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1.
Am J Case Rep ; 22: e927011, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384403

RESUMO

BACKGROUND Pandemic coronavirus disease 2019 (COVID-19) originated in Wuhan, China, and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe respiratory symptoms are a hallmark of the disease, which may also include complications related to a hypercoagulable state and central nervous system involvement. These complications can occur during either the acute or the recovery phase. The cerebral involvement typically manifests as intracranial hypertension, intracerebral hemorrhage, diffuse encephalopathy, or cerebral venous thrombosis. The hemorrhagic form of cerebral venous thrombosis can be a diagnostic challenge and is treated by anticoagulation therapy, despite the existence of an intracerebral hemorrhage. This report describes a case of superficial cerebral venous thrombosis and intracerebral hematoma in a 48-year-old man weeks after recovering from the acute phase of SARSCoV-2 infection. CASE REPORT A 48-year-old man with a past medical history of SARS-CoV-2 infection confirmed by SARS-CoV-2 reverse-transcription polymerase chain reaction presented with left upper-limb numbness, weakness, and impaired positional sensorium. After initial stabilization, noncontrast computerized tomography and magnetic resonance imaging confirmed an intracerebral hemorrhage with underlying cerebral venous thrombosis. The patient was successfully treated with enoxaparin anticoagulation therapy, and symptoms improved over the following 12 days. CONCLUSIONS Central nervous system venous thrombosis is an atypical presentation of the hypercoagulable state primarily seen in younger patients, and it can occur in a delayed fashion after recovery from mild forms of COVID-19.


Assuntos
/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Trombose Intracraniana/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Hemorragia Cerebral/virologia , Enoxaparina/uso terapêutico , Hematoma/virologia , Humanos , Trombose Intracraniana/tratamento farmacológico , Trombose Intracraniana/virologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Trombose Venosa/tratamento farmacológico , Trombose Venosa/virologia
2.
Vasa ; 50(1): 30-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33393383

RESUMO

Background: Deep venous thrombosis (DVT) and in particular, iliofemoral thrombosis (IFT) can lead to recurrent thrombosis and postthrombotic syndrome (PTS). Data on the prevalence, predictors and outcome of IFT are scarce. Patients and methods: We retrospectively searched our database of outpatients who had presented with DVT and IFT including the iliac veins from 2014 until 2017. In addition, we performed a prospective registry in a subgroup of patients with IFT. These patients received duplex ultrasound, magnetic resonance venography and measurement of symptom-free walking distance using a standardized treadmill ergometry. The severity of PTS was analyzed using the Villalta-Scale (VS) and quality of life was assessed using the VEINES-QOL/Sym Questionnaire. Results: 847 patients were retrospectively identified with DVT and 19.7% (167/847) of these presented with IFT. 50.9% (85/167) of the IFT-patients agreed to participate in the prospective registry. The majority of these patients (76.5%: 65/85) presented with left-sided IFT. In 53.8% (35/65) May-Thurner syndrome was suspected. 27.1% (23/85) underwent invasive therapy. Moderate or severe PTS (VS ≥ 10) occurred in 10.6% (9/85). The severity of PTS is correlated with a reduced quality of life (ρ (CI 95%) = -0.63 (-0.76; -0.46); p < 0.01). None of the patients presented with a venous ulcer at any time. A high body mass index was a significant predictor (OR (CI 95%) = 1.18 (1.05; 1.33), p = 0.007) for the development of clinically relevant PTS (VS ≥ 10) and venous claudication. Conclusions: Every fifth patient with DVT presented with an IFT. The majority developed left sided IFT. Every 10th patient developed moderate or severe PTS (VS ≥ 10). A high body mass index was predictive for the development of PTS and venous claudication.


Assuntos
Veia Ilíaca/diagnóstico por imagem , Síndrome Pós-Trombótica/epidemiologia , Qualidade de Vida , Trombose Venosa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Flebografia , Síndrome Pós-Trombótica/diagnóstico por imagem , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Trombose Venosa/diagnóstico por imagem
3.
Clin Nucl Med ; 46(1): e29-e30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33031241

RESUMO

An 82-year-old man had a diagnosis of prostate cancer and underwent curative radiotherapy. During the oncological follow-up, the patient showed biochemical relapse and underwent whole-body Cu-prostate-specific membrane antigen PET/CT for restaging purpose. Cu-prostate-specific membrane antigen PET/CT showed a pathological uptake in left iliac venous axis, subsequently confirmed as venous thrombosis.


Assuntos
Antígenos de Superfície/metabolismo , Radioisótopos de Cobre , Glutamato Carboxipeptidase II/metabolismo , Veia Ilíaca/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Trombose Venosa/diagnóstico por imagem , Idoso de 80 Anos ou mais , Humanos , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia
4.
Vasa ; 50(1): 2-10, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33138741

RESUMO

Intravascular ultrasound (IVUS) has been used extensively in coronary applications. Its use in venous applications has increased as endovascular therapy has increasingly become the mainstay therapy for central venous diseases. IVUS has been used for both diagnostic and therapeutic purposes in managing venous stenotic disease, venous occlusive disease, and IVC filter placement and removal. IVUS has been proven to be effective in providing detailed measurement of the venous anatomy, which aid in determining the appropriate size and the approach for venous stent placement. In IVC filter placement, IVUS can provide detailed measurement and guide IVC filter placement in emergent and critical care settings. It also has certain utility in filter removal. At any rate, to date there are only a few studies examining its impact on patient outcomes. Prospective randomized controlled trials are warranted in the future.


Assuntos
Ultrassonografia de Intervenção/métodos , Filtros de Veia Cava , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/terapia , Idoso , Constrição Patológica , Veia Femoral/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem
5.
J Stroke Cerebrovasc Dis ; 30(1): 105320, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33131982

RESUMO

We herein report a case involving a 32-year-old Japanese man with recurrent cerebral venous thrombosis due to hereditary protein C deficiency. He was admitted to our hospital with impaired consciousness. Brain magnetic resonance imaging demonstrated high intensities diffusely along the bilateral sulci and magnetic resonance venography revealed left transverse sinus and superior sagittal sinus stenoses. His father had a history of cerebral infarction and venous thrombosis. The protein C activity level examined by chromogenic synthetic substrate assay was markedly reduced. He was diagnosed with protein C deficiency, and a genetic analysis revealed a heterozygous mutation at exon 3 c.199G>A,p.Glu67Lys on the protein C gene. Four months later, at his second admission, he had transient aphasia, and his protein C activity was under 10%. We switched warfarin to the direct oral anticoagulants edoxaban. He remains fully recovered with no adverse events after the administration of edoxaban for a year. Direct oral anticoagulants may be a new tool for treating cerebral venous thrombosis due to hereditary protein C deficiency.


Assuntos
Inibidores do Fator Xa/administração & dosagem , Trombose Intracraniana/prevenção & controle , Mutação , Proteína C/genética , Piridinas/administração & dosagem , Tiazóis/administração & dosagem , Trombose Venosa/prevenção & controle , Administração Oral , Adulto , Substituição de Medicamentos , Heterozigoto , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/etiologia , Masculino , Deficiência de Proteína C/complicações , Deficiência de Proteína C/diagnóstico , Deficiência de Proteína C/tratamento farmacológico , Deficiência de Proteína C/genética , Recidiva , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
6.
Vasa ; 50(1): 22-29, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33047662

RESUMO

The treatment of non-thrombotic iliac vein lesions (NIVL) remains debatable with many advocating conservative treatments, whilst others offering venous stenting. The objective of this review was to systematically assess the treatment options for symptomatic iliac vein compression syndrome (IVCS) in patients without evidence of thrombotic disease at the time of diagnosis. An online search of published literature looking for randomised controlled trials and observational studies that evaluated the treatment for symptomatic NIVL was performed. Nine studies were included with a total 953 patients of which 782 patients had NIVL. Patency rates ranged between 94.8%-100% in the first month, 88.2%-94.1% in six months and 73.4%-98% in 12 months, in patients with NIVL post stenting. Longer follow-up of up to 5 years shows promising patency rates of 94% in patients with IVCS. Patients with IVCS are likely to benefit from a combination of endovenous treatment at the time of diagnosis including stent placement to maintain lumen patency and prevent recurrent deep venpus thrombosis and/or postthrombotic syndrome.


Assuntos
Angioplastia/métodos , Anticoagulantes/uso terapêutico , Síndrome de May-Thurner/terapia , Stents , Trombose Venosa/terapia , Humanos , Veia Ilíaca/diagnóstico por imagem , Síndrome de May-Thurner/diagnóstico por imagem , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem
7.
Vasa ; 50(1): 74-77, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33291997

RESUMO

A 74-year-old woman presented with acute symptomatic left thigh and calf swelling; imaging demonstrated evidence of occlusive thrombosis from the upper left common iliac vein to the mid-thigh. Single session zero-thrombolysis venous thrombectomy was performed using the ReVeneTM Thrombectomy Catheter.


Assuntos
Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Trombectomia/métodos , Trombose Venosa/cirurgia , Idoso , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Veia Ilíaca/diagnóstico por imagem , Qualidade de Vida , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem
8.
J Stroke Cerebrovasc Dis ; 30(1): 105434, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33190109

RESUMO

SARS-CoV-2, the virus responsible for novel Coronavirus (COVID-19) infection, has recently been associated with a myriad of hematologic derangements; in particular, an unusually high incidence of venous thromboembolism has been reported in patients with COVID-19 infection. It is postulated that either the cytokine storm induced by the viral infection or endothelial damage caused by viral binding to the ACE-2 receptor may activate a cascade leading to a hypercoaguable state. Although pulmonary embolism and deep venous thrombosis have been well described in patients with COVID-19 infection, there is a paucity of literature on cerebral venous sinus thrombosis (cVST) associated with COVID-19 infection. cVST is an uncommon etiology of stroke and has a higher occurrence in women and young people. We report a series of three patients at our institution with confirmed COVID-19 infection and venous sinus thrombosis, two of whom were male and one female. These cases fall outside the typical demographic of patients with cVST, potentially attributable to COVID-19 induced hypercoaguability. This illustrates the importance of maintaining a high index of suspicion for cVST in patients with COVID-19 infection, particularly those with unexplained cerebral hemorrhage, or infarcts with an atypical pattern for arterial occlusive disease.


Assuntos
/complicações , Trombose dos Seios Intracranianos/etiologia , Acidente Vascular Cerebral/etiologia , Tromboembolia/etiologia , Trombose Venosa/etiologia , Adolescente , Adulto , Idoso , /terapia , Evolução Fatal , Feminino , Humanos , Masculino , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/terapia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Tromboembolia/diagnóstico por imagem , Tromboembolia/terapia , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
9.
Vasc Endovascular Surg ; 55(1): 69-72, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32862786

RESUMO

Venous stent placement of symptomatic occlusion of the superior and inferior vena cava is considered the treatment of choice in malignant disease because this technique can restore patency and achieve a relief of symptoms. However, tumor thrombus extension into the right atrium harbors the potential risk of stent migration and perforation. One strategy to avoid this potential life-threatening complication could be the placement of a bridging stent from the superior vena cava-to-inferior vena cava. This case reports describes the superior vena cava-to-inferior vena cava bridging stent technique in 2 patients with malignant occlusion of the superior and inferior vena cava. Special considerations such as technical details of the devices and potential complications are discussed.


Assuntos
Procedimentos Endovasculares/instrumentação , Átrios do Coração , Neoplasias/complicações , Stents , Síndrome da Veia Cava Superior/terapia , Veia Cava Inferior , Veia Cava Superior , Trombose Venosa/terapia , Idoso , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/patologia , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/patologia
10.
J Stroke Cerebrovasc Dis ; 29(12): 105412, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33254367

RESUMO

INTRODUCTION: Early studies suggest that acute cerebrovascular events may be common in patients with coronavirus disease 2019 (COVID-19) and may be associated with a high mortality rate. Most cerebrovascular events described have been ischemic strokes, but both intracerebral hemorrhage and rarely cerebral venous sinus thrombosis (CVST) have also been reported. The diagnosis of CVST can be elusive, with wide-ranging and nonspecific presenting symptoms that can include headache or altered sensorium alone. OBJECTIVE: To describe the presentation, barriers to diagnosis, treatment, and outcome of CVST in patients with COVID-19. METHODS: We abstracted data on all patients diagnosed with CVST and COVID-19 from March 1 to August 9, 2020 at Boston Medical Center. Subsequently, we reviewed the literature and extracted all published cases of CVST in patients with COVID-19 from January 1, 2020 through August 9, 2020 and included all studies with case descriptions. RESULTS: We describe the clinical features and management of CVST in 3 women with COVID-19 who developed CVST days to months after initial COVID-19 symptoms. Two patients presented with encephalopathy and without focal neurologic deficits, while one presented with visual symptoms. All patients were treated with intravenous hydration and anticoagulation. None suffered hemorrhagic complications, and all were discharged home. We identified 12 other patients with CVST in the setting of COVID-19 via literature search. There was a female predominance (54.5%), most patients presented with altered sensorium (54.5%), and there was a high mortality rate (36.4%). CONCLUSIONS: During this pandemic, clinicians should maintain a high index of suspicion for CVST in patients with a recent history of COVID-19 presenting with non-specific neurological symptoms such as headache to provide expedient management and prevent complications. The limited data suggests that CVST in COVID-19 is more prevalent in females and may be associated with high mortality.


Assuntos
/complicações , Trombose dos Seios Intracranianos/etiologia , Trombose Venosa/etiologia , Adulto , Idoso , Anticoagulantes/uso terapêutico , /terapia , Feminino , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/terapia , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
11.
J Stroke Cerebrovasc Dis ; 29(12): 105379, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33254369

RESUMO

BACKGROUND: There has been increasing reports associating the coronavirus disease 2019 (COVID-19) with thromboembolic phenomenon including ischemic strokes and venous thromboembolism. Cerebral venous thrombosis (CVT) is a rare neurovascular emergency that has been observed in some COVID-19 patients, yet much remains to be learnt of its underlying pathophysiology. OBJECTIVE: We present a case series of local patients with concomitant COVID-19 infection and CVT; and aim to perform a systematic review of known cases in the current literature. METHODS: We describe two patients with concomitant COVID-19 infection and CVT from a nationwide registry in Singapore. We then conducted a literature search in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 11th June 2020. All studies reporting CVT in COVID-19 patients were included. RESULTS: Nine studies and 14 COVID-19 patients with CVT were studied. The median age was 43 years (IQR=36-58) and majority had no significant past medical conditions (60.0%). The time taken from onset of COVID-19 symptoms to CVT diagnosis was a median of 7 days (IQR=6-14). CVT was commonly seen in the transverse (75.0%) and sigmoid sinus (50.0%); 33.3% had involvement of the deep venous sinus system. A significant proportion of patients had raised D-dimer (75.0%) and CRP levels (50.0%). Two patients reported presence of antiphospholipid antibodies. Most patients received anticoagulation (91.7%) while overall mortality rate was 45.5%. CONCLUSIONS: The high mortality rate of CVT in COVID-19 infection warrants a high index of suspicion from physicians, and early treatment with anticoagulation should be initiated.


Assuntos
/complicações , Trombose dos Seios Intracranianos/etiologia , Trombose Venosa/etiologia , Adulto , Anticorpos Antifosfolipídeos/sangue , Anticoagulantes/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trombose dos Seios Intracranianos/sangue , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/tratamento farmacológico , Resultado do Tratamento , Trombose Venosa/sangue , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
12.
Medicina (Kaunas) ; 56(12)2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33287199

RESUMO

Pulmonary embolism (PE) is a commonly encountered clinical entity in patients with coronavirus disease 2019 (COVID-19). Up to 1/3 of patients have been found to have PE in the setting of COVID-19. Given the novelty of the virus causing this pandemic, it has not been easy to address diagnostic and management issues in PE. Ongoing research and publications of the scientific literature have helped in dealing with COVID-19 lately and this applies to PE as well. In this article, we attempt to succinctly yet comprehensively discuss PE in patients with COVID-19 with a review of the prevailing literature.


Assuntos
/sangue , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Trombofilia/sangue , Anticoagulantes/uso terapêutico , Angiografia por Tomografia Computadorizada , Gerenciamento Clínico , Coagulação Intravascular Disseminada/sangue , Ecocardiografia , Oxigenação por Membrana Extracorpórea , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Humanos , Extremidade Inferior/diagnóstico por imagem , Tempo de Tromboplastina Parcial , Contagem de Plaquetas , Sistemas Automatizados de Assistência Junto ao Leito , Tempo de Protrombina , Embolia Pulmonar/sangue , Embolia Pulmonar/etiologia , Terapia Trombolítica , Trombofilia/complicações , Ultrassonografia Doppler Dupla , Trombose Venosa/diagnóstico por imagem , Cintilografia de Ventilação/Perfusão
13.
Tidsskr Nor Laegeforen ; 140(18)2020 12 15.
Artigo em No | MEDLINE | ID: mdl-33322869

RESUMO

BACKGROUND: There is emerging evidence of an increased risk of venous thromboembolism as well as several reports of cerebral venous thrombosis in COVID-19. CASE PRESENTATION: A previously healthy man in his fifties was admitted due to sudden confusion and reduced consciousness. One month earlier the patient had symptoms with headache, fever, dry cough, vomiting and diarrhoea and reduced sense of taste and smell. He was diagnosed with COVID-19 and the symptoms were mainly resolved within three weeks. On admission the patient was disorientated with aphasia. Brain imaging revealed a haemorrhagic infarction in the left temporal lobe due to thrombosis of the left transverse sinus and low-molecular weight heparin was instituted. On follow-up four months later, there was clinical improvement with only slight problems with short term memory and concentration. INTERPRETATION: This case illustrates the risk of serious neurological complications due to cerebral venous thrombosis in COVID-19.


Assuntos
/complicações , Trombose Intracraniana/virologia , Trombose Venosa/virologia , Encéfalo/diagnóstico por imagem , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Masculino , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
15.
J Med Vasc ; 45(6): 334-343, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33248536

RESUMO

INTRODUCTION: The Coronavirus disease-2019 outbreak (COVID-19) has been declared a pandemic by the World Health Organization. Studies report both a severe inflammatory syndrome and a procoagulant state in severe COVID-19 cases, with an increase of venous thromboembolism, including pulmonary embolism (PE) and deep vein thrombosis (DVT). In this context, we discuss the use of doppler ultrasonography (DUS) in the screening and diagnosis of DVT in ambulatory and hospitalized patients with, or suspected of having, COVID-19, outside the intensive care unit (ICU). MATERIAL AND METHODS: Non-systematic review of the literature. RESULTS: In patients hospitalized for or suspected of COVID-19 infection with the presence of either (a) DVT clinical symptoms, (b) a strong DVT clinical probability (Wells score>2) or (c) elevated D-dimer levels without DVT clinical symptoms and without PE on lung CT angio-scan, DVT should be investigated with DUS. In the presence of PE diagnosed clinically and/or radiologically, additional systematic DVT screening using DUS is not recommended during the COVID-19 pandemic. The use of 4-points compression DUS for DVT screen and diagnosis is the most appropriate method in this context. DISCUSSION: Systematic DUS for DVT screening in asymptomatic COVID patients is not recommended unless the patient is in the ICU. This would increase the risk of unnecessarily exposing medical staff to SARS-CoV-2 and monopolizing limited resources during this period.


Assuntos
/diagnóstico , Hospitalização , Ultrassonografia Doppler , Trombose Venosa/diagnóstico por imagem , Biomarcadores/sangue , /terapia , Tomada de Decisão Clínica , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Incidência , Valor Preditivo dos Testes , Fatores de Risco , Trombose Venosa/epidemiologia
16.
Praxis (Bern 1994) ; 109(15): 1205-1209, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33234040

RESUMO

Not Another Arm Vein Thrombosis - Memories of the Past Abstract. This article points out relevant differential diagnoses of a unilateral arm swelling that is a key clinical sign of an upper extremity vein thrombosis. The presented case is a patient with a symptomatic, iatrogenic arteriovenous fistula between the subclavian artery and vein due to central venous port system implantation.


Assuntos
Fístula Arteriovenosa , Trombose , Trombose Venosa , Idoso , Braço , Humanos , Veia Subclávia/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem
18.
J Clin Neurosci ; 79: 30-32, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33070913

RESUMO

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan, China in December 2019, and is ongoing pandemic. While a majority of patients with SARS-CoV-2 infection shows asymptomatic or mild disease, hospitalized patients can develop critical condition, such as pneumonia, sepsis, and respiratory failure. Some cases deteriorate into sever systemic disease and multiorgan failure. Many patients of severe COVID-19 show hypercoagulable state and complicate with venous thromboembolism and atrial thrombosis. We herein reported a case of COVID-19 who developed cerebral venous thrombosis (CVT) co-incidence with pulmonary thromboembolism (PTE). A 56-year-old Japanese man was presented with fever and malaise and diagnosed with COVID-19. He was treated with ciclesonide and azithromycin, but his respiratory condition deteriorated. Thus, systemic corticosteroids and favipiravir were initiated and these treatments resulted in afebrile state, improving malaise and respiratory failure. However, he suddenly developed severe headache and vomiting with increased concentration of D-dimer. Brain CT and MRI showed typical images of CVT in the left transvers sinus and CT pulmonary angiography showed PE. Administration of unfractionated heparin followed by edoxaban treatment reduced the levels of D-dimer and improved his clinical presentation and thrombosis. Monitoring coagulopathy is important in COVID-19 patients and in case of venous thromboembolism, including cerebral venous system, appropriate anticoagulant therapy should be initiated.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Trombose Intracraniana/etiologia , Pneumonia Viral/complicações , Trombose Venosa/etiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Heparina/uso terapêutico , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pandemias , Piridinas/uso terapêutico , Tiazóis/uso terapêutico , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
19.
J Stroke Cerebrovasc Dis ; 29(11): 105244, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066947

RESUMO

INTRODUCTION: Intracerebral haemorrhage in patients suffering from cerebral venous thrombosis (CVT) is relatively uncommon. CVT typically occurs in hypercoagulable state of various causes. Some drugs play a causative role in CVT and thrombopoietin receptor agonists are among them. CASE SUMMARY: We present a female patient with refractory immune thrombocytopenic purpura (ITP) treated with romiplostim, suffering from severe thrombosis of jugular vein expanding intracranially. Despite being treated with adequate anticoagulation, she developed spontaneous bilateral epidural and subdural hematomas with devastating outcome. DISCUSSION: To our knowledge, this is the first reported case of spontaneous atraumatic epidural hematomas due to CVT in adult patient. We support that in our patient, blood stasis leading to the dissection of dura mater, platelet dysfunction, and anticoagulation treatment contributed to the formation of the intracranial, extracerebral haemorrhages.


Assuntos
Hemorragia Cerebral/etiologia , Hematoma Epidural Craniano/etiologia , Trombose Intracraniana/etiologia , Púrpura Trombocitopênica Idiopática/complicações , Trombose Venosa/etiologia , Adulto , Anticoagulantes/efeitos adversos , Hemorragia Cerebral/diagnóstico por imagem , Evolução Fatal , Feminino , Hematoma Epidural Craniano/diagnóstico por imagem , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Fatores de Risco , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
20.
Zhonghua Wai Ke Za Zhi ; 58(11): 864-869, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120450

RESUMO

Objective: To examine the ultrasound features and clinical characteristics of the intestinal ischemia secondary to acute mesenteric venous thrombosis (AMVT). Methods: From January 2016 to June 2019, 11 patients were diagnosed as intestinal ischemia secondary to AMVT confirmed by surgical pathology or CT in Peking Union Medical College Hospital. The patients included 7 males and 4 females, aging of (52.8±11.9) years (range: 34 to 81 years).The clinical characters and ultrasound features were retrospectively reviewed. Results: Abdomen pain was the chief complaint of all patients. Other complaints include 2 cases of blood in the stool, 1 case of hematemesis, 2 cases of vomiting, 1 case of diarrhea. Six patients showed rebound pain on physical examination. All patients had elevated white blood cell account and D-Dimer. Nine patients had a thrombosis in the portal vein simultaneously. All 11 patients underwent the CT scan including 10 contrast-enhanced CT. Mesenteric venous thrombosis was detected in 10 cases who underwent contrast-enhanced CT imaging. On CT imaging, 11 patients demonstrated intestinal wall thicken, 5 patients showed intestinal dilation. Eight patients underwent superior mesenteric venous ultrasound examination. Of them, 7 patients were correctly diagnosed as AMVT. Of the 10 patients who underwent abdominal ultrasound, 5 patients showed intestinal lesions including intestinal wall thicken in 4 patients and intestinal dilation in 1 patient. Peritoneal fluid was detected in 10 patients by ultrasound, which was consistent with CT. Ten patients underwent surgical procedures while 1 patient received conservative treatment. Conclusion: Ultrasound is an accurate imaging method in diagnosing superior mesenteric vein thrombosis and can detect intestinal wall thickening, intestinal dilation, and peritoneal fluid.


Assuntos
Isquemia Mesentérica , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
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