of tests used to identify an obscure source of fever/bacteraemia.
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Affiliation(s)
- Patrick Harnett
- Southend University Hospital NHS Foundation Trust, Southend, UK
| | - Shaifali Jain
- Southend University Hospital NHS Foundation Trust, Southend, UK
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27
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Olarinoye-Akorede SA, Silas BT. Mondor's disease of the breast in a Nigerian woman previously treated for invasive ductal carcinoma in the contralateral breast: A case report. Niger J Clin Pract 2017; 20:1040-1043. [PMID: 28891551 DOI: 10.4103/njcp.njcp_354_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mondor's disease is a self-limiting sclerosing angitis mostly affecting the superficial veins of the breast and chest wall. It is seldom diagnosed, and its etiology and epidemiology are speculative. However, numerous predisposing factors including breast cancer have been postulated. In Nigerian literature, only two cases have been documented to the best of our knowledge. This report is aimed at reminding breast specialists to include it as a diagnostic consideration in patients presenting with a breast lump in the appropriate clinical setting. Its imaging features are also highlighted because it may be incorrectly overlooked as mere ductal dilatation. We present the case of a 60-year-old woman who complained of a painful cordlike lesion in her right breast. Mondor's disease was diagnosed based on the clinical and radiological findings. She had also been previously treated for invasive ductal breast carcinoma in the contralateral breast. Mondor's disease is usually a benign entity, which may resolve spontaneously. On the other hand, it may also be the sole presenting symptom or clue of a breast malignancy; hence, a need for increased awareness.
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Affiliation(s)
| | - B T Silas
- Department of Radiology, Kaduna State University, Kaduna, Nigeria
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28
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Abstract
Lemierre syndrome is an uncommon condition in which internal jugular vein thrombosis presents after recent oropharyngeal infection. Frequently, this is accompanied by septic emboli. This report outlines a variant of this disease process, with septic thrombophlebitis of the neck associated with a necrotizing skin infection of the lower lip and chin. A 25-year-old man with lower lip and chin swelling, initially managed with intravenous antibiotics, progressed to the development of a left facial vein thrombus, septic emboli to the lungs, and a necrotizing lower lip and chin infection that was managed with debridement, thrombectomy, and prolonged hemodynamic and pulmonary support. A necrotizing skin infection with thrombus of the jugular system and septic emboli is a very rare variant of Lemierre syndrome. Early recognition of an infection with septic emboli and/or necrotizing pathobiological findings allows for prompt antibiotic and surgical therapy, minimizing the mortality of these potentially lethal infections.
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Affiliation(s)
- Karl Cuddy
- Fellow, Advanced Craniomaxillofacial Surgery and Trauma, Legacy Emanuel Medical Center, The Head and Neck Institute, Portland, OR.
| | - Nariman Saadat
- Resident, Division of Oral and Maxillofacial Surgery, Oregon Health Science University, Portland, OR
| | - Baber Khatib
- Fellow, Advanced Craniomaxillofacial Surgery and Trauma, Legacy Emanuel Medical Center, The Head and Neck Institute, Portland, OR
| | - Ashish Patel
- Head and Neck Surgeon and Oral and Maxillofacial Surgeon, Legacy Emanuel Medical Center, The Head and Neck Institute, Portland, OR
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29
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Górski G, Szopiński P, Michalak J, Marianowska A, Borkowski M, Geremek M, Trochimczuk M, Brotánek J, Sárník S, Seménka J, Wilkowski D, Noszczyk W. Liposomal Heparin Spray: A New Formula in Adjunctive Treatment of Superficial Venous Thrombosis. Angiology 2016; 56:9-17. [PMID: 15678251 DOI: 10.1177/000331970505600102] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the efficacy and safety of liposomal heparin spray—a new formula of topical heparin delivery. This was a randomized, multicenter, controlled open clinical trial with 2 parallel groups. Forty-six outpatients with clinical signs of superficial venous thrombosis (SVT) were treated with either topical liposomal heparin spraygel (LHSG) (Lipohep Forte Spraygel, 4 puffs of 458 IU tid (n=22) or with low-molecular-weight heparin (LMWH) (Clexane 40 mg once a day (n=24), administered subcutaneously (sc). Main outcome measures were efficacy parameters (improvement of local symptoms—pain control and planimetric evaluation of erythema size, duplex Doppler assessment of thrombus regression) and safety parameters (documentation of adverse events, with particular reference to deep vein thrombosis [DVT] by duplex sonography, and patients’ and investigators’ assessment of drug tolerance). Patients’ and investigators’ subjective assessment of efficacy of treatment and change in basic biochemical parameters were defined as secondary outcome measures. Statistical analysis was performed with use of Wilcoxon test, Mann-Whitney U-test and Chi-square test. Regression of SVT-related symptoms, including pain, erythema, and thrombus presence, was shown as comparable in LHSG and LMWH groups. These results were corroborated by efficacy assessment by investigators and patients. Three cases of deep venous thrombosis in heparin spraygel and 1 in heparin sc group were reported. No significant adverse reactions were observed in the spraygel group, but 1 serious allergic reaction was observed in the LMWH group. Tolerance of new formula heparin was assessed as good. Heparin spraygel—a new topical mode of heparin application, seems a promising method of heparin delivery. This initial study has demonstrated comparable efficacy and safety of LHSG and LMWH in local treatment of SVT. These findings should be confirmed by further extensive study that will reach appropriate statistical power to support such conclusion, for despite heparin treatment, significant risk of DVT was demonstrated in both groups.
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Affiliation(s)
- Grzegorz Górski
- Department of General and Vascular Surgery, Medical Academy in Warsaw, Poland
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30
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Affiliation(s)
- T Ikegami
- Department of Emergency Medicine, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki Okayama, Kurashiki, Okayama 710-8602, Japan
| | - A Kuriyama
- Department of General Medicine, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki Okayama, Kurashiki, Okayama 710-8602, Japan
| | - S Matsukubo
- Department of Emergency Medicine, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki Okayama, Kurashiki, Okayama 710-8602, Japan
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31
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Takayanagi H, Hayami R, Tsuneizumi M, Nakagami K. [Thrombophlebitis in an Elderly Japanese Woman Treated with Tamoxifen for Breast Cancer]. Gan To Kagaku Ryoho 2015; 42:1203-1205. [PMID: 26489549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this study, we report the rare case of an elderly woman who developed thrombophlebitis after being treated with tamoxifen for breast cancer. She visited our department with a lump in her left breast. She underwent core needle biopsy, and she was diagnosed with breast cancer (invasive ductal carcinoma, ER- and PgR-positive, HER2-negative). We chose hormonal therapy because surgical treatment was deemed too invasive considering her general status. She was administered tamoxifen (20 mg/day) instead of an aromatase inhibitor in consideration of her osteoporosis. Six months after initiating tamoxifen therapy, she exhibited swelling in her left leg. Computed tomography and ultrasound revealed thrombophlebitis in her left femoral vein. She stopped taking tamoxifen and started warfarin potassium as thrombolytic therapy, after which thrombophlebitis was relieved. Advanced age may be a risk factor for thrombophlebitis associated with tamoxifen treatment; therefore, precautions should be taken accordingly.
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32
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Affiliation(s)
- H Nasr
- Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, B9 5SS, UK
| | - J M Scriven
- Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, B9 5SS, UK
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33
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Serracant-Barrera A, Llaquet-Bayo H, Sánchez-Delgado J, Romaguera-Monzonis A, Dalmau-Obrador B, Bejarano-González N, Navas-Pérez AM, Llopart-Valdor E, García-Borobia FJ, Navarro-Soto S. Pylephlebitis and liver abscesses secondary to acute advanced appendicitis. Rev Esp Enferm Dig 2015; 107:397-398. [PMID: 26031880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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34
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Stuttle AW, Klosok J, Peters AM, Henderson BL, Lavender JP. Imaging venous thrombosis with indium-111 labelled P256 Fab'. Curr Stud Hematol Blood Transfus 2015:200-4. [PMID: 1954768 DOI: 10.1159/000419362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A W Stuttle
- Department of Medical Physics, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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36
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Chernukha LM, Shchukin SP. [Thrombotic complications in severe forms of varicose disease: diagnosis, surgical treatment, using miniinvasive methods]. Klin Khir 2015:35-37. [PMID: 25842677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Actual issues of surgical treatment of patients, suffering complications of varicose disease severe forms, are discussed. The causes of unsatisfactory results of treatment of patients, suffering varicothrombophlebitis, the main of which is the absence of common tactics of operative treatment and anticoagulant therapy, were analyzed. There were formatted the groups of patients, suffering severe forms of varicose disease of various localization of thrombotic process, a differentiated tactics of their surgical treatment was proposed.
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37
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Tsukanov IT, Tsukanov AI, Nikolaĭchuk AI. [Monitoring of the state of the proximal portion of thrombus in conservative treatment of patients with varicothrombophlebitis]. Angiol Sosud Khir 2015; 21:64-69. [PMID: 26673295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Ultrasound duplex scanning (USD) was used to study dynamics of the state of the proximal portion of the thrombus in patients presenting with acute varicothrombophlebitis of saphenous veins during conservative treatment. We examined a total of fifty-four 29-to-78-year-old (mean age 53.5 years) patients with acute varicothrombophlebitis of saphenous veins, including 15 (27.8%) men and 39 (72.2%) women. USD was used to determine: localization and extent of thrombosis, proximal level of the thrombus, presence of the free portion of the thrombus, density and structure of the proximal and distal portion of the thrombus, thickness of the inflamed venous wall and paravasal fat at the level of the proximal and distal portions of the thrombus. Twelve (22.2%) patients were found to have signs of thrombus flotation with high embologenic risk; these patients underwent the operation of Troyanov-Trendelenburg and were excluded from the study. The remaining 42 patients received conservative treatment and were dynamically followed up by means of USD. All patients on the background of comprehensive conservative treatment showed positive dynamics consisting in decreased mass and density of the thrombus, shift of its proximal border in the distal direction, decreased thickness of the inflamed venous wall and paravasal fat. Two variants of dynamics were singled out: relatively rapid (during a week) - group 1 (n=11) and relatively slow (during one month) - group 2 (n=31). It was determined that the most significant factors promoting rapid lysis of the proximal portion of the thrombus were as follows: the term of seeking medical attention (duration of thrombosis), low echogenicity of the thrombus, cellular pattern of the thrombus and thickness of the paravasal fat. A conclusion was drawn that monitoring of the state of the proximal portion of the thrombus by means of USD makes it possible to maximally approach solving the problem of individualized treatment of patients with thrombosis of saphenous veins.
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Affiliation(s)
- Iu T Tsukanov
- Omsk State Medical University of the Russian Public Health Ministry, Omsk, Russia
| | - A Iu Tsukanov
- Omsk State Medical University of the Russian Public Health Ministry, Omsk, Russia
| | - A I Nikolaĭchuk
- Omsk State Medical University of the Russian Public Health Ministry, Omsk, Russia
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Fournet M, Behaghel A, Pavy C, Flecher E, Thebault C. Spontaneous bacterial coronary sinus septic thrombophlebitis treated successfully medically. Echocardiography 2014; 31:E92-3. [PMID: 24749166 DOI: 10.1111/echo.12430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A 38-year-old farmer was hospitalized for fever, chills, cough, and chest pain lasting for 7 days. Due to persistent symptoms, patient was referred to hospital. Blood cultures identified oxacillin-sensitive Staphylococcus aureus (OSSA). Transthoracic echocardiography (TTE) showed large pericardial effusion, a mobile heterogeneous mass originating from the coronary sinus ostium, no sign of valvular endocarditis. Pericardiocentesis was done carrying out purulent fluid, microbiological culture isolating an OSSA. Parenteral penicillin M was administered for 6 weeks. At the end of this antibiotherapy regimen, TTE showed no coronary sinus mass with complete vacuity of the coronary sinus vein and no pericardial effusion.
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Ben-Horin S, Lubetsky A, Heyman Z, Kleinbaum Y. Superficial abdominal thrombophlebitis (Mondor's disease) presenting as loss of response to adalimumab in a Crohn's disease patient. J Crohns Colitis 2014; 8:1557-8. [PMID: 24835166 DOI: 10.1016/j.crohns.2014.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
| | - Aaron Lubetsky
- Coagulation Unit, Hematology Department, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Zahava Heyman
- Radiology Department, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - Yeroham Kleinbaum
- Radiology Department, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
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Rusyn VI, Riashko MI, Sirchak SS, Lopit VM, Krasnopol's'ka OS. [Surgical treatment tactics for acute varicothrombophlebitis atypical forms]. Klin Khir 2014:40-42. [PMID: 25252552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Changes of phlebohemodynamics under control of ultrasonographic investigation were registered in 237 patients, suffering an acute varicothrombophlebitis (AVTH) of superficial veins of lower extremities (LE). In 21 patients atypical forms of AVTH were revealed, including reflux toward a big subcutaneous vein (BSV) of the leg and/or small subcutaneous vein (SSV); reflux toward insufficient indirect veins on hip and shin; reflux toward insufficient direct perforant veins. For atypical forms of AVTH the urgent operations on hip and shin were performed: crossectomy, short or long stripping, phlebectomy and/or scleroobliteration of tributaries; open subfascial resection (mini-Linton); deferred operations: phlebectomy of the BSV/SSV tributaries, open scleroobliteration, subfascial resection (mini-Linton). Systematization of the AVTH forms in accordance to the LE segments have permitted to determine strategy and tactics of the patients treatment, what have important practical significance.
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41
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Kalný J, Tomášková L, Pažin J. [Superficial thrombophlebitis of the lower limbs from the surgeons point of view]. Rozhl Chir 2014; 93:260-270. [PMID: 24891243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION A new consensus on the management of superficial thrombophlebitis (STP) from the Central European Vascular Forum (CEVF) for the diagnosis and treatment of STP recommends anticoagulation treatment either with Fondaparinux 2.5 mg for at least 45 days or with low molecular weight heparin (LMWH) for 4 weeks in patients with thrombosis of GSV/SSV proven by duplex ultrasonography (DUS) and with thrombus length exceeding 5 cm. The dosage and duration of anticoagulation treatment depend on the associated diseases and other risk factors for TVE. Many options for doses an duration of treatment are referred to in the literature. Emergency surgery is not recommended. The aim of this study is to demonstrate the role of DUS examination in acute ascending thrombophlebitis (ASTP) of the GSV, and demonstrate the efficiency of surgical treatment - crossectomy and phlebectomy of thrombosed GSV/SSV. MATERIAL AND METHODS The authors present their clinical experience with DUS diagnosis and surgical treatment of acute ascending thrombophlebitis in GSV/SSV on 66 patients with 68 operations. In two of them bilateral crossectomy was performed. In the diagnosis it is necessary to perform DUS examination after clinical diagnosis of acute thrombophlebitis. It should be done bilaterally, not only in the affected limb. DUS confirms the measure, progression and eventually ascension of the thrombosis on the trunk of the GSV/SSV and perforating veins. Progress of the thrombotic process from the thigh to the SF/SP junction is usually a matter of a few hours. Daily ultrasound assessment should therefore be performed in acute thrombophlebitis, even during anticoagulation therapy. Thrombus near the SF/SP junction is a reason for urgent surgery - crossectomy and phlebectomy. RESULTS 66 patients were operated on under general anaesthesia without any complications. A large hematoma in the subinguinal region developed in one patient after surgery. A 50-year-old patient returned with colliquation of the residual varicose vein on the lower leg. Outpatient incision and evacuation had to be performed 3 weeks after surgery. Anticoagulation therapy with warfarin was started in two patients. The other patients were discharged 4 to 6 days following surgery without any problems. Post-operative anti-coagulation in other patients was not longer than 2 weeks. CONCLUSION Urgent crossectomy and phlebectomy represent a reliable method of treatment in the management of acute ascending thrombophlebitis of GSV/SSV, guaranteeing prophylaxis of complications, especially in pregnant women with PT in the later phase of pregnancy. Surgical treatment destroys the damaged vein with crossectomy as a potential cause of deep vein thrombosis (DVT), pulmonary embolism (PE) and STP recurrence. After anticoagulation therapy the affected vein remains in situ. It can potentially cause the recurrence of STP, and DVT and PE may develop.
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42
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Luna PC, Martín C, Panizzardi A, Vallarino C, Florenzano N, Larralde M. [Mondor disease]. Medicina (B Aires) 2014; 74:232. [PMID: 24918675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Paula C Luna
- Servicio de Dermatología, Hospital Alemán, Buenos Aires, Agentina
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Gavornik P, Dukát A, Gašpar L. [Management of superficialis thrombophlebitis. Guidelines of the Angiologiy Section of the Slovak Medical Chamber (2013)]. Vnitr Lek 2013; 59:1009-1016. [PMID: 24279446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED The aim of Guidelines of the Angiology Section of the Slovak Medical Chamber (AS SMC) is to address a last european guidelines for the management of thrombophlebitis superficialis, as well as results in evidence based medicine (EBM) in order to assess their contribution to our expanding knowledge on rational management of thrombophlebitis superficialis. DISCUSSION Superficial thrombophlebitis is a common disease, usually considered to be benign. However, the practice of systemic duplex ultrasonography has revealed a large number of cases of deep vein thrombosis concomitant with superficial thrombophlebitis. Assessment of clinical probability of deep vein thrombosis and venous tromboembolism and systematic duplex ultrasound investigation has been proposed in the initial management of superficial thrombophlebitis, to detect the presence of any underlying deep vein thrombosis. In contrast with extensive information on the management of deep vein thrombosis, there is little knowledge about the most appropriate treatment of the superficial thrombophlebitis. CONCLUSION The treatment of superficial thrombophlebitis should improve local symptoms while preventing the development of complications such as venous thromboembolism. The most effective therapeutic approach to superficial thrombophlebitis seems to be represented by fondaparinux (a synthetic selective indirect inhibitor of factor Xa) which have been shown to prevent VTE events and the extension and/ or recurrence of superficial thrombophlebitis.
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Astradsson T, Ekspong L, Norlander T. [Lemierre syndrome is a forgotten disease that primarily affects young people. Early antibiotic treatment can prevent fatal outcome]. Lakartidningen 2013; 110:413-415. [PMID: 23488437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Kan'o T, Nishimaki H, Kataoka Y, Soma K. Pulse-spray treatment of total occlusive jugular venous suppurative thrombophlebitis. Intern Med 2013; 52:819-22. [PMID: 23545683 DOI: 10.2169/internalmedicine.52.7804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 63-year-old man was diagnosed with jugular venous suppurative thrombophlebitis after undergoing strangulation ileus surgery. His condition was not stabilized by therapy with antibiotics, heparin or other supportive treatments. Pulse-spray treatment (PST) was administered, following which, the patient was afebrile without symptoms and the laboratory data improved. There were no complications such as sustained sepsis, septic embolisms or pulmonary embolisms. This is a unique case report of the use of a pulse-spray catheter in the treatment of total occlusive jugular venous suppurative thrombophlebitis following the failure of medical therapy.
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Affiliation(s)
- Tomomichi Kan'o
- Department of Emergency & Critical Care Medicine, Kitasato University, Japan.
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Kalafateli M, Triantos C, Kakkos SK, Mougiou A, Labropoulou-Karatza C. Superficial venous thrombophlebitis associated with pegylated interferon alpha-2a treatment in a patient with chronic hepatitis B. J Gastrointestin Liver Dis 2012; 21:328-329. [PMID: 23012682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Picardi M, Pagliuca S, Chiurazzi F, Iula D, Catania M, Rossano F, Pane F. Early ultrasonographic finding of septic thrombophlebitis is the main indicator of central venous catheter removal to reduce infection-related mortality in neutropenic patients with bloodstream infection. Ann Oncol 2012; 23:2122-2128. [PMID: 22228450 DOI: 10.1093/annonc/mdr588] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Septic thrombophlebitis increases patient morbidity and mortality following metastatic infections, pulmonary emboli, and/or septic shock. Central venous catheter (CVC) removal for occult septic thrombophlebitis challenges current strategy in neutropenic patients. PATIENTS AND METHODS We prospectively evaluated infection-related mortality in 100 acute leukemia patients, with CVC-related bloodstream infection (CRBSI) after chemotherapy, who systematically underwent ultrasonography to identify the need for catheter removal. Their infection-related mortality was compared with that of a historical cohort of 100 acute leukemia patients, with CRBSI after chemotherapy, managed with a clinically driven strategy. Appropriate antimicrobial therapy was administered in all patients analyzed. RESULTS In the prospective series, 30/100 patients required catheter removal for ultrasonography-detected septic thrombophlebitis after 1 median day from BSI onset; 70/100 patients without septic thrombophlebitis retained their CVC. In the historical cohort, 60/100 patients removed the catheter (persistent fever, 40 patients; persistent BSI, 10 patients; or clinically manifest septic thrombophlebitis, 10 patients) after 8 median days from BSI onset; 40/100 patients retained the CVC because they had not clinical findings of complicated infection. At 30 days median follow-up, one patient died for infection in the ultrasonography-assisted group versus 17 patients in the historical cohort (P<0.01). With the ultrasonography-driven strategy, early septic thrombophlebitis detection and prompt CVC removal decrease infection-related mortality, whereas clinically driven strategy leads to inappropriate number, reasons, and timeliness of CVC removal. CONCLUSION Ultrasonography is an easy imaging diagnostic tool enabling effective and safe management of patients with acute leukemia and CRBSI.
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Affiliation(s)
- M Picardi
- Departments of Biochemistry and Medical Biotechnology
| | - S Pagliuca
- Departments of Biochemistry and Medical Biotechnology
| | - F Chiurazzi
- Departments of Biochemistry and Medical Biotechnology
| | - D Iula
- Cellular and Molecular Biology and Pathology, Federico II University Medical School, Naples, Italy
| | - M Catania
- Cellular and Molecular Biology and Pathology, Federico II University Medical School, Naples, Italy
| | - F Rossano
- Cellular and Molecular Biology and Pathology, Federico II University Medical School, Naples, Italy
| | - F Pane
- Departments of Biochemistry and Medical Biotechnology.
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Affiliation(s)
- O Zimhony
- Kaplan Medical Center, affiliated to the School of Medicine, Hebrew University, Rehovot, Israel.
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Machan K, Rojo-Carmona LE, Marquez-Moreno AJ, Herrera-Imbroda B, Ruiz-Escalante JF, Herrera-Gutierrez D, Acebal-Blanco MM. Ultrasound diagnosis of three cases of Mondor's disease. ARCH ESP UROL 2012; 65:262-266. [PMID: 22414457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To describe clinical features and ultrasound findings of three cases of a little-known and relatively infrequent entity in daily clinical activity, which is often unnoticed and under-reported: penile Mondor's disease or superficial penile veins thrombophlebitis. METHODS We are reporting the cases of three patients aged 33, 25 and 39 years who were referred to our department, the first case with suspicion of inguinal hernia, the second one to rule out testicular pathology because of pubic and perineal discomfort, and the third one for painful induration of the dorsal region of the penis. The three patients underwent Doppler-ultrasound examination (Toshiba®, using a 13-18MHz linear transducer) to establish definitive diagnosis, and had a favorable evolution with conservative management. RESULTS Ultrasound examination revealed: Case 1. Penile superficial dorsal vein and lateral superficial veins thrombosis. Case 2. Thrombosis of the right branch of the superficial dorsal vein and its perineal distal connections. Case 3. Penile superficial dorsal vein thrombosis. Definitive diagnosis of the three cases was Mondor's disease. CONCLUSIONS Mondor's disease is an often under-reported entity in daily clinical activity. Doppler-ultrasound findings (echogenic material within veins, lack of any response after compression by the transducer and absence of color flow) confirm de diagnosis. This disease has a favorable evolution and functional prognosis. Knowledge of Mondor's disease by echographists is basic to avoid false-negative results in radiologic examination.
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Affiliation(s)
- K Machan
- Sección de ecografía y ecografía-doppler, Servicios de Radiología y Urología, Hospital Clínico Universitario Málaga, Málaga, Spain
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile Livorno, Viale Alfieri 36, 57100, Livorno, Italy.
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