RESUMEN
Takayasu arteritis (TAK) is the main type of large vessel arteritis in young adults, which mainly affects the aorta and its main branches, leading to clinical manifestations such as syncope, intermittent limb claudication, hypertension, and abdominal pain. Among them, venous involvement is rarely reported. Here we show a case of TAK presenting as phlebitis. This was a 27-year-old woman, who initially admitted to our hospital with myalgia of the upper and lower extremities and night sweats. She was diagnosed as TAK according to the 1990 American College of Rheumatology TAK criteria. Surprisingly, vascular ultrasonography revealed wall thickening as indicated by macaroni sign of the multiple veins. TAK phlebitis appeared at the active phase, while disappearing rapidly at remission. Phlebitis might have a close relationship with disease activity. By retrospective study in our department, the estimated incidence rate of phlebitis might be 9.1% in TAK. With the literature review, it revealed that phlebitis might be an ignored manifestation in active TAK. However, due to the smaller sample size, it should be noted that a direct cause-effect relationship cannot be established.
Asunto(s)
Hipertensión , Flebitis , Arteritis de Takayasu , Femenino , Adulto Joven , Humanos , Adulto , Arteritis de Takayasu/diagnóstico , Arteritis de Takayasu/diagnóstico por imagen , Estudios Retrospectivos , Aorta , Flebitis/diagnóstico por imagen , Flebitis/etiologíaRESUMEN
Primary phlebitis of the central nervous system (PPCNS) is a rare condition that might be a subset of primary angiitis of the CNS. In this case report, the patient was a 39-year-old man with a 2-week history of anterograde amnesia and abnormal behaviours. Black-blood MRI (BB-MRI) showed contrast enhancement of the left basilar vein and cerebral superficial veins. Angiography showed unremarkable change in arteries. After a thorough differential diagnosis, we diagnosed PPCNS and then administered methylprednisolone pulse and cyclophosphamide pulse. The neuropsychological symptoms and MRI findings gradually improved, and after 2 months, the dose of prednisolone was gradually reduced to 20 mg. No recurrence was observed. This case shows that BB-MRI may be useful for diagnosing PPCNS.
Asunto(s)
Flebitis , Vasculitis del Sistema Nervioso Central , Adulto , Sistema Nervioso Central , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/uso terapéutico , Flebitis/diagnóstico por imagen , Flebitis/tratamiento farmacológico , Vasculitis del Sistema Nervioso Central/diagnóstico por imagen , Vasculitis del Sistema Nervioso Central/tratamiento farmacológicoAsunto(s)
Fiebre de Origen Desconocido , Flebitis , Fiebre de Origen Desconocido/diagnóstico por imagen , Fiebre de Origen Desconocido/etiología , Fluorodesoxiglucosa F18 , Humanos , Hígado , Flebitis/diagnóstico por imagen , Flebitis/etiología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía de Emisión de Positrones , RadiofármacosAsunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/efectos adversos , Absceso Hepático/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Flebitis/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Humanos , Absceso Hepático/inducido químicamente , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Flebitis/inducido químicamente , Tomografía Computarizada por Rayos XAsunto(s)
Enterocolitis/diagnóstico por imagen , Enfermedades Inflamatorias del Intestino/diagnóstico por imagen , Linfocitos , Flebitis/diagnóstico por imagen , Anciano , Enterocolitis/complicaciones , Enterocolitis/cirugía , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/cirugía , Masculino , Flebitis/complicaciones , Flebitis/cirugíaRESUMEN
HistoryA 55-year-old man with a history of chronic pancreatitis secondary to chronic alcohol abuse presented to the hospital with acute abdominal pain, generalized weakness, weight loss, and pyrexia. A clinical examination revealed he was tender to touch in the upper abdomen. Laboratory tests revealed a serum alkaline phosphatase level of 370 U/L (6.1 µkat/L) (normal range, 30-130 U/L [0.5-2.2 µkat/L]), a lipase level of 172 U/L (2.9 µkat/L) (normal range, 0-60 U/L [0-1.0 µkat/L]), a C-reactive protein level of 159 mg/L (1514 nmol/L) (normal value, <8.0 mg/L [76.2 nmol/L]), and a white cell count of 7 × 109/L (normal range, [4-11] × 109/L). During the present admission, the patient underwent urgent CT for his acute symptoms. His relevant medical history included a hospital admission 2 months earlier for abdominal discomfort. Given his history of chronic pancreatitis, baseline abdominal MRI was performed to determine the cause of his symptoms and to assess the pancreas.
Asunto(s)
Fístula del Sistema Digestivo/diagnóstico por imagen , Fístula del Sistema Digestivo/etiología , Conductos Pancreáticos/diagnóstico por imagen , Pancreatitis Crónica/complicaciones , Flebitis/diagnóstico por imagen , Flebitis/etiología , Vena Porta/diagnóstico por imagen , Fístula del Sistema Digestivo/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Stents , Tomografía Computarizada por Rayos XRESUMEN
Pylephlebitis, or suppurative thrombophlebitis of the portal vein, typically occurs in the context of an intraabdominal infection or abdominal sepsis. Antibiotics are the mainstay of treatment. The role of anticoagulation in the management of pylephlebitis is controversial, and data regarding its impact on outcomes is limited. The records of 67 consecutive patients with pylephlebitis treated at our institution over a 19 year period were retrospectively reviewed. Data was gathered regarding their baseline characteristics, presentations, management, and outcomes. Patients who did and did not receive anticoagulation were compared. Outcomes of interest included survival, portal vein thrombosis (PVT) resolution, development of chronic symptomatic portal hypertension, and major bleeding. Forty-seven patients received anticoagulation and 20 did not. The anticoagulated and non-anticoagulated groups did not differ significantly with respect to potential covariates or confounders. Anticoagulated patients had significantly higher rates of PVT resolution than non-anticoagulated patients (58% vs. 21%, p = 0.0201). This translated to lower rates of future chronic portal hypertensive symptoms among anticoagulated patients (11% vs. 47%, p = 0.0034). Anticoagulated patients had a trend toward improved survival however this improvement was not significant on multivariable analysis. There was no significant difference in rates of major bleeding between groups. Thrombophilia testing was common in this cohort however the occurrence of meaningful positive results was exceedingly low. Anticoagulation significantly improves the rate of PVT resolution, and significantly reduces the rate of chronic symptomatic portal hypertension, among patients with pylephlebitis. Treatment of pylephlebitis should incorporate the use of systemic anticoagulation whenever possible.
Asunto(s)
Anticoagulantes/administración & dosificación , Flebitis/diagnóstico por imagen , Flebitis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/sangre , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flebitis/sangre , Vena Porta/diagnóstico por imagen , Estudios Retrospectivos , Trombofilia/sangre , Trombofilia/diagnóstico por imagen , Trombofilia/tratamiento farmacológico , Resultado del Tratamiento , Adulto JovenRESUMEN
Peripheral vein phlebitis (inflammation) is a relatively frequent complication in dogs, however, published information on the ultrasonographic characteristics is currently lacking. This prospective, observational study describes the ultrasound (US) characteristics of normal canine cephalic veins, and veins with clinical phlebitis. Correlations among US findings and between US findings versus time that the intravenous catheter was in place were investigated. Safety of the US procedure was evaluated. Fifty patients were prospectively recruited for the study and 18 met the final inclusion criteria. Each patient underwent daily US examinations and was assessed for multiple criteria (vascular wall appearance, compressibility, spontaneity of flow, color fill, and presence/absence of filling defects, flow contour, direction, non-pulsatility). Characteristics of normal canine cephalic veins were as follows: smooth and thin wall, complete compressibility, no flow disturbances, no filling defects, smooth flow contours, and unidirectional, non-pulsatile flow with no turbulence. Characteristics of cephalic veins with clinical phlebitis were as follows: wall thickening (83%), decreased compressibility (55%), filling defects consistent with intraluminal thrombus (55%), vessel wall hyperechogenicity (44%), and abnormal color Doppler flow (39%). Significant correlations were found between Doppler filling defects and compressibility, Doppler filling defects and presumed thrombosis, and compressibility and presumed thrombosis (P = .001, P = .001, P = .000, respectively). No correlation was found between the US findings and time the intravenous catheter was in place. Findings indicated that duplex and compressibility US are feasible and safe methods for characterizing and monitoring cephalic veins in dogs with clinical phlebitis.
Asunto(s)
Enfermedades de los Perros/diagnóstico por imagen , Flebitis/veterinaria , Animales , Velocidad del Flujo Sanguíneo , Enfermedades de los Perros/fisiopatología , Perros , Femenino , Masculino , Flebitis/diagnóstico por imagen , Estudios Prospectivos , Flujo Pulsátil , Ultrasonografía Doppler en Color/veterinariaAsunto(s)
Amiodarona/efectos adversos , Flebitis/inducido químicamente , Anciano , Amiodarona/administración & dosificación , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Flebitis/diagnóstico por imagen , Flebitis/epidemiología , Flebitis/prevención & control , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Enterocolic lymphocytic phlebitis (ELP) is a rare enteropathy characterized by lymphocytic phlebitis of the mesenteric veins without arteritis. Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare disease similar to ELP, characterized by myointimal hyperplasia that constricts the lumen of veins, causing mucosal injury. A 62-year-old man with chief complaint of abdominal pain was treated by partial resection of the ileum after 3â¯months of conservative therapy. The pathologic diagnosis was ELP with prominent myointimal hyperplasia. Histologically, the lesion consisted of lymphocytic infiltration into the vein accompanied by prominent myointimal hyperplasia and perivenous concentric fibrosis, which are characteristics shared by ELP and IMHMV. The observations in this case suggest that some of ELP and IMHMV may belong to the same disease spectrum. Furthermore, perivascular concentric fibrosis was a remarkable observation that may contribute to differential diagnosis between ELP and "true" IMHMV.
Asunto(s)
Linfocitos T CD4-Positivos/patología , Enfermedades Intestinales/patología , Venas Mesentéricas/patología , Flebitis/patología , Túnica Íntima/patología , Biopsia , Angiografía por Tomografía Computarizada , Diagnóstico Diferencial , Fibrosis , Humanos , Hiperplasia , Inmunohistoquímica , Enfermedades Intestinales/diagnóstico por imagen , Enfermedades Intestinales/cirugía , Masculino , Venas Mesentéricas/diagnóstico por imagen , Venas Mesentéricas/cirugía , Persona de Mediana Edad , Flebitis/diagnóstico por imagen , Flebitis/cirugía , Flebografía/métodos , Valor Predictivo de las Pruebas , Resultado del Tratamiento , Túnica Íntima/diagnóstico por imagen , Túnica Íntima/cirugíaRESUMEN
BACKGROUND: Cyanoacrylate closure for the treatment of incompetent saphenous veins does not cause thermal damage and demonstrates satisfactory outcomes with rapid recovery. However, the characteristics of phlebitis-like abnormal reaction (PLAR), the most common adverse event after cyanoacrylate closure, have not been clarified. Moreover, it differs from typical phlebitis after thermal ablation. The objective of our study is to investigate the clinical features of PLAR after cyanoacrylate closure and to report its management. METHODS: A total of 160 patients with 271 incompetent saphenous veins (great saphenous veins, 201; small saphenous veins, 70) underwent cyanoacrylate closure with the VenaSeal™ system. We defined PLAR as any unusual skin condition that develops suddenly, such as erythema, itching, swelling, and pain/tenderness, over the treated veins several days after cyanoacrylate closure. Oral antihistamines and intravenous dexamethasone were administered to manage PLAR. RESULTS: Of the 271 treated veins, 69 experienced PLAR (25.4%). The mean time of occurrence was 13.6 ± 4.6 days after treatment. The rate of occurrence of erythema, itching, swelling, and pain/tenderness were 92.2%, 91.2%, 66.2%, and 48.5%, respectively. The occurrence of PLAR was significantly higher for great saphenous veins than for small saphenous veins (P < 0.001). Occurrences were more frequent in cases with a suprafascial great saphenous vein of length >10 cm than in cases with a subfascial great saphenous vein (P = 0.001). The proportion of patients who reported swelling decreased by more than half after the administration of oral antihistamine. The pain score on the 10th day also decreased significantly after the administration of antihistamine (P = 0.006). CONCLUSIONS: PLAR must be distinguished from classic phlebitis. We believe that PLAR is a type IV hypersensitivity reaction due to a foreign body, and in our experience, antihistamines or steroids are effective for the prevention and management of PLAR.
Asunto(s)
Cianoacrilatos/efectos adversos , Reacción a Cuerpo Extraño/inducido químicamente , Hipersensibilidad Tardía/inducido químicamente , Flebitis/inducido químicamente , Vena Safena , Adhesivos Tisulares/efectos adversos , Insuficiencia Venosa/terapia , Administración Intravenosa , Administración Oral , Adulto , Anciano , Dexametasona/administración & dosificación , Femenino , Reacción a Cuerpo Extraño/diagnóstico por imagen , Reacción a Cuerpo Extraño/tratamiento farmacológico , Reacción a Cuerpo Extraño/fisiopatología , Glucocorticoides/administración & dosificación , Antagonistas de los Receptores Histamínicos/administración & dosificación , Humanos , Hipersensibilidad Tardía/diagnóstico por imagen , Hipersensibilidad Tardía/tratamiento farmacológico , Hipersensibilidad Tardía/fisiopatología , Masculino , Persona de Mediana Edad , Flebitis/diagnóstico por imagen , Flebitis/tratamiento farmacológico , Flebitis/fisiopatología , Estudios Prospectivos , Factores de Riesgo , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatología , Adulto JovenRESUMEN
INTRODUCTION: Venous phlebitis in Neurosarcoidosis (NS) is rare but is often associated with intracranial hemorrhage (ICH). Imaging findings in such cases have been recently described on susceptibility weighted imaging (SWI). CASE PRESENTATION AND OUTCOME: We report a patient who presented with ICH. Magnetic resonance imaging provided evidence for parenchymal and leptomeningeal involvement while SWI and vessel wall imaging (VWI) helped confirmed NS associated intracranial phlebitis. The patient was subsequently diagnosed with systemic sarcoidosis. DISCUSSION: The emerging role of VWI and SWI in the diagnosis of this rare entity is discussed.
Asunto(s)
Enfermedades del Sistema Nervioso Central/diagnóstico por imagen , Venas Cerebrales/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico por imagen , Imagen por Resonancia Magnética , Neuroimagen/métodos , Flebitis/diagnóstico por imagen , Sarcoidosis/diagnóstico por imagen , Adulto , Enfermedades del Sistema Nervioso Central/complicaciones , Trastornos Cerebrovasculares/etiología , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/etiología , Masculino , Flebitis/etiología , Valor Predictivo de las Pruebas , Sarcoidosis/complicacionesRESUMEN
AIMS: The pathological diagnosis of IgG4-related disease (IgG4-RD) relies on histology, IgG4-positive cells, and an increased IgG4/IgG ratio. Small biopsies from patients with a presumptive diagnosis of IgG4-RD often fail to meet consensus histological criteria. The aims of this study were to evaluate consecutive small biopsies from patients with a presumptive diagnosis of IgG4-RD, and to assess the significance of the pathological findings. METHODS AND RESULTS: We evaluated 55 small biopsies from patients with a presumptive diagnosis of IgG4-RD. The retrospective cohort comprised 71 patients with IgG4-RD and 57 mimics. We performed immunohistochemistry (IHC) and in-situ hybridisation (ISH) for IgG4 and IgG. Twenty-six patients from the prospective cohort met the histological criteria for IgG4-RD (definite); 29 patients lacked one or more pathological features (borderline). Twenty biopsies (36%) lacked both storiform fibrosis and obliterative phlebitis, and nine (16%) lacked an increase in the number of IgG4-positive plasma cells. Ninety-three per cent of patients showed an IgG4/total IgG ratio of >40% (>30% by ISH). There were no differences in the incidence of multiorgan disease (P = 0.9), serum IgG4 levels (P = 0.6) and response to therapy between the definite and borderline groups. A strong correlation (Pearson 0.77) between the IHC and ISH platforms was noted with regard to the IgG4/total IgG ratio. CONCLUSION: Patients with a presumptive diagnosis of IgG4-RD but lacking the characteristic pathological features of this disease appear to be clinically similar to those who meet the current pathological criteria. An elevated IgG4/total IgG ratio is the most sensitive pathological feature, and ISH provides a robust quantification platform. We recommend evaluating tumefactive lymphoplasmacytic infiltrates with an increased IgG4/IgG ratio, regardless of histological features, for IgG4-RD.
Asunto(s)
Enfermedad Relacionada con Inmunoglobulina G4/patología , Espacio Retroperitoneal/patología , Glándulas Salivales/patología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Diagnóstico Diferencial , Femenino , Fibrosis/diagnóstico por imagen , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Enfermedad Relacionada con Inmunoglobulina G4/tratamiento farmacológico , Inmunohistoquímica , Inmunosupresores/uso terapéutico , Hibridación in Situ , Masculino , Persona de Mediana Edad , Flebitis/diagnóstico por imagen , Células Plasmáticas/citología , Células Plasmáticas/inmunología , Estudios Prospectivos , Estudios Retrospectivos , Rituximab/uso terapéutico , Esteroides/uso terapéutico , Adulto JovenAsunto(s)
Colitis Isquémica/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Flebitis/diagnóstico por imagen , Esclerosis/diagnóstico por imagen , Colon/irrigación sanguínea , Colon/diagnóstico por imagen , Colon/patología , Diagnóstico Diferencial , Humanos , Masculino , Ilustración Médica , Persona de Mediana EdadRESUMEN
Venous malformations are congenital, abnormally formed vessels, present at birth. They do not undergo regression with the growth of the patient. Due to the stagnation of blood flow in venous malformations, thrombosis and phlebolith formation may occur. Phleboliths are calcified thrombi which radiographically must be differentiated from calcified lymph nodes, sialoliths, foreign bodies, and other radiopacities. We report an extensive venous malformation in a 19-year-old woman with panoramic radiography demonstrating multiple phleboliths. Magnetic resonance imaging revealed the extension of the lesion into the hard palate and the masseter muscles superiorly, extending from the oropharynx to the tongue, inferiorly reaching the right clavicula and spreading between the right sternocleidomastoid muscle and strap muscles of the neck. The article is presented because the presence of phleboliths demonstrated on panoramic radiography is rarely described in the literature.
Asunto(s)
Flebitis/diagnóstico por imagen , Calcificación Vascular/diagnóstico por imagen , Malformaciones Vasculares/diagnóstico por imagen , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Radiografía Panorámica , Adulto JovenAsunto(s)
Enfermedad de Caroli/diagnóstico por imagen , Absceso Piógeno Hepático/diagnóstico por imagen , Flebitis/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Enfermedad de Caroli/complicaciones , Femenino , Hepatomegalia/complicaciones , Hepatomegalia/diagnóstico por imagen , Humanos , Absceso Piógeno Hepático/complicaciones , Persona de Mediana Edad , Flebitis/complicacionesRESUMEN
INTRODUCTION: Peripheral intravenous catheters (PIVCs) are frequently removed due to phlebitis. We hypothesized that catheters made of polyurethane, which is more flexible than Teflon, would decrease phlebitis, and that flexibility could be estimated by measuring the catheter-tip angle. Ultrasonography in two groups of patients with different catheter types was then used to compare catheter-tip angles and phlebitis. METHODS: Observational studies were carried out at a medical ward in a university hospital. Infusion therapy was administered to one group of patients in 2014 using Teflon catheters (control group, n = 200), and to another group of patients in 2015 using polyurethane catheters (investigational group, n = 207). The symptoms were assessed according to a scale developed by the Infusion Nurses Society. Long-axis ultrasonography images taken immediately before catheter removal were used to measure the angle between the central line of the catheter within 2 mm from the distal point and a tangent to the vessel wall. RESULTS: There were no significant differences between the two groups with respect to sex, age, and medical diagnosis. In the control and investigational groups, the rates of phlebitis were 37% (73/200) and 17% (36/207), respectively (p<0.001). The median angles of the catheter tip were 7.8° and 4.1°, respectively (p<0.001). Phlebitis occurred more frequently when the catheter-tip was placed at angle >5.8°. DISCUSSION: The frequency of phlebitis was lower in the polyurethane, in which the catheter was placed at lower angle, almost parallel to the vessel. Our results will aid in developing new catheters and in improving PIVC-securement techniques.