scholarly journals Deep Vein Thrombosis as Initial Manifestation of Whipple Disease

2016 ◽  
Vol 10 (3) ◽  
pp. 640-645 ◽  
Author(s):  
Mônica Souza de Miranda Henriques ◽  
Alexandre Rolim da Paz ◽  
Ana Beatriz Person Gaertner ◽  
Cibelle Ingrid Stephen Melo ◽  
Priscyanne Lins Filgueiras ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Lower Limb ◽  
Periodic Acid ◽  
Blood Stasis ◽  
Clinical Manifestations ◽  
Pathological Examination ◽  
Intestinal Lymphangiectasia ◽  
Initial Manifestation ◽  
Vein Thrombosis ◽  
Whipple Disease

Introduction: Wipple disease (WD) is a rare chronic disease caused by the bacillus Tropheryma whipplei. Constitutive, rheumatologic, gastrointestinal, cardiac, cerebral, lymphatic, cutaneous, and ophthalmological signs are possible systemic symptoms. However, thrombotic manifestations are rarely described as “stroke-like syndrome” or arterial thrombosis. Diagnosis is based on clinical manifestations and pathological examination. Laboratory findings may include anemia, leukocytosis, and thrombocytosis. Objective: We report a case of venous thrombosis as initial manifestation of WD. Case Report: We describe the case of a 53-year-old male with iliofemoral vein thrombosis followed by intermittent diarrhea, loss of appetite, abdominal distension, and bloating. A mild malnutrition state with a weight loss of 13 kg, pallor (+/4 +), presence of lower-limb edema (+/4 +), and hypertympanic distended abdomen occurred. Laboratory tests on admission revealed anemia, positive inflammatory activity tests, and normal coagulation. Endoscopic examination showed villous edema with white dotted infiltrates in the second duodenal portion and intestinal lymphangiectasia in the terminal ileum. Pathological examination revealed numerous macrophages with positive periodic acid-Schiff inclusions. Venous Doppler ultrasound showed extensive deep thrombosis on the left lower limb and recanalization of the femoral vein in the right lower limb. The patient was treated with ceftriaxone and enoxaparin sodium, which led to an improvement of gastrointestinal and thrombosis symptoms. Comments: Hypercoagulability, endothelial damage, vasculitis, and blood stasis are present in T. whipplei infection, which are associated with the activation of inflammatory mechanisms as well as procoagulant and thromboembolic events. WD should be part of the differential diagnosis of diseases that cause venous thrombosis of unknown origin.

The risk of lower-limb superficial vein thrombosis relative to lower-limb venous thrombotic events is not increased in winter months

2020 ◽  
Vol 35 (7) ◽  
pp. 533-537
Author(s):  
Samir Henni ◽  
Pierre Ramondou ◽  
Guillaume Duval ◽  
Jean Picquet ◽  
Georges Leftheriotis ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limb ◽  
Homogeneous Distribution ◽  
Superficial Vein ◽  
Chi Square ◽  
Venous Flow ◽  
Vein Thrombosis ◽  
Superficial Vein Thrombosis ◽  
Chi Square Test

Objectives Ambient temperature (that impacts differently venous flow in superficial and deep veins) could have a different effect on the risk of superficial and deep venous thrombosis. We searched for a trimestral variation of the risk of superficial venous thrombosis among all lower-limb thrombotic events (lower-limb thrombotic events = superficial venous thrombosis + deep venous thrombosis). Methods We retrospectively analyzed the results of venous ultrasound investigations performed among 11,739 patients (aged 67 ± 19 years old, 56.1% males) referred for suspected lower-limb thrombotic events over a 12-year period. Chi-square test was used to compare the superficial venous thrombosis/lower-limb thrombotic events ratio observed by trimesters to a homogeneous distribution. Results The proportion of lower-limb thrombotic events were 30.7%, 28.8%, 31.1%, and 31.4% (Chi2: 0.133; p = 0.987) of total investigations, while that of superficial venous thrombosis among all lower-limb venous thrombotic events were 27.2%, 30.0%, 31.4%, and 31.0%, for the first, second, third, and fourth trimesters respectively (Chi2: 0.357; p: 0.949). Conclusion No trimestral variation of the superficial venous thrombosis/lower-limb venous thrombotic events ratio was observed.

Evaluation of Acute Deep Venous Thrombosis of the Lower Limb, Using an Automated Venous Occlusion Plethysmograph

1991 ◽  
Vol 6 (4) ◽  
pp. 241-248 ◽  
Author(s):  
Håkan Ahlström ◽  
Stefan Nilsson ◽  
Göran Hellers
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Strain Gauge ◽  
Lower Limb ◽  
False Negative ◽  
Venous Occlusion ◽  
Vein Thrombosis ◽  
Deep Vein

One-hundred-and-eleven consecutive patients who were referred for routine phlebography because of clinically suspected deep vein thrombosis (DVT) were also investigated with a new, simplified, computerized strain-gauge plethysmograph (Phlebotest, Eureka AB). An occlusion plethysmograph curve was obtained from each leg simultaneously. Four different numerical parameters were defined and determined from this curve. These parameters were correlated with the phlebographic diagnosis. Three of the parameters of the plethysmograph curve correlated well with the phlebographic diagnosis, which proved correct in 54 patients without DVT, including two false negative cases, and in 12 patients with thrombosis. In 45 patients, plethysmography alone was not sufficient to establish a diagnosis. The plethysmograph described is easy to handle and is suggested for use in selecting those patients, with or without thrombosis, who do not require supplementary phlebography.

scholarly journals Total preservation of patency and valve function after percutaneous pharmacomechanical thrombolysis using the Trellis®-8 system for an acute, extensive deep venous thrombosis

2012 ◽  
Vol 94 (2) ◽  
pp. e103-e105 ◽  
Author(s):  
JR Wormald ◽  
TRA Lane ◽  
PE Herbert ◽  
M Ellis ◽  
NJ Burfitt ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Lower Limb ◽  
Complete Recovery ◽  
Normal Function ◽  
Acute Management ◽  
Vein Thrombosis ◽  
Valve Function ◽  
Total Preservation ◽  
Deep Vein

Pharmacomechanical thrombolysis is being used increasingly for the treatment of deep vein thrombosis (DVT) and aims to reduce the severity of post-thrombotic syndrome. We report the case of a 60-year-old woman with extensive lower limb DVT that was treated using pharmacomechanical thrombolysis leading to complete recovery of her deep venous system. The prompt use of pharmacomechanical thrombolysis for the acute management of extensive DVT should be considered when treating patients with extensive DVT in order to facilitate return of normal function.

Rare thromboses of cerebral, splanchnic and upper-extremity veins

2010 ◽  
Vol 103 (06) ◽  
pp. 1136-1144 ◽  
Author(s):  
Valerio De Stefano ◽  
Ida Martinelli
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Upper Extremity ◽  
Myeloproliferative Neoplasms ◽  
Clinical Manifestations ◽  
First Episode ◽  
Vein Thrombosis ◽  
Local Risk ◽  
Venous Thromboses

SummaryVenous thrombosis typically involves the lower extremity circulation. Rarely, it can occur in the cerebral or splanchnic veins and these are the most frightening manifestations because of their high mortality rate. A third site of rare venous thrombosis is the deep system of the upper extremities that, as for the lower extremity, can be complicated by pulmonary embolism and post-thrombotic syndrome. The authors conducted a narrative review focused on clinical manifestations, risk factors, and treatment of rare venous thromboses. Local risk factors such as infections or cancer are frequent in thrombosis of cerebral or portal veins. Upper extremity deep-vein thrombosis is mostly due to local risk factors (catheter- or effort-related). Common systemic risk factors for rare venous thromboses are inherited thrombophilia and oral contraceptive use; chronic myeloproliferative neoplasms are closely associated with splanchnic vein thrombosis. In the acute phase rare venous thromboses should be treated conventionally with low-molecular-weight heparin. Use of local or systemic fibrinolysis should be considered in the case of clinical deterioration in spite of adequate anticoagulation. Anticoagulation with vitamin K-antagonists is recommended for 3–6 months after a first episode of rare venous thrombosis. Indefinite anticoagulation is recommended for Budd-Chiari syndrome, recurrent thrombosis or unprovoked thrombosis and permanent risk factors. In conclusion, the progresses made in the last couple of decades in diagnostic imaging and the broadened knowledge of thrombophilic abnormalities improved the recognition of rare venous thromboses and the understanding of pathogenic mechanisms. However, the recommendations for treatment mainly derive from observational studies.

Catheter-related venous thrombosis in NICU: A case-control retrospective study

2020 ◽  
pp. 112972982098320
Author(s):  
Karolina Chojnacka ◽  
Zbigniew Krasiński ◽  
Katarzyna Wróblewska-Seniuk ◽  
Jan Mazela
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Venous Thrombosis ◽  
Neonatal Intensive Care ◽  
Neonatal Period ◽  
Clinical Manifestations ◽  
Significant Risk ◽  
Case Control ◽  
Control Group ◽  
Vein Thrombosis

Introduction: Newborns treated in a neonatal intensive care unit (NICU) are susceptible to several complications one of them being vein thrombosis. Aim: The study aims to evaluate risk factors of catheter-related venous thrombosis, clinical manifestations, treatment, and the outcomes of thrombotic events (TE) during the neonatal period. Methods: This work is a case-control retrospective study performed on patients in the tertiary NICU between January 2013 and June 2016. The analysis includes data from infants with CVC diagnosed with thrombosis and infants with CVC, not being diagnosed with thrombosis (control group). Statistica 10 software was used for statistical analysis. Results: Vein thrombosis was diagnosed in 19 NICU infants including 16 cases of catheter-related vein thrombosis (84% of complicated cases). Other statistically significant risk factors were asphyxia, infection, and the duration of CVC use. The incidence of thrombosis in our population increased during the study which may result from a statistically significant increase in the number of inserted CVC (294 vs 435), and more frequent diagnosis of incidental thrombosis (1 vs 9). Conclusion: Vein catheterization, asphyxia, infection, and prolonged CVC use are critical risk factors for thrombosis in the neonatal period. Given the hereinbefore mentioned increased number of central line catheterizations in the NICU, it would be useful to conduct a prospective study with a scheduled routine ultrasound protocol applied not only as a tool to diagnose thrombosis but also to prevent it by determining a proper catheter for a particular vein.

The Coinicidence of Venous and Arterial Thrombosis in Patients with Antiphospholipid Syndrome - Correlation with Laboratory Findings.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4045-4045
Author(s):  
Wolfgang A. Miesbach ◽  
Robert Hudeck ◽  
Martina Boehm ◽  
Inge Scharrer
Keyword(s):  
Venous Thrombosis ◽  
Antiphospholipid Syndrome ◽  
Arterial Thrombosis ◽  
Clinical Manifestations ◽  
Anticardiolipin Antibodies ◽  
Enzyme Linked Immunosorbent Assay ◽  
Normal Range ◽  
Laboratory Findings ◽  
Lupus Anticoagulants ◽  
Vein Thrombosis

Abstract The antiphospholipid syndrome (APS) is one of the most common acquired causes of thrombosis on the venous or arterial site. The initial type of the thrombosis appears to be the most likely type of event to recur. In general, APS patients present more common venous thrombosis, especially deep vein thrombosis of the legs. Arterial thromboses are less common and mostly manifest with ischemia or infarction. It is not clear whether a combination of phospholipid antibodies or the additional presence of lupus anticoagulants in patients with anticardiolipin antibodies increase the risk of manifestation of APS. Methods: We investigated retrospectively 300 patients with elevated aCL antibodies. IgG and IgM aCL antibodies were tested by enzyme-linked immunosorbent assay (ELISA). LA were tested by more than 2 different methods according to the proposed criteria of the SSC of the ISTH. Results: Of these patients, 61 % suffered from manifestations of APS, 35 % from venous and 28 % from arterial thrombosis, 7 % of the patients had abortions. In 39 % no thromboembolic disease was found. The coincidence of venous and arterial thrombosis was found in 25/300 (8 %) of the patients. An increased titer of IgG aCL was found in 135 of 300 patients (45 %, median 49 GPL-U/ml, normal range: - 11,3 GPL-U/ml), and an increased titer of IgM aCL in 260 patients (87 %, median 13 MPL-U/ml, normal range: 5,6 MPL-U/ml). Lupus anticoagulants were additionally detected in 130/300 patients (43 %). The rate of clinical manifestations did not differ between LA-positive patients (78 of 130 patients, 60 %) and LA-negative patients (105 of 170, 62 %) patients with elevated aCL antibodies. Regarding the patients with the coincidence of venous and arterial thrombosis, we found a significantly higher rate of positive lupus anticoagulants than in the patients with APS manifestation of one site only (17/25 vs. 113/275, p < 0.05, OR 3.04; 95 % CI 1.31 – 7.06). An elevation of IgG-aCL titres were more frequently found, too. Table 1: Characteristics of the patients with a coincidence of venous and arterial thrombosis compared to patients with thrombosis of one site only Conclusion: The additional presence of lupus anticoagulants in patients with anticardiolipin antibodies identifies a group of patients with high risk of recurrent manifestations of the antiphospholipid syndrome. Particularly the risk of manifestation of both, arterial and venous thrombosis in these patients should be early recognized to initiate a careful follow-up and antithrombotic therapy in these patients. Venous and Arterial Thrombosis Thrombosis of One Site No APS Manifestation n 25/300 (8 %) 157/300 (59 %) 118/300 (39 %) Age (yrs) median 48.5 50 46 Sex (F/M) 17/8 (2.1) 62/157 (2.1) 51/118 (2.3) LA 17/25 (68 %) 62/157 (39 %) 51/118 (43 %) IgG-aCL 15/25 (60 %) 73/157 (46 %) 47/118 (40 %) median titre 108 GPL 87 GPL 37 GPL IgM-aCL 24/25 (96 %) 129/157 (82 %) 104/118 (88 %) median titre 13 MPL 14 MPL 14 MPL

scholarly journals Diagnostic Approach for Classic Compared With Localized Whipple Disease

2018 ◽  
Vol 5 (7) ◽  
Author(s):  
Nicholas R Crews ◽  
Kelly A Cawcutt ◽  
Bobbi S Pritt ◽  
Robin Patel ◽  
Abinash Virk
Keyword(s):  
Small Bowel ◽  
Synovial Fluid ◽  
Periodic Acid ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Diagnostic Approach ◽  
Diagnostic Challenge ◽  
Small Bowel Biopsy ◽  
Whipple Disease

Abstract Background Whipple disease (WD), a rare systemic infection caused by Tropheryma whipplei, can be a diagnostic challenge due to its variable presentation. The role of T. whipplei polymerase chain reaction (PCR) is unclear as small bowel biopsy with Periodic acid-Schiff (PAS) staining remains the diagnostic gold standard. Individualized diagnostic approaches based on variable clinical manifestations are underutilized. We investigated the methodologies employed at our institution to diagnose WD. Methods We retrospectively collected all cases of WD diagnosed from 1994 to 2016. Microbiology laboratory and anatomic pathology databases were queried. Case characteristics and disease clinical phenotypes (classical, localized WD arthritis, and localized central nervous system [CNS] disease) were described. The diagnostic approach and testing yield were analyzed and reported. Results Thirty-three cases of WD were diagnosed (18 classic WD [CWD], 9 localized WD arthritis [LWD], 6 CNS WD). Misdiagnosis and delay in diagnosis were frequent. Diagnostic approach and test yield differed by classical vs localized WD involvement. Small bowel tissue biopsy PAS stain/PCR was overwhelmingly positive (86%/92%) in CWD, yet seldom positive (12%/42%) in LWD (P &lt; .001). Affected joint synovial fluid PCR was frequently positive in both CWD (100%, 3/3) and LWD (85%, 6/7). Conclusions These results support the role of small bowel biopsy PAS stain/PCR in the diagnosis of CW, though this approach may be of limited utility in LWD or CNS WD without gastrointestinal symptoms. Affected joint synovial fluid or cerebrospinal fluid PCR was frequently positive in both CWD and LWD, supporting its diagnostic usefulness.

scholarly journals Venous Thrombosis could be Gender Specific, Women Beware!

2019 ◽  
Vol 69 (5) ◽  
pp. 503-509
Author(s):  
Swati Srivastava ◽  
Iti Garg ◽  
Lilly Ganju ◽  
Bhuvnesh Kumar
Keyword(s):  
Venous Thrombosis ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Normal Pregnancy ◽  
Hormonal Changes ◽  
Activity Increase ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Post Menopausal ◽  
Flow Stasis

Venous thrombosis (VT) is the third major cause of mortality in the world after heart attack and stroke. Its two major clinical manifestations are deep vein thrombosis (DVT) and pulmonary embolism (PE) which are serious medical conditions but often remain under-diagnosed. Although rate of occurrence of venous thrombosis in men is slightly higher, a number of studies have pointed out that woman poses higher risk of venous thromboembolism (VTE) compared to men at various stages of life. Risk of VTE increases in women’s life particularly with use of oral contraceptives, during pregnancy and with exogenous administration of hormones like in post-menopausal hormone therapy. Various reports show that these factors increase risk of DVT and PE by several folds. DVT is considered as an important cause of maternal death in western countries. It is often asymptomatic and its signs and symptoms are similar to those of normal pregnancy. The hormonal changes at various stages of life and less physical activity increase the risk of VTE by blood flow stasis. It is extremely important for women to know the stages of life when they are prone to develop VTE, about its prevention and treatment. Detailed studies on differences in clinical manifestations of VTE between men and women are lacking. This review focusses on assessing the increased risk of VTE and its prognosis in women based on available literature.

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