RESUMEN
PURPOSE: To report venous thrombosis and associated perfusion defect in amebic liver abscess (ALA) using MDCT. METHOD: MDCT images of 62 patients with ALA were reviewed for venous thrombosis and associated perfusion abnormalities. RESULT: The study found 43 (69%) patients with venous thrombosis: portal vein thrombosis (PVT) occurred in 39, hepatic vein thrombosis (HVT) in 37 and inferior vena cava (IVC) thrombosis in 4. Combined PVT and HVT occurred in 33 (77%) patients. The portal vein thrombi remained localized in subsegmental branches in 25 patients and extended to segmental branches in 14. The hepatic vein thrombi were confined to peripheral branches in 18 patients; they progressed to the main trunk in 19 and to the IVC in 4. A wedge-shaped hypoattenuating zone suggesting ischemia was identified in 33 (77%) patients in portal phase: 31 had combined PVT and HVT, 2 had HVT alone, but none had PVT alone. It occurred significantly more often with combined PVT and HVT than HVT alone (p = 0.05). Arterial phase enhancement occurred in 2 of 13 patients with multiphasic CT. All patients were symptomatic despite medical therapy and therefore required percutaneous drainage. About half of the patients were identified with ruptured abscesses. Segmental atrophy was observed in seven of nine patients who underwent follow-up CT. CONCLUSION: Combined PVT and HVT commonly occur with ALA and often manifests as segmental hypoperfusion in portal venous phase, indicating ischemia. The detection of such events by CT may be indicative of severe disease that requires aggressive management involving percutaneous drainage.
Asunto(s)
Absceso Hepático Amebiano/diagnóstico por imagen , Hígado/irrigación sanguínea , Tomografía Computarizada Multidetector/métodos , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/parasitología , Adolescente , Adulto , Anciano , Síndrome de Budd-Chiari/diagnóstico por imagen , Síndrome de Budd-Chiari/parasitología , Medios de Contraste , Femenino , Humanos , India , Yohexol , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Vena Porta/parasitología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/parasitologíaRESUMEN
Portal vein thrombosis is considered a vaso-occlusive process that can appear during the course of hepatosplenic Schistosoma mansoni, but may result from impaired portal blood flow or be associated with acquired or inherited thrombophilic factors. Here, we report the case of a 67-year-old woman who developed thrombocytopenia as a result of hypersplenism. Following the diagnosis of hepatosplenic schistosomiasis, portal vein thrombosis was detected by ultrasound examination, while haematological tests revealed low levels of protein C (43.3%) and high levels of factor VIII (183.1%). The pathogenesis of portal vein thrombosis remains unclear in some patients with S. mansoni. We recommend, therefore, that early clinical and haemostatic investigations are done to evaluate risk of portal vein thrombosis and hence avoid further complications.
Asunto(s)
Deficiencia de Proteína C/diagnóstico , Esquistosomiasis/diagnóstico , Esplenomegalia/diagnóstico , Trombocitopenia/diagnóstico , Trombosis de la Vena/diagnóstico , Anciano , Animales , Factor VIII/metabolismo , Femenino , Expresión Génica , Hemostasis , Humanos , Hígado/metabolismo , Hígado/parasitología , Hígado/patología , Vena Porta/metabolismo , Vena Porta/parasitología , Vena Porta/patología , Proteína C/metabolismo , Deficiencia de Proteína C/sangre , Deficiencia de Proteína C/complicaciones , Deficiencia de Proteína C/parasitología , Schistosoma mansoni/patogenicidad , Schistosoma mansoni/fisiología , Esquistosomiasis/sangre , Esquistosomiasis/complicaciones , Esquistosomiasis/parasitología , Bazo/metabolismo , Bazo/parasitología , Bazo/patología , Esplenomegalia/sangre , Esplenomegalia/complicaciones , Esplenomegalia/parasitología , Trombocitopenia/sangre , Trombocitopenia/complicaciones , Trombocitopenia/parasitología , Trombosis de la Vena/sangre , Trombosis de la Vena/complicaciones , Trombosis de la Vena/parasitologíaRESUMEN
Infection with the trematode Clonorchis sinensis is the most common human fluke infection in East Asian populations. Although this infection is associated with obstructive jaundice or choledocholithiasis, portal vein thrombosis has not been reported. Here, we report the first case of a 60-year-old man who had both C. sinensis infection and portal vein thrombosis with severe hyperbilirubinemia (75.4 mg/dl). He initially presented with abdominal pain and jaundice. Computed tomography revealed gallstones, common bile duct calculus, and thrombus in the left main branch of the portal vein. A nasobiliary tube was inserted under endoscopic retrograde cholangiography. Cytology of the bile juice revealed many C. sinensis eggs. The abdominal pain and jaundice improved following choledocholithotomy and combination treatment with a chemotherapeutic agent and anti-coagulant. This case suggests that inflammation around the portal vein as a result of C. sinensis infection has the potential to evoke portal vein thrombosis. Such cases should be treated with both a chemotherapeutic agent and anti-coagulant therapy. In conclusion, the possibility of infection with C. sinensis should be considered in patients presenting with hyperbilirubinemia and portal vein thrombosis, particularly in East Asian populations.
Asunto(s)
Bilis/parasitología , Clonorquiasis/diagnóstico , Clonorchis sinensis/aislamiento & purificación , Hiperbilirrubinemia/diagnóstico , Vena Porta/patología , Trombosis de la Vena/diagnóstico , Animales , Bilis/citología , Clonorquiasis/complicaciones , Clonorquiasis/parasitología , Humanos , Hiperbilirrubinemia/complicaciones , Hiperbilirrubinemia/parasitología , Masculino , Persona de Mediana Edad , Trombosis de la Vena/complicaciones , Trombosis de la Vena/parasitologíaRESUMEN
We report for the first time in the Philippines a case of portal vein thrombosis in a 12 year old Filipino boy with advanced schistosomiasis. The boy was referred to the Research Institute for Tropical Medicine (RITM), Manila, due to a rapidly enlarging spleen post-praziquantel treatment. At RITM, liver function tests were within normal limits but complete blood examinations showed pancytopenia and abnormal coagulation times. Serum markers for hepatitis A, B and C were negative. Abdominal MRI revealed schistosome-induced periportal fibrosis. The main portal vein appeared thrombosed with characteristic cavernous transformation of the right portal vein. Varices were seen in the oesophagus, gastrohepatic ligament, and splenic hilum. The spleen was markedly enlarged, with parenchymal foci representing Gamna-Gandy bodies. The patient underwent splenectomy. Histopathologic findings in the liver showed moderate pipestem fibrosis and schistosome egg granulomas. The patient was discharged from the hospital in excellent clinical condition.
Asunto(s)
Vena Porta , Esquistosomiasis/complicaciones , Esplenectomía , Esplenomegalia/cirugía , Trombosis de la Vena/parasitología , Niño , Diagnóstico Diferencial , Humanos , Hipertensión Portal/parasitología , Masculino , Esplenomegalia/diagnóstico , Esplenomegalia/parasitología , Resultado del Tratamiento , Trombosis de la Vena/diagnósticoRESUMEN
Idiopathic thrombosis of palmar finger veins is rare and women suffer from it almost exclusively. Synovial cysts, epidermoid inclusion cysts, giant cell tumours and haemangiomatous lesions should be considered in the process of diagnosis. We present a 56-year-old woman with idiopathic and symptomatic thrombosis of palmar finger veins. Using the palmar approach the painful veins were identified and excised completely. An uncomplicated wound healing has followed with completely unrestricted and painless range of motion. Surgical excision of the finger vein thrombosis should be considered if there is continuing pain.
Asunto(s)
Dedos/irrigación sanguínea , Microcirugia/métodos , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/cirugía , Anestesia de Conducción , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Rango del Movimiento Articular/fisiología , Ultrasonografía , Venas/patología , Venas/cirugía , Trombosis de la Vena/parasitología , Cicatrización de Heridas/fisiologíaAsunto(s)
Equinococosis/complicaciones , Equinococosis/diagnóstico , Músculos Psoas/parasitología , Trombosis de la Vena/etiología , Anciano , Equinococosis/parasitología , Humanos , Extremidad Inferior , Masculino , Músculos Psoas/patología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/parasitologíaRESUMEN
The aim of this study was to assess interobserver agreement of ultrasound parameters for portal hypertension in hepatosplenic mansonic schistosomiasis. Spleen size, diameter of the portal, splenic and superior mesenteric veins and presence of thrombosis and cavernous transformation were determined by three radiologists in blinded and independent fashion in 30 patients. Interobserver agreement was measured by the kappa index and intraclass correlation coefficient. Interobserver agreement was considered substantial (kappa = 0.714-0.795) for portal vein thrombosis and perfect (kappa = 1) for cavernous transformation. Interobserver agreement measured by the intraclass correlation coefficient was excellent for longitudinal diameter of the spleen (r = 0.828-0.869) and splenic index (r = 0.816-0.905) and varied from fair to almost perfect for diameter of the portal (r = 0.622-0.675), splenic (r = 0.573-0.913) and superior mesenteric (r = 0.525-0.607) veins. According to the results, ultrasound is a highly reproducible method for the main morphological parameters of portal hypertension in schistosomiasis patients.
Asunto(s)
Hipertensión Portal/diagnóstico por imagen , Parasitosis Hepáticas/diagnóstico por imagen , Sistema Porta/ultraestructura , Esquistosomiasis mansoni/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Hipertensión Portal/etiología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Tamaño de los Órganos , Sistema Porta/parasitología , Estudios Prospectivos , Reproducibilidad de los Resultados , Esquistosomiasis mansoni/complicaciones , Enfermedades del Bazo/parasitología , Ultrasonografía Doppler en Color , Trombosis de la Vena/parasitologíaRESUMEN
We report herein on a case of renal cell carcinoma with retrohepatic inferior vena cava tumor thrombus in which intraoperative cardiac arrest from a massive pulmonary embolism was managed successfully with emergency sternotomy and cardiopulmonary bypass, followed by the removal of the primary site and pulmonary artery embolus.