scholarly journals A Case Series of Non-Hodgkin's Lymphoma Recurrence in Lower Extremities Mimicking Deep Vein Thrombosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5344-5344
Author(s):  
Shelly Ann Christiansen ◽  
Philip Cohen ◽  
Catherine Broome
Keyword(s):  
Lower Extremity ◽  
Inguinal Lymph Node ◽  
Bone Biopsy ◽  
Patient Characteristics ◽  
Ct Guided ◽  
Vein Thrombosis ◽  
Pet Ct ◽  
History Of ◽  
Relapsed Disease ◽  
Deep Vein

Background: While uncommon, non-Hodgkin's Lymphoma (NHL) can relapse in extranodal sites in the lower extremities. It is well established that venous thomboembolism occurs in higher incidence in patients with underlying malignancy. We describe 3 cases of NHL in which relapsed disease was discovered after lower extremity swelling prompted evaluation for deep vein thrombosis (DVT), and revealed recurrent NHL. CASE 1: A 61 YO F with history of Stage IEA Marginal Zone Lymphoma (MZL) of the dura diagnosed in 2012 received treatment with whole-brain and local brain radiation. In 2016 she developed recurrence in cervical lymph nodes. Six months after receiving 4 cycles of bendamustine and rituximab she developed left leg pain and calf swelling. PET/CT showed a hypermetabolic lesion in left tibia. MRI confirmed large lesion in mid-shaft of tibia extending down the length of the bone. CT-guided bone biopsy confirmed MZL. CASE 2: A 67 YO F with history of triple-negative inflammatory breast cancer treated in 2000 with neoadjuvant chemotherapy and mastectomy. PET/CT in 2008 showed 2 left femoral lesions. She underwent CT-guided bone biopsy of femoral lesion which confirmed follicular lymphoma (FL). Interim PET/CT in 2010 showed decreased FDG uptake in left femur. She was followed with watchful waiting. Then in 2014 patient developed leg swelling and pain, thought to be a DVT. Duplex ultrasound of the lower extremity was negative. PET/CT showed a left inguinal mass and left calf mass. MRI confirmed large mass within the left lower leg centered on the left fibular diaphysis with a very large associated soft tissue component with extensive muscular and neurovascular involvement. Biopsy of left inguinal lymph node confirmed diffuse large B-Cell lymphoma (DLBCL). CASE 3: A 61 YO M with history Stage IV FL in 1988 and initially treated with 4 cycles of PROMACE-CytaBOM. He relapsed nodally in 1995 and was treated on the IDEC investigational protocol with rituximab which led to a complete remission. In 2001 he developed a subcutaneous nodule on his back, biopsy showed FL, grade 1. A staging CT scan of neck, chest, abdomen, and pelvis was unremarkable, but a PET scan showed left axillary disease. He was re-treated with rituximab and local radiation which led to a complete response. Patient presented in 2008 with right calf swelling. Ultrasound at that time showed no DVT but confirmed swelling and suggested right inguinal adenopathy. PET/CT showed FDG uptake in multiple areas in groin and pelvis plus extensive uptake in thickened calf muscles extending from the right knee to the toe. Biopsy of right inguinal lymph node confirmed FL. Conclusion: Among NHLs, relapse patterns can vary significantly. Timing and frequency of relapse is largely dependent on whether NHL is classified as indolent or aggressive. However, location of relapsed disease in NHL is less well established. NHL relapse can occur in a fashion mimicking DVT with lower extremity swelling. When patients with history of NHL present with lower extremity swelling, relapsed disease should be included in the differential diagnosis. Table Patient characteristics Table. Patient characteristics Disclosures Cohen: Takeda Oncology: Honoraria; Pharmacyclics: Honoraria; Seattle Genetics: Honoraria; Amgen: Honoraria. Broome:True North Therapeutics: Honoraria; Alexion Pharmaceuricals: Honoraria.

scholarly journals Warfarin-Induced Spontaneous Bilateral Breast and Extrathoracic Hematoma in an Elderly Woman

2020 ◽  
Author(s):  
Behnam Shakerian ◽  
Negin Razavi
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Rare Disease ◽  
Chest Wall ◽  
Elderly Woman ◽  
Warfarin Therapy ◽  
Vein Thrombosis ◽  
History Of ◽  
Deep Vein

Warfarin- induced spontaneous breast hematoma is a very rare disease, with only a few cases having been reported in the literature so far. We describe an 80-year-old woman who had warfarin therapy due to deep vein thrombosis in a lower extremity. The patient was admitted with a history of swelling and red area on her bilateral breasts, chest wall, right arm, and right flank. She was treated conservatively with success. She was discharged after about 3 weeks without complications and was well at 6 months’ follow-up.

Factor V leiden and Prothrombin Gene Mutations: Differences by Gender

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5135-5135
Author(s):  
Camila Sahebi ◽  
Alice J. Cohen ◽  
Mirza Hamza Parvez Mughal
Keyword(s):  
Lower Extremity ◽  
Gene Mutation ◽  
Gene Mutations ◽  
Factor V Leiden ◽  
Factor V ◽  
Vein Thrombosis ◽  
Time To Recurrence ◽  
History Of ◽  
Prothrombin Gene ◽  
Deep Vein

Abstract Abstract 5135 Background: Factor V Leiden (FVL) and prothrombin gene mutation (PT) are the most common cause of inherited thrombophilia in Caucasian populations, accounting for 40 to 50 % of cases. The incidence of inherited thrombophilia in subjects with a deep vein thrombosis ranges from 24 to 37 %. Women with factor V Leiden or prothrombin gene mutation have a substantially increased risk of clotting in pregnancy and on estrogen -containing birth control pills or hormone replacement in the form of deep vein thrombosis (DVT) and pulmonary embolism (PE). There have been multiple studies done in regards to thrombophilia in women but few reports specific to the behavior of these mutations in men. Objective: To investigate the difference in clinical presentations of men vs women with Factor V Leiden and prothrombin gene mutations. Methods: A retrospective study of patients (pts) over the age of 18 years (yrs) with FVL and PT mutation with history of thrombosis was conducted. These pts were followed in Comprehensive Hemophilia and Thrombosis Disorder Center at Newark Beth Israel Medical Center (NBIMC). Results: 72 pts with symptomatic diagnoses of FVL or PT mutation were identified. The female to male ratio was (43/17) 2:1. Of the male patients 13/17 (76%) had FVL mutation and 4/17(24%) had PT gene mutation. The mean age was 32 yrs (range18–54 yrs). The majority, 15/17(88%) had a lower extremity DVT; 2/17(12%) had PE at presentation. 13/15(86%) of the DVTs were provoked: 5/13 (38%) had surgery, 5/13(38%) had history of recent travel, 3/13(24%) had history of trauma. Of the male pts 11/17 (65%) of the pts had a family history of thrombophilia. 9/17 (53%) had a second thrombotic event with a mean time of 10 yrs (range 1–30 years). Of the female pts 31/43(72%) were diagnosed with FVL gene mutation and 12/43(28%) with PT mutation. The mean age was 32 yrs (18–79 yrs). Of the females 13/43(30%) presented with pregnancy loss, 11/43(23%) with a provoked lower extremity DVT [ 3/43 (6%) had history of oral contraceptive pills use, 5/43(12%) with recent surgery, 2/43(5%) with pregnancy, 1/43(2%) with travel history], 5/43 (12%) had unprovoked DVT, and 13/43(30%) had other thrombotic events (2/43 (5%)CVA, 1/43 (2%)neck vein thrombosis, 1/43(2%) arteriovenous fistula thrombosis, 6/43 (14%) PE, 1/43(2%)with retinal artery thrombosis, 1/43 (2%) with mesenteric ischemia, and 1/43(2%) with portal vein thrombosis). In this group 21/43(49%) had a family history of thrombophilia. Second events occurred in 8/43(18%) with a mean time to recurrence of 7 yrs (range 1–41 yrs). Conclusion: Clinical presentations in patients with FVL and PT mutations differ between males and females including location, time to recurrence and associated conditions. First events in females included both arterial and venous thrombosis and were predominantly hormone related. In contrast, the most common site of thrombosis in our male pts was a provoked lower extremity venous thrombosis especially post surgery and prolonged travel. Additionally, males had higher recurrent events. Prospective long term outcome studies of patients and their asymptomatic family members are necessary to confirm these differences. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Design and Baseline Data for a Prospective Observational Study of Rivaroxaban in Patients with Venous Thromboembolism in Japan (XASSENT)

TH Open ◽  
2021 ◽  
Author(s):  
Ikuo Fukuda ◽  
Atsushi Hirayama ◽  
Kazuo Kawasugi ◽  
Takao Kobayashi ◽  
Hideaki Maeda ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Patient Characteristics ◽  
Open Label ◽  
Phase 3 ◽  
Vein Thrombosis ◽  
Post Marketing Surveillance ◽  
Post Marketing ◽  
History Of ◽  
Deep Vein

Background The efficacy and safety of rivaroxaban have been demonstrated in phase 3 trials of patients with venous thromboembolism (VTE; pulmonary embolism [PE] and deep vein thrombosis [DVT]). Data regarding rivaroxaban treatment of VTE in routine Japanese clinical practice remain limited. Objectives XASSENT will evaluate rivaroxaban treatment of VTE in real-world Japanese clinical practice. We report the study design and baseline patient characteristics. Methods XASSENT (NCT02558465) is a an open-label, prospective observational, post-marketing surveillance cohort study in patients receiving rivaroxaban treatment for VTE. Enrolment took place between November 2015 and March 2018. XASSENT will follow patients for up to 2 years. Primary outcome variables: major bleeding and symptomatic recurrent VTE. Statistical analyses are exploratory and descriptive. Results Baseline patient characteristics at June 2020 (n=2,299) are presented (58.2% female; mean age 66.7 years; mean weight 60.9kg). The population encompasses patients with wide-ranging characteristics including older age, low weight, and renal dysfunction. Most participants (67.6%) had a history of VTE risk factors at baseline. Half of the population (50.4%) had DVT only; 41.4% had DVT with PE; 8.2% had PE only. Overall, 68.4% were inpatients and 77.1% had symptomatic VTE. Rivaroxaban was prescribed for initial treatment in 84.6% of patients and maintenance treatment in 15.4%. Most were prescribed the approved dose of rivaroxaban for initial (30mg daily; 84.4%) or maintenance (15mg daily; 81.9%) treatment of VTE in Japan. The most common reason for selecting non-recommended dose was ‘elderly’. Conclusions Results from XASSENT will complement phase 3 trial data and inform clinical practice.

scholarly journals Calf deep vein thrombosis – clinical relevance, diagnostic approaches and therapeutic options

VASA ◽  
2020 ◽  
Vol 49 (5) ◽  
pp. 359-366
Author(s):  
Giovanna Elmi ◽  
Elisa Rebecca Rinaldi ◽  
Andrea Domanico ◽  
Leonardo Aluigi
Keyword(s):  
Natural History ◽  
Optimal Dose ◽  
Patient Characteristics ◽  
Diagnostic Strategy ◽  
Vein Thrombosis ◽  
History Of ◽  
Proximal Extension ◽  
Meta Analyses ◽  
Deep Vein ◽  
Deep Vein Thromboses

Summary. Isolated distal deep vein thromboses (IDDVT) represent up to 50 % of legs deep vein thromboses (DVT). However, since their natural history is to date unknown, the need to diagnose and treat them is a matter of debate. The diagnostic strategy based on the assessment of pre-test probability and D-dimer demonstrated a scarse efficiency for IDDVT. The choice between a proximal and a complete ultrasonographic approach should be guided by the clinical context, the local expertise and the patient characteristics. Randomized and observational studies have analyzed the need of therapy and compared different regimens of anticoagulation, with conflicting results. Systematic reviews and meta-analyses tend to support the usefulness of an anticoagulant treatment, even if the optimal dose and duration are not still defined. A careful stratification of the patient’s profile, taking into account risk factors for proximal extension, recurrence and bleeding should address the therapeutic approach, which must always be discussed with an adequately informed patient. Further studies aimed to clarify the natural history of IDDVT, and to assess safety and efficacy of lower intensity and shorter duration protocols are urgently needed.

Laterality of lower extremity deep vein thrombosis after colectomy: A retrospective study using the national inpatient sample

2021 ◽  
pp. 026835552199498
Author(s):  
Ivan E Saraiva ◽  
Hirotaka Kato
Keyword(s):  
Lower Extremity ◽  
P Value ◽  
National Inpatient Sample ◽  
Chi Square ◽  
Vein Thrombosis ◽  
Left Lower Extremity ◽  
Chi Square Test ◽  
History Of ◽  
The Difference ◽  
Deep Vein

Background and aims Deep venous thrombosis (DVT) is known to occur preferentially on the left lower extremity. The renowned surgeon Denis Burkitt advanced the theory that a heavy sigmoid colon would compress the left pelvic veins and predispose to DVT. Our study aimed to evaluate this hypothesis by comparing the laterality distributions with and without a prior colectomy. Methods We conducted a retrospective analysis of the 2016 National Inpatient Sample database by stratifying the patients at any age with acute DVT of lower extremity by history of prior colectomy, thereby eliminating local gut mechanical factors in the development of DVT. We compared the laterality distribution (i.e., left, right, bilateral, and unspecified) between the patients with and without a prior colectomy. We also conducted a subgroup analysis by the sex category to examine the difference in laterality distribution for male and female patients. Chi-square test for independence was used. P value ≤0.05 was considered statistically significant. Results We found an estimated total of 342,525 cases. Among patients without a prior colectomy, 136,605 (41.6%) were left-sided DVT versus 119,555 (36.4%) right-sided, with 55,555 bilateral and 16,865 unspecified. Among patients with a prior colectomy, 5,750 (41.2%) were left-sided, 5,000 (35.9%) were right-sided, 2,345 were bilateral and 850 were unspecified. The laterality distribution between the two groups was not significantly different ( p = .167). The left-side predominance disappeared only in males with a prior colectomy (37.1% for left vs. 38.9% for right, p = .027). Conclusions Our findings did not confirm the Burkitt’s hypothesis. The left-side predominance of lower extremity DVT was attenuated only in male patients with a prior colectomy.

scholarly journals Lower extremity deep vein thrombosis after heavy exertion

2013 ◽  
Vol 2013 (nov18 1) ◽  
pp. bcr2013201488-bcr2013201488
Author(s):  
S. Tak ◽  
S. Tak
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Vein Thrombosis ◽  
Deep Vein

scholarly journals Recurrence of Upper Extremity Deep Vein Thrombosis Secondary to COVID-19

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 878
Author(s):  
Yesha H. Parekh ◽  
Nicole J. Altomare ◽  
Erin P. McDonnell ◽  
Martin J. Blaser ◽  
Payal D. Parikh
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Deep Vein

Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.

scholarly journals Study on the Risk Factors of Preoperative Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture

2021 ◽  
Vol 27 ◽  
pp. 107602962110029
Author(s):  
Wenjie Chang ◽  
Bin Wang ◽  
Qiwei Li ◽  
Yongkui Zhang ◽  
Wenpeng Xie
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Color Doppler ◽  
Fracture Site ◽  
Vein Thrombosis ◽  
Lower Extremity Fracture ◽  
Extremity Fracture ◽  
Deep Vein ◽  
D Dimer

Objective: The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by preoperative deep vein thrombosis (DVT). Methods: A total of 11,891 patients with closed fractures of lower extremities were selected. By analyzing each patient’s gender, age, presence or absence of diabetes and hypertension, preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by preoperative DVT were analyzed. Results: A total of 578 with preoperative DVT were detected, displaying a total incidence of 4.86%. All patients were categorized into either the DVT group or non-DVT group. The results demonstrate that there were statistically significant differences between the 2 groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level ( P < 0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT. Conclusion: Age, the presence of diabetes, the fracture site, and increased D-dimer levels were found to be potential risk factors and indicators for preoperative DVT in patients with lower extremity fractures. In addition, the preoperative plasma D-dimer level has certain guiding significance for the prediction of venous thrombosis after lower extremity fracture, which is conducive to the early prediction and diagnosis of DVT, but it often must be followed with good clinic acumen and examinations.

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