DOCSLIB.ORG

Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism JASON WILBUR, MD, and BRIAN SHIAN, MD, Carver College of Medicine, University of Iowa, Iowa City, Iowa

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism JASON WILBUR, MD, and BRIAN SHIAN, MD, Carver College of Medicine, University of Iowa, Iowa City, Iowa Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism JASON WILBUR, MD, and BRIAN SHIAN, MD, Carver College of Medicine, University of Iowa, Iowa City, Iowa Venous thromboembolism manifests as deep venous thrombosis (DVT) or pulmonary embolism, and has a mortal- ity rate of 6 to 12 percent. Well-validated clinical prediction rules are available to determine the pretest probability of DVT and pulmonary embolism. When the likelihood of DVT is low, a negative D-dimer assay result excludes DVT. Likewise, a low pretest probability with a negative D-dimer assay result excludes the diagnosis of pulmonary embo- lism. If the likelihood of DVT is intermediate to high, compression ultrasonography should be performed. Imped- ance plethysmography, contrast venography, and magnetic resonance venography are available to assess for DVT, but are not widely used. Pulmonary embolism is usually a consequence of DVT and is associated with greater mortality. Multidetector computed tomography angiography is the diagnostic test of choice when the technology is available and appropriate for the patient. It is warranted in patients who may have a pulmonary embolism and a positive D-dimer assay result, or in patients who have a high pre- test probability of pulmonary embolism, regardless of D-dimer assay result. Ventilation-perfusion scanning is an acceptable alternative to computed tomography angiography in select settings. Pulmonary angiography is needed only when the clinical suspicion for pulmo- nary embolism remains high, even when less invasive study results are negative. In unstable emergent cases highly suspicious for pulmo- nary embolism, echocardiography may be used to evaluate for right ventricular dysfunction, which is indicative of but not diagnostic for pulmonary embolism. (Am Fam Physician. 2012;86(10):913-919. Copyright © 2012 American Academy of Family Physicians.) ILLUSTRATION TODD BY BUCK ▲ Patient information: enous thromboembolism (VTE) have an associated pulmonary embolism by A handout on this topic is is a blood clotting condition that lung scan; about 70 percent of patients pre- available at http://family doctor.org/familydoctor/ has two major manifestations: deep senting with pulmonary embolism are found 2,3 en/diseases-conditions/ venous thrombosis (DVT) and pulmo- to have DVT in the legs. deep-vein-thrombosis. Vnary embolism. In the general U.S. popula- To provide prompt and accurate diagnosis, html. tion, the incidence of first-time VTE is about clinical prediction rules and diagnostic algo- 100 per 100,000 person-years and increases rithms have been developed for VTE. The with advancing age. About one-third of American Academy of Family Physicians patients who have symptomatic VTE present and the American College of Physicians with pulmonary embolism, and two-thirds developed a joint guideline on the diagnosis present with DVT.1 Within one month of and management of VTE,4 and the European diagnosis, the mortality rate is approximately Society of Cardiology has developed diag- 6 percent in patients with DVT and 12 percent nosis and management guidelines for acute in patients with pulmonary embolism.1 pulmonary embolism.5 A common approach Compared with DVT, pulmonary embo- is to use a validated prediction rule for risk lism is more often fatal, has a higher recur- stratification, screen with D-dimer assay as rence rate, and presents with less specific appropriate, and if necessary, perform the symptoms. Pulmonary embolism is usually appropriate imaging studies to confirm or a consequence of DVT. About 40 percent of exclude VTE. This article reviews the diag- patients with proximal DVT are found to nosis of pulmonary embolism and DVT. Downloaded from the American Family Physician Web site at www.aafp.org/afp. Copyright © 2012 American Academy of Family Physicians. For the private, noncommer- Novembercial 15, use 2012of one ◆individual Volume user 86, of Number the Web site.10 All other rights reserved.www.aafp.org/afp Contact [email protected] for copyright questionsAmerican and/or permission Family Physician requests. 913 DVT and Pulmonary Embolism SORT: KEY RECOMMENDATIONS FOR PRACTICE Evidence Clinical recommendation rating References In patients with a low pretest probability of DVT or pulmonary embolism, a negative result from a high- C 7, 10 sensitivity D-dimer assay is sufficient to exclude venous thromboembolism. Validated clinical prediction rules can be used to estimate pretest probability of DVT and pulmonary C 16, 17, 20 embolism, and guide further evaluation. Compression ultrasonography should be the initial test for patients with intermediate to high pretest C 23, 26 probability of DVT in the lower extremities. In patients with intermediate to high pretest probability of DVT, negative ultrasonography alone is C 21, 23, 24 insufficient to exclude the diagnosis of DVT. Further assessment is recommended, including checking the D-dimer level and repeating ultrasonography in one week if the D-dimer level is elevated. For patients with contraindications to computed tomography, including contrast allergy, renal disease, and C 34, 35 pregnancy, ventilation-perfusion scanning is the preferred imaging modality for evaluation of possible pulmonary embolism. DVT = deep venous thrombosis. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease- oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp. org/afpsort.xml. Risk Factors The pathogenesis of VTE is often described by Vir- Table 1. Risk Factors for Venous chow’s triad, which proposes that venous thrombosis is Thromboembolism the result of at least one of three etiologic factors: hyper- coagulability, alterations in blood flow, and endothe- Strong risk factors (odds ratio > 10) lial injury or dysfunction.6 Risk factors for VTE reflect Fracture (hip or leg) these underlying pathophysiologic mechanisms, and Hip or knee replacement between 75 and 96 percent of patients with VTE have Major general surgery at least one risk factor.6 If VTE is suspected, risk factors Major trauma should be assessed to determine the pretest probability. Spinal cord injury Some factors suggest greater risk of VTE than others Intermediate risk factors (odds ratio 2 to 9) (Table 1).6 Arthroscopic knee surgery Central venous lines D-dimer Chemotherapy D-dimer is a fibrin degradation product, a small protein Chronic heart or respiratory failure fragment detectable in the blood after a blood clot is Hormone therapy degraded by fibrinolysis. D-dimer assays are fast, accu- Malignancy rate, and readily available. However, D-dimer assays Oral contraceptive therapy vary in their sensitivity and specificity. Enzyme-linked Paralytic stroke immunosorbent assay (ELISA), quantitative rapid Pregnancy/postpartum Previous venous thromboembolism ELISA, and advanced turbidimetric D-dimer determina- tions are more than 95 percent sensitive for VTE.7 Thrombophilia The negative predictive value of the high-sensitivity Weak risk factors (odds ratio < 2) D-dimer assay is about 94 percent.7,8 However, the Bed rest longer than three days D-dimer assay is useful only for ruling out VTE if results Immobility due to sitting (e.g., car or air travel longer than eight are negative; positive results are not diagnostic because hours) many conditions, such as impaired renal function, Increasing age ongoing blood loss, pregnancy, and atrial fibrillation, Laparoscopic surgery Obesity (body mass index greater than 40 kg per m2) can cause D-dimer levels to rise. A negative D-dimer Pregnancy/antepartum assay result combined with a low pretest probability Varicose veins determined by a well-validated clinical prediction rule suffices to rule out VTE; no further workup is neces- Adapted with permission from Anderson FA Jr, Spencer FA. Risk factors sary in such cases, even in patients who have had a prior for venous thromboembolism. Circulation. 2003;107(23 suppl 1):I10. VTE.4,9-11 In patients with intermediate to high pretest 914 American Family Physician www.aafp.org/afp Volume 86, Number 10 ◆ November 15, 2012 DVT and Pulmonary Embolism probability of VTE, a D-dimer assay should not be per- best known. It divides patients into low-, intermediate-, formed initially because a negative result cannot safely and high-risk categories14-16 (Table 216). The preva- exclude the diagnosis of VTE. lence of DVT is 5, 17, and 53 percent for these groups, respectively.17 Clinical Presentation Similarly, in cases of suspected pulmonary embolism, The classic clinical presentation of DVT includes swell- a pretest probability should be assigned. Implicit clinical ing, pain, warmth, and redness in the involved extrem- judgment, essentially the physician’s estimation of the ity. Alternatively, DVT can occur asymptomatically. probability of pulmonary embolism in a given patient, Individual symptoms are neither sensitive nor specific has been evaluated and found to be fairly accurate for for DVT. Trauma, infection, peripheral artery disease, classifying patients into three categories of clinical like- and other venous diseases can present with clinical fea- lihood of pulmonary embolism: low, intermediate, and tures similar to DVT. Furthermore, DVT can coexist high.5 Because this approach lacks standardization and with any of these processes. is difficult to teach, implicit judgment can be replaced The most common symptoms and signs of pulmo- with explicit clinical prediction
Load more

Recommended publications
  • Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD)
    Evidence-based Practice Center Systematic Review Protocol Project Title: Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD) Project ID: DVTT0515 Initial publication date if applicable: March 7, 2016 Amendment Date(s) if applicable: May 6th, 2016 (Amendments Details–see Section VII) I. Background for the Systematic Review Lower extremity chronic venous disease (LECVD) is a heterogeneous term that encompasses a variety of conditions that are typically classified based on the CEAP classification, which defines LECVD based on Clinical, Etiologic, Anatomic, and Pathophysiologic parameters. This review will focus on treatment strategies for patients with LECVD, which will be defined as patients who have had signs or symptoms of LE venous disease for at least 3 months. Patients with LECVD can be asymptomatic or symptomatic, and they can exhibit a myriad of signs including varicose veins, telangiectasias, LE edema, skin changes, and/or ulceration. The etiology of chronic venous disease includes venous dilation, venous reflux, (venous) valvular incompetence, mechanical compression (e.g., May-Thurner syndrome), and post-thrombotic syndrome. Because severity of disease and treatment are influenced by anatomic segment, LECVD is also categorized by anatomy (iliofemoral vs. infrainguinal veins) and type of veins (superficial veins, perforating veins, and deep veins). Finally, the pathophysiology of LECVD is designated typically as due to the presence of venous reflux, thrombosis, and/or obstruction. LECVD is common
    [Show full text]
  • Venous Ulcers: Diagnosis and Treatment
    Venous Ulcers: Diagnosis and Treatment Susan Bonkemeyer Millan, MD; Run Gan, MD; and Petra E. Townsend, MD University of Florida Health Wound Care and Hyperbaric Center and the University of Florida College of Medicine, Gainesville, Florida Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous throm- bosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for heal- ing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. On physical examination, venous ulcers are generally irregular and shallow with well-defined borders and are often located over bony prominences. Signs of venous disease, such as varicose veins, edema, or venous dermatitis, may be present. Other associated findings include telangiectasias, corona phlebectatica, atrophie blanche, lipodermatosclerosis, and inverted champagne-bottle deformity of the lower leg. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change. Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products.
    [Show full text]
  • Budd-Chiari Syndrome Secondary to Catheter-Associated Inferior Vena
    CASE REPORT | RELATO DE CASO Budd-Chiari syndrome secondary to catheter-associated inferior vena cava thrombosis Síndrome de Budd-Chiari secundária a trombose de veia cava inferior associada a cateter Authors ABSTRACT RESUMO Gustavo N. Araujo 1 Luciane M. Restelatto 1 Introduction: Patients with chronic Introdução: Pacientes com doença renal crô- Carlos A. Prompt 1,2 kidney disease (CKD) are at increased nica (DRC) apresentam risco aumentado de Cristina Karohl 1,2 risk for thrombotic complications. The complicações trombóticas e o uso de cateter use of central venous catheters as dialysis venoso central para realização de hemodiáli- vascular access additionally increases se aumenta este risco. Nós descrevemos um 1 Hospital de Clínicas de this risk. We describe the first case of caso de síndrome de Budd-Chiari (SBC) cau- Porto Alegre. Budd-Chiari syndrome (BCS) secondary sado pelo mal posicionamento de um cateter 2 Universidade Federal do to central venous catheter misplacement de diálise em um paciente com DRC e, para Rio Grande do Sul. in a patient with CKD. Case report: A nosso conhecimento, este é o primeiro caso 30-year-old female patient with HIV/AIDS relatado na literatura. Caso clínico: Paciente and CKD on hemodialysis was admitted feminina, 30 anos, com diagnóstico de HIV/ to the emergency room for complaints of SIDA e DRC em hemodiálise foi admitida fever, prostration, and headache in the na emergência com queixas de febre, pros- last six days. She had a tunneled dialysis tração e cefaleia há 6 dias. Ela apresentava catheter placed at the left jugular vein. um cateter de diálise tunelizado implantado The diagnosis of BCS was established 7 dias antes na veia jugular esquerda.
    [Show full text]
  • Chapter 6: Clinical Presentation of Venous Thrombosis “Clots”
    CHAPTER 6 CLINICAL PRESENTATION OF VENOUS THROMBOSIS “CLOTS”: DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLUS Original authors: Daniel Kim, Kellie Krallman, Joan Lohr, and Mark H. Meissner Abstracted by Kellie R. Brown Introduction The body has normal processes that balance between clot formation and clot breakdown. This allows clot to form when necessary to stop bleeding, but allows the clot formation to be limited to the injured area. Unbalancing these systems can lead to abnormal clot formation. When this happens clot can form in the deep veins usually, but not always, in the legs, forming a deep vein thrombosis (DVT). In some cases, this clot can dislodge from the vein in which it was formed and travel through the bloodstream into the lungs, where it gets stuck as the size of the vessels get too small to allow the clot to go any further. This is called a pulmonary embolus (PE). This limits the amount of blood that can get oxygen from the lungs, which then limits the amount of oxygen that can be delivered to the rest of the body. How severe the PE is for the patient has to do with the size of the clot that gets to the lungs. Small clots can cause no symptoms at all. Very large clots can cause death very quickly. This chapter will describe the symptoms that are caused by DVT and PE, and discuss the means by which these conditions are diagnosed. What are the most common signs and symptoms of a DVT? The symptoms that are caused by DVT depend on the location and extent of the clot.
    [Show full text]
  • Thrombosis in Vasculitis: from Pathogenesis to Treatment
    Emmi et al. Thrombosis Journal (2015) 13:15 DOI 10.1186/s12959-015-0047-z REVIEW Open Access Thrombosis in vasculitis: from pathogenesis to treatment Giacomo Emmi1*†, Elena Silvestri1†, Danilo Squatrito1, Amedeo Amedei1,2, Elena Niccolai1, Mario Milco D’Elios1,2, Chiara Della Bella1, Alessia Grassi1, Matteo Becatti3, Claudia Fiorillo3, Lorenzo Emmi2, Augusto Vaglio4 and Domenico Prisco1,2 Abstract In recent years, the relationship between inflammation and thrombosis has been deeply investigated and it is now clear that immune and coagulation systems are functionally interconnected. Inflammation-induced thrombosis is by now considered a feature not only of autoimmune rheumatic diseases, but also of systemic vasculitides such as Behçet’s syndrome, ANCA-associated vasculitis or giant cells arteritis, especially during active disease. These findings have important consequences in terms of management and treatment. Indeed, Behçet’syndrome requires immunosuppressive agents for vascular involvement rather than anticoagulation or antiplatelet therapy, and it is conceivable that also in ANCA-associated vasculitis or large vessel-vasculitis an aggressive anti-inflammatory treatment during active disease could reduce the risk of thrombotic events in early stages. In this review we discuss thrombosis in vasculitides, especially in Behçet’s syndrome, ANCA-associated vasculitis and large-vessel vasculitis, and provide pathogenetic and clinical clues for the different specialists involved in the care of these patients. Keywords: Inflammation-induced thrombosis, Thrombo-embolic disease, Deep vein thrombosis, ANCA associated vasculitis, Large vessel vasculitis, Behçet syndrome Introduction immunosuppressive treatment rather than anticoagulation The relationship between inflammation and thrombosis is for venous or arterial involvement [8], and perhaps one not a recent concept [1], but it has been largely investigated might speculate that also in AAV or LVV an aggressive only in recent years [2].
    [Show full text]
  • Deep Vein Thrombosis (DVT) / Thrombophlebitis: Assessment & Urgent Referral
    WSCC Clinics Protocol Adopted: 09/05 To be revised: 02/09 Deep Vein Thrombosis (DVT) / Thrombophlebitis: Assessment & Urgent Referral This condition requires urgent referral. Untreated proximal DVT can lead to pulmonary emboli in up to 50% of patients. 95% of all pulmonary emboli are from DVT and have a 30% mortality rate. There is currently no consensus as to whether the empirical judgment of the practitioner or utilization of one of the published decision- making tools is more accurate in deciding which patients should be referred for diagnostic testing. Information on both approaches is contained in this document. Background pulmonary embolism (PE), and post- thrombotic syndrome. Approximately 2 million people a year develop deep vein thrombosis (DVT). In about half of Proximal deep vein thrombosis involves the these patients, the DVT is asymptomatic until popliteal vein or more proximal veins. 80% of a pulmonary embolism occurs. (Caprini 2005) symptomatic patients with confirmed DVT In rare cases, the embolism will travel through have proximal thrombosis. Proximal DVT a patent foramen ovale in the heart wall and leads to a much higher incidence of result in a stroke. pulmonary embolism than does distal. The formation of venous thrombosis usually Distal deep vein thrombosis involves the begins when platelets aggregate at the site of posterior tibial vein in the calf and leads to a endothelial damage. Stasis encourages much lower incidence of pulmonary thrombus formation, followed by the embolism. deposition of fibrin, leukocytes and erythrocytes. The process begins in the cusps Note: Although distal DVT by itself rarely of venous valves. The resulting thrombus may causes pulmonary emboli, in about 30% of move along the vessel as a free-floating clot cases, the distal thrombosis expands upward and the organized thrombus then adheres in to the proximal veins and causes proximal a venous sinus in about 7-10 days.
    [Show full text]
  • Deep Venous Thrombosis
    In the Clinic WHAT YOU SHOULD Annals of Internal Medicine KNOW ABOUT DEEP VENOUS THROMBOSIS What Is Deep Venous Thrombosis? Deep venous thrombosis (DVT) is a blood clot in the veins deep in the leg. If the clot is big enough, it may cause pain and swelling. It is im- portant to treat DVT so the clot does not get worse. Also, the clot could move to the lungs and cause serious breathing problems, circula- tion problems, and even death. DVT can happen: • If you don't move your legs enough after an injury • While in the hospital, when you are in bed for a long time • After an operation • During a long airplane trip • In some people with cancer • In some women who take birth control pills or hormones • In people with blood that clots more easily • For no clear reason What Are the Warning Signs? In about half of all DVT cases, there may be no symptoms. Some symptoms are: • Swelling in the leg, including the ankle and foot • Pain in the leg. The pain often starts in the calf and can feel like cramping • Skin that feels warm to the touch • Changes in skin color (redness) How Is It Diagnosed? Your doctor will examine your leg. He or she may order a test called an ultrasound to see if there's a clot in the veins of the leg. Ultrasound is pain- • What symptoms require emergency care? less and creates a picture of the veins. Also, • How long will I need to stay on blood blood tests may be done to check if you are at a thinners? higher risk for blood clots.
    [Show full text]
  • Peripheral Vascular Disease Assessment in the Lower Limb: a Review of Current and Emerging Non‑Invasive Diagnostic Methods
    Shabani Varaki et al. BioMed Eng OnLine (2018) 17:61 https://doi.org/10.1186/s12938-018-0494-4 BioMedical Engineering OnLine REVIEW Open Access Peripheral vascular disease assessment in the lower limb: a review of current and emerging non‑invasive diagnostic methods Elham Shabani Varaki1* , Gaetano D. Gargiulo1, Stefania Penkala2 and Paul P. Breen1,3 *Correspondence: e.shabaniv@westernsydney. Abstract edu.au Background: Worldwide, at least 200 million people are afected by peripheral 1 The MARCS Institute for Brain, Behaviour & vascular diseases (PVDs), including peripheral arterial disease (PAD), chronic venous Development, Western insufciency (CVI) and deep vein thrombosis (DVT). The high prevalence and seri- Sydney University, Penrith, ous consequences of PVDs have led to the development of several diagnostic tools NSW 2750, Australia Full list of author information and clinical guidelines to assist timely diagnosis and patient management. Given the is available at the end of the increasing number of diagnostic methods available, a comprehensive review of avail- article able technologies is timely in order to understand their limitations and direct future development efort. Main body: This paper reviews the available diagnostic methods for PAD, CVI, and DVT with a focus on non-invasive modalities. Each method is critically evaluated in terms of sensitivity, specifcity, accuracy, ease of use, procedure time duration, and training requirements where applicable. Conclusion: This review emphasizes the limitations of existing methods, highlighting a latent need for the development of new non-invasive, efcient diagnostic methods. Some newly emerging technologies are identifed, in particular wearable sensors, which demonstrate considerable potential to address the need for simple, cost-efec- tive, accurate and timely diagnosis of PVDs.
    [Show full text]
  • Chronic Leg Ulcers: the Impact of Venous Disease
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector INVITED COMMENT Chronic leg ulcers: The impact of venous disease David Bergqvist, MD, PhD, Christina Lindholm, RN, PhD, and Olle Nelzén, MD, PhD, Uppsala, Sweden Chronic leg ulceration of various causes has been PREVALENCE OF LEG ULCERS a health care problem throughout history. The prob- Differences in leg ulcer prevalence between vari- lematic consequences of the disease and the difficul- ous studies may have several causes, such as the use ties in the promotion of healing conditions once cre- of overall or point prevalence, the inclusion or exclu- ated the need for a special saint for chronic leg ulcers, sion of foot ulcers, the age and sex distribution in St Peregrinus. At one of the oldest hospitals in the patient series, and the methodology of identify- Sweden, patients with leg ulcers comprised a large ing patients. With a combination of questionnaires proportion of all in-hospital patients during the years to the health care system (eg, wards, outpatient clin- 1767 to 1771.1 Both internal (laxatives) and external ics, nurses) and questionnaires to randomly selected (turpentine, honey) treatment options were used, individuals within the population and a thorough and, after a couple of months, at least some of the investigation of the random samples of responders, it ulcers healed. Bandaging therapy was mentioned would seem as if an optimal estimate is obtained. We already in the Old Testament of the Bible (Isaiah have been especially interested in an investigation of 1:6).
    [Show full text]
  • Cerebral Vein and Cerebral Venous Sinus Thrombosis
    Cerebral vein and cerebral venous sinus thrombosis Cerebral vein and cerebral venous sinus thromboses are blood clots that form in the veins that drain the blood from the brain called the sinuses and cerebral veins. They can lead to severe headaches, confusion, and stroke-like symptoms. They may lead to bleeding into the surrounding brain tissues. The clots can be triggered by infections of the ear, face, or neck, by medications containing estrogen, pregnancy, or dehydration. They can also be caused by clotting disorders. Sometimes the cause is unknown. The diagnosis is uncommon. It can take a special MRI or CT scan (called MR venogram or CT venogram) to make the diagnosis. The first line of treatment is the blood thinner medication heparin or enoxaparin. After the initial treatment with heparin the patient will start taking warfarin which is another blood thinning medication. The length of treatment with warfarin depends on what caused the clot. If the cause was a temporary trigger such as an infection, pregnancy or use of medications containing estrogen, then treatment would last 3-6 months. If the cause was not identified or if the patient has is a strong clotting disorder, then treatment may last 6-12 months. - 1 - Other names for cerebral vein and cerebral venous sinus thrombosis Cerebral venous thrombosis (CVT) Cerebral vein thrombosis Cerebral venous and sinus thrombosis, Cerebral venous sinus thrombosis (CVST) Cerebral sinovenous thrombosis (CSVT) Cerebral vein and dural sinus thrombosis Sinus and cerebral vein thrombosis How common is cerebral vein and cerebral venous sinus thrombosis? Cerebral vein and cerebral venous sinus thrombosis is an uncommon type of clot.
    [Show full text]
  • Treatment of Superficial Vein Thrombosis: Role of Anticoagulation
    4/14/2016 Suman Rathbun MD, MS No relevant disclosures Professor of Medicine Director, Vascular Medicine University of Oklahoma Health Sciences Center Epidemiology More common than DVT 1:1000 Clinical Presentation Estimated 3 to 8% of the general population Diagnosis Risk factors: varicose veins, immobilization, trauma, surgery, Treatment pregnancy and post-partum, hormonal contraception or -Medical replacement therapy, increasing age, obesity, history of VTE, -Surgical malignancy, autoimmune disease, thrombophilia, IV catheter -Topical Females>Males -Clinical trials Varicose vein SVT • Most common risk factor for SVT • Lower risk of progression to DVT Varicose veins • May be precipitated by trauma • Tender nodules Traumatic • Localized induration Septic and Suppurative • More common after foam sclera vs. thermal ablation Migratory Mondor’s Disease Small saphenous Upper extremity Post endovascular vein treatment 1 4/14/2016 Septic thrombophlebitis • Infusion therapy • IV lines with septicemia • Direct endothelial injury of irritating solutions • Leukocytosis • Pain, tenderness and erythema at catheter insertion • Intense pain • Vein may contract rather than recanalize • Staph aureus, Pseudomonas, Klebsiella, Candida • Removal of catheter; IV antibiotics • Excision of vein in rare cases Great/Small Saphenous Vein SVT Mondor’s disease • Can progress to common femoral or popliteal DVT • Similar morbidity with GSV or SSV SVT • Thoracoepigastric vein of the breast/chest wall • Breast carcinoma or hypercoagulable states • Benign
    [Show full text]
  • Budd-Chiari Syndrome: a Rare and Life-Threatening Complication of Crohn’S Disease Camila C Simoes,1 Yezaz a Ghouri,2 Shehzad N Merwat,2 Heather L Stevenson1
    Unusual association of diseases/symptoms BMJ Case Reports: first published as 10.1136/bcr-2017-222946 on 17 January 2018. Downloaded from CASE REPORT Budd-Chiari syndrome: a rare and life-threatening complication of Crohn’s disease Camila C Simoes,1 Yezaz A Ghouri,2 Shehzad N Merwat,2 Heather L Stevenson1 1Department of Pathology, SUMMARY CASE PRESENTATION University of Texas Medical Budd-Chiari syndrome (BCS) is characterised by A 27-year-old African-American man was admitted Branch, Galveston, Texas, USA 2 obstruction of hepatic venous outflow and may be to our institution as a transfer from an outside Department of Internal triggered by the prothrombotic state associated with hospital to receive a higher level of care due to Medicine, University of Texas Medical Branch, Galveston, inflammatory bowel disease (IBD). We reported a case new-onset ascites and bilateral lower extremity Texas, USA of Crohn’s disease (CD) that presented with anasarca, oedema for the previous 2 weeks. He had a history ascites, symptomatic hepatomegaly, elevated liver of intermittent abdominal pain, haematochezia and Correspondence to enzymes, increased prothrombin time and low albumin. diarrhoea for the past year, when he was diagnosed Dr Heather L Stevenson, Oesophagogastroduodenoscopy and colonoscopy with IBD at an outside hospital. At that time, he hlsteven@ utmb. edu confirmed active CD.A bdominal CT showed hepatic vein was prescribed mesalamine and steroids, which he thrombosis. Liver biopsy revealed severe perivenular CCS and YAG contributed took for a short period with improvement in his equally. sinusoidal dilation with areas of hepatocyte dropout, diarrhoea although he never achieved complete bands of hepatocyte atrophy and centrizonal fibrosis, remission.
    [Show full text]