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2.
Ann Vasc Surg ; 60: 479.e1-479.e4, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31201970

RESUMO

Septic thrombophlebitis is a rare diagnosis in this era of widespread antibiotic usage. The clinical diagnosis requires astute clinical suspicion and evaluation. We describe an asplenic 63-year-old woman who presented to the emergency department with a 24-hour history of a tender, swollen, right neck and upper chest wall. She denied any recent illnesses, but two years before, she was hospitalized and treated for Streptococcus pneumoniae meningitis and endocarditis. An enhanced computed tomography scan demonstrated inflammatory changes around a thrombosed right internal jugular vein, which extended to the brachiocephalic/superior vena cava junction. A retropharyngeal effusion was present, but no pulmonary or oropharyngeal abscess was identified. Lemierre's syndrome, although rare, must be recognized promptly to reduce morbidity and mortality associated with this condition.


Assuntos
Fusobacterium necrophorum/isolamento & purificação , Síndrome de Lemierre/microbiologia , Sepse/microbiologia , Tromboflebite/microbiologia , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Feminino , Humanos , Síndrome de Lemierre/diagnóstico por imagem , Síndrome de Lemierre/tratamento farmacológico , Pessoa de Meia-Idade , Sepse/diagnóstico , Sepse/tratamento farmacológico , Tromboflebite/diagnóstico por imagem , Tromboflebite/tratamento farmacológico , Resultado do Tratamento
5.
Ann Vasc Surg ; 59: 313.e1-313.e3, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009730

RESUMO

BACKGROUND: Pregnancy is a hypercoagulable state associated with a fivefold increase in the risk of venous thromboembolism. Thrombolysis is the preferred level of care for patients with acute iliofemoral deep vein thrombosis (DVT); however, most studies exclude pregnant patients, highlighting the lack of data regarding the efficacy and safety of thrombolytic therapy for mother and fetus. METHODS: We describe the successful use of thrombolytic therapy in conjunction with ultrasound to remove a large ileofemoral DVT in a first-trimester patient with phlegmasia cerulea dolens. The procedure was performed safely for both mother and fetus. RESULTS: No radiation or contrast dye was used, and intravascular ultrasound confirmed patency of the entirety of the venous system. She delivered a healthy term baby after the procedure and had no further sequalae. CONCLUSION: Thrombolysis with intravascular ultrasound may be considered in first-trimester pregnant patients with threatened limb due to DVT.


Assuntos
Veia Femoral/efeitos dos fármacos , Fibrinolíticos/administração & dosagem , Veia Ilíaca/efeitos dos fármacos , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Terapia Trombolítica , Tromboflebite/tratamento farmacológico , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Nascimento Vivo , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez , Tromboflebite/diagnóstico por imagem , Tromboflebite/fisiopatologia , Resultado do Tratamento , Ultrassonografia de Intervenção , Ultrassonografia Pré-Natal/métodos , Grau de Desobstrução Vascular
6.
Pediatr Emerg Care ; 35(5): e93-e95, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30907849

RESUMO

An 8-year-old boy presented to the emergency department with swelling and pain of his left knee and calf for approximately 1 week. His examination was significant for moderate knee effusion and swelling of the posterior calf with erythema and warmth of the affected areas. An ultrasound obtained at an outside hospital showed a large heterogeneous mass in the gastrocnemius, and a magnetic resonance imaging revealed a large, heterogeneous, rim-enhancing collection in the medial head of the left gastrocnemius muscle with surrounding myositis involving the gastrocnemius muscle. The child was taken to the operating room by the orthopedic team for drainage and irrigation of the knee effusion and of the collection in the gastrocnemius. The diagnosis of Lyme pseudothrombophlebitis was made through Lyme serology testing of aspirated fluid. He improved after this drainage but required a prolonged antibiotic course.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Doença de Lyme/diagnóstico por imagem , Doença de Lyme/cirurgia , Criança , Diagnóstico Diferencial , Humanos , Masculino , Tromboflebite/diagnóstico por imagem
8.
Int J Gynaecol Obstet ; 145(1): 122-123, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30648745

RESUMO

A patient had septic pelvic thrombophlebitis complicated by multiple septic emboli after intrauterine device insertion. Fusobacterium necrophorum, a well­known cause of Lemierre's syndrome, was identified.


Assuntos
Dispositivos Intrauterinos/efeitos adversos , Síndrome de Lemierre/microbiologia , Tromboflebite/etiologia , Feminino , Fusobacterium necrophorum/isolamento & purificação , Humanos , Síndrome de Lemierre/complicações , Tromboflebite/diagnóstico por imagem , Tomografia Computadorizada por Raios X
9.
Acta Clin Belg ; 74(3): 206-210, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29783881

RESUMO

OBJECTIVE AND IMPORTANCE: Lemierre's syndrome (LS) is a rare condition that typically starts with a bacterial oropharyngeal infection complicated by a thrombophlebitis of the internal jugular vein and septic emboli to the lungs or other organs. The most common organism isolated is Fusobacterium necrophorum, although other causative organisms are isolated in rare cases. CASE PRESENTATION: We discuss a case of LS in a 44-year-old, previously healthy man presenting with an oropharyngeal infection. F. necrophorum was isolated from blood cultures and Computed tomography of the chest demonstrated septic emboli in the lungs. Magnetic resonance imaging showed a thrombophlebitis of the sigmoid and transverse vein with continuity to the internal jugular vein. METHODS: Case report and literature review. RESULTS: F. necrophorum isolates show in vitro susceptibility to metronidazole, clindamycin, beta-lactam/beta-lactamase inhibitor combinations and carbapenems with no signs of resistance or reduced sensitivity. Anticoagulation is believed to play a favourable role in recovery of the disease because of the potential for faster resolution of thrombophlebitis and bacteraemia. Conflicting results exist in literature with many studies or reviews indicating a favourable outcome both with and without anticoagulation. Anticoagulation for LS consists in most cases of Warfarin or Low molecular weight heparins, with the last being the first choice in children. Indications for the use of anticoagulation in literature are significant clot burden, complication of septic emboli, arterial ischemic stroke, poor response to antibiotics, thrombophilia and cerebral infarction. CONCLUSIONS: Antibiotics are considered the mainstay of treatment, although statistically valid trials to evaluate optimal treatment regimens have not yet been conducted due to the low incidence of the infection. The use of anticoagulation in LS is still heavily debated as a result of conflicting results in literature. Due to the disease's low incidence, statistically valid trials that evaluate anticoagulation are lacking. Further prospective and randomized research is needed to establish the benefit of anticoagulation in the treatment of LS.


Assuntos
Infecções por Fusobacterium/microbiologia , Fusobacterium necrophorum/isolamento & purificação , Veias Jugulares/diagnóstico por imagem , Síndrome de Lemierre/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Tromboflebite/diagnóstico por imagem , Adulto , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Infecções por Fusobacterium/complicações , Infecções por Fusobacterium/tratamento farmacológico , Humanos , Veias Jugulares/microbiologia , Síndrome de Lemierre/tratamento farmacológico , Síndrome de Lemierre/microbiologia , Imagem por Ressonância Magnética , Masculino , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/microbiologia , Tromboflebite/tratamento farmacológico , Tromboflebite/microbiologia , Tomografia Computadorizada por Raios X
10.
J Microbiol Immunol Infect ; 52(4): 672-673, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30042036

RESUMO

Pylephlebitis is a condition with thrombophlebitis of the portal mesenteric venous system. Herein, we report a patient suggesting odontogenic bacteremia as a risk factor of pylephlebitis. He was diagnosed as superior mesenteric vein thrombophlebitis, and blood cultures grew Gemella sanguinis and Streptococcus gordonii.


Assuntos
Bacteriemia/complicações , Bacteriemia/microbiologia , Gemella/patogenicidade , Veias Mesentéricas/patologia , Streptococcus gordonii/patogenicidade , Tromboflebite/complicações , Antibacterianos/uso terapêutico , Implantes Dentários/efeitos adversos , Humanos , Masculino , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Boca/microbiologia , Veia Porta , Fatores de Risco , Tromboflebite/diagnóstico por imagem , Tromboflebite/patologia , Extração Dentária/efeitos adversos
11.
AJR Am J Roentgenol ; 211(6): 1390-1396, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30300008

RESUMO

OBJECTIVE: The objective of this study was to identify differences between venous malformations (VMs) with arteriovenous (AV) microshunts and VMs without AV microshunts. MATERIALS AND METHODS: In this retrospective study, 83 patients with untreated VMs of the extremities underwent a prospectively defined MRI protocol performed at 3 T. MR images were reviewed to determine localization and extent of each VM and tissue involvement. The VM volume and the lesion volume relative to body surface were measured. The number of phleboliths within the lesions was determined. Using time-resolved MR angiography, the hemodynamic subtype (VM with AV microshunts versus VM without AV microshunts) was classified, and the interval between the onset of arterial enhancement and lesion enhancement (tonset) was measured. Clinical data were reviewed to determine patient demographic characteristics, the onset of symptoms, the frequency of thrombophlebitis, and the pain score. RESULTS: Of the 83 patients, 56 (67%) presented with AV microshunts. The tonset (p ≤ 0.001), absolute and relative lesion volume (p = 0.001), and number of phleboliths (p = 0.038) differed significantly between these two subgroups. With use of a multivariable regression model, the strongest indicator for VM with AV microshunts was the presence of more than two phleboliths (odds ratio, 2.80; p = 0.007). No differences were noted regarding patient demographic characteristics and history or lesion morphologic features or anatomy. CONCLUSION: Occurrence of AV microshunts in untreated VM is a frequent phenomenon. This hemodynamic subtype is significantly associated with phleboliths and large lesions. The subtypes did not differ in terms of history and clinical course.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Tromboflebite/complicações , Tromboflebite/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Extremidades/irrigação sanguínea , Extremidades/diagnóstico por imagem , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Rev Int Androl ; 16(1): 38-41, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30063022

RESUMO

Acute thrombophlebitis of spermatic vein is an unusual pathology involving, in most of the cases, the left side, and whose etiology remains uncertain. Most of them are found during a a differential diagnosis in acute testicular pain. We introduce the case of a 29 years old male with abusive cocaine consumption, admitted to hospital due to severe testicular pain. Doppler-ultrasound examination was undertaken, showing right spermatic vein flux alteration. Conservative management was decided and anticoagulant and non-esteroidal anti-inflammatory drugs were started. Eco-doppler is the most specific and sensible technique for diagnosis of these cases, while TC can always confirm etiologic diagnosis. Treatment was initially conservative based on anticoagulation. Hematological study is necessary in order to determine coagulation alterations.


Assuntos
Dor Aguda/etiologia , Testículo/irrigação sanguínea , Tromboflebite/diagnóstico por imagem , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Anticoagulantes/administração & dosagem , Transtornos Relacionados ao Uso de Cocaína/complicações , Diagnóstico Diferencial , Humanos , Masculino , Ultrassonografia Doppler
15.
Vasc Endovascular Surg ; 52(8): 641-647, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29898647

RESUMO

We describe the cases of 2 patients who had septic thrombophlebitis and were successfully managed with endovascular thrombectomy. Patient A developed septic thrombophlebitis of the inferior vena cava after several retroperitoneal resections for metastatic renal cell carcinoma. The thrombus was successfully removed via endovascular mechanical balloon thrombectomy. Patient B was a patient with pancreatic adenocarcinoma involving the portal vein who developed a septic inferior vena cava thrombus extending from the level and beyond the renal veins, for which she underwent endovascular thrombectomy. We argue that this approach is safe and feasible. It should be considered as a supplemental treatment modality for select decompensating patients who require lifesaving interventions and have contraindications to traditional management of surgical thrombectomy or excision of the involved venous segment.


Assuntos
Procedimentos Endovasculares , Sepse/cirurgia , Trombectomia/métodos , Tromboflebite/cirurgia , Veia Cava Inferior/cirurgia , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Sepse/diagnóstico , Sepse/microbiologia , Tromboflebite/diagnóstico por imagem , Tromboflebite/microbiologia , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/microbiologia
17.
Ann Vasc Surg ; 51: 239-245, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29518511

RESUMO

BACKGROUND: Phlegmasia cerulea dolens (PCD) is a severe complication of deep veions thrombosis, and there are several treatment methods. This study aimed to investigate the clinical efficacy of surgical thrombectomy and simultaneous iliac vein stent implantation for the treatment of PCD caused by iliac vein occlusion. PURPOSE: This study aimed to investigate the clinical efficacy of surgical thrombectomy and simultaneous iliac vein stent implantation for the treatment of phlegmasia cerulea dolens (PCD) caused by iliac vein occlusion. METHODS: From February 2014 to December 2016, 5 patients with secondary PCD complicated with iliac vein occlusion were treated in our center. Thrombectomy by venous incision was performed with simultaneous iliac vein balloon dilatation and stents implantation. Efficacy and stents patency were assessed. Iliac vein occlusions were confirmed in all 5 patients by angiography after the thrombectomy. Stents implantation were performed after balloon dilatation. Three stents were implanted in 1 case of iliac vein and inferior vena cava (IVC) occlusion, whereas 1 stent was implanted in each of the other 4 cases. RESULTS: Symptoms were significantly relieved after surgery, with no complications. Patients were followed up for 6-24 months, and minor swelling of the affected limb was found in 1 case, with no thrombosis recurrence in all cases and vascular stent patency. CONCLUSIONS: Thrombectomy by venous incision and simultaneous iliac vein stent implantation for the treatment of PCD caused by iliac vein occlusion can quickly relieve symptoms, is easily implemented, is associated with fewer complications, and has good midterm efficacy and a high patency rate, making this technique a good treatment method.


Assuntos
Angioplastia com Balão/instrumentação , Veia Ilíaca/cirurgia , Stents , Trombectomia , Tromboflebite/terapia , Trombose Venosa/terapia , Adulto , Angioplastia com Balão/efeitos adversos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Trombectomia/efeitos adversos , Tromboflebite/diagnóstico por imagem , Tromboflebite/etiologia , Tromboflebite/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
18.
Wiad Lek ; 71(1 pt 1): 93-95, 2018.
Artigo em Polonês | MEDLINE | ID: mdl-29558359

RESUMO

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.


Assuntos
Pênis/irrigação sanguínea , Escleroderma Sistêmico/diagnóstico , Tromboflebite/diagnóstico , Veias/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Angioscopia Microscópica , Pênis/diagnóstico por imagem , Escleroderma Sistêmico/diagnóstico por imagem , Tromboflebite/diagnóstico por imagem , Ultrassonografia Doppler
19.
Rev. int. androl. (Internet) ; 16(1): 38-41, ene.-mar. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-170579

RESUMO

La tromboflebitis aguda de la vena espermática es una dolencia de muy baja frecuencia, con afectación mayoritaria del lado izquierdo, y de etiología desconocida en la mayoría de las ocasiones. Suele ser un hallazgo inesperado en el diagnóstico diferencial del dolor testicular agudo. Se trata de un varón de 29 años con un consumo abusivo de cocaína que acude con dolor testicular agudo. Se confirma la afectación de la vena espermática derecha mediante ecografía-doppler. Se optó por manejo conservador con anticoagulación y antiinflamatorios. La eco-doppler es la técnica con mayor especificidad y sensibilidad para diagnosticarlo, mientras que la TC puede completar su diagnóstico etiológico. El tratamiento de elección es conservador basado en la anticoagulación del paciente. Es imperativo un estudio hematológico en búsqueda de alteraciones de la coagulación (AU)


Acute thrombophlebitis of spermatic vein is an unusual pathology involving, in most of the cases, the left side, and whose etiology remains uncertain. Most of them are found during a a differential diagnosis in acute testicular pain. We introduce the case of a 29 years old male with abusive cocaine consumption, admitted to hospital due to severe testicular pain. Doppler-ultrasound examination was undertaken, showing right spermatic vein flux alteration. Conservative management was decided and anticoagulant and non-esteroidal anti-inflammatory drugs were started. Eco-doppler is the most specific and sensible technique for diagnosis of these cases, while TC can always confirm etiologic diagnosis. Treatment was initially conservative based on anticoagulation. Hematological study is necessary in order to determine coagulation alterations (AU)


Assuntos
Humanos , Masculino , Adulto , Tromboflebite/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/complicações , Abuso de Maconha/complicações , Dor Aguda/etiologia , Cordão Espermático/irrigação sanguínea
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