scholarly journals Splanchnic venous thrombosis in a nephrotic patient following COVID-19 infection: a case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maged H. Hussein ◽  
Mohamad S. Alabdaljabar ◽  
Noorah Alfagyh ◽  
Mohammad Badran ◽  
Khalid Alamiri
Keyword(s):  
Nephrotic Syndrome ◽  
Case Reports ◽  
Hypercoagulable State ◽  
Hepatic Veins ◽  
Vein Thrombosis ◽  
Abdominal Symptoms ◽  
Small Series ◽  
Steroid Dependent ◽  
Nephrotic Patient ◽  
The Right

Abstract Background As the COVID-19 pandemic spread worldwide, case reports and small series identified its association with an increasing number of medical conditions including a propensity for thrombotic complications. And since the nephrotic syndrome is also a thrombophilic state, its co-occurrence with the SARS-CoV-2 infection is likely to be associated with an even higher risk of thrombosis, particularly in the presence of known or unknown additional risk factors. Lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common manifestations of COVID-19-associated hypercoagulable state with other venous or arterial sites being much less frequently involved. Although splanchnic vein thrombosis (SVT) has been reported to be 25 times less common than usual site venous thromboembolism (VTE) and rarely occurs in nephrotic patients, it can have catastrophic consequences. A small number of SVT cases have been reported in COVID-19 infected patients in spite of their number exceeding 180 million worldwide. Case presentation An unvaccinated young adult male with steroid-dependent nephrotic syndrome (SDNS) who was in a complete nephrotic remission relapsed following contracting SARS-CoV-2 infection and developed abdominal pain and diarrhea. Abdominal US revealed portal vein thrombosis. The patient was anticoagulated, yet the SVT rapidly propagated to involve the spleno-mesenteric, intrahepatic and the right hepatic veins. In spite of mechanical thrombectomy, thrombolytics and anticoagulation, he developed mesenteric ischemia which progressed to gangrene leading to bowel resection and a complicated hospital course. Conclusion Our case highlights the potential for a catastrophic outcome when COVID-19 infection occurs in those with a concomitant hypercoagulable state and reminds us of the need for a careful assessment of abdominal symptoms in SARS-CoV-2 infected patients.

scholarly journals Postpartum ovarian vein thrombosis manifesting as acute appendicitis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Christos Tsitlakidis ◽  
Khalil Ibrahim Salim Al Ajmi ◽  
Alya Yousuf Al Madhani ◽  
Adel Hassan Ahmidat
Keyword(s):  
Acute Appendicitis ◽  
Penicillin G ◽  
Ovarian Vein ◽  
Intravenous Contrast ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Abdominal Symptoms ◽  
Renal Hilum ◽  
Group A ◽  
The Right

Abstract Background Postpartum ovarian thrombosis is an uncommon condition. It appears with the nonspecific, predominantly right-sided abdominal symptoms and must be differentiated from other acute visceral conditions. If left untreated, postpartum ovarian thrombosis can have severe consequences, including sepsis, pulmonary embolism, and even death. Momentarily, there are no specific guidelines for postpartum ovarian thrombosis management. We present a case of postpartum ovarian thrombosis admitted to our hospital with symptoms of acute appendicitis. Case presentation  A 39-year-old Omani obese multiparous woman of Afro-Arab origin was admitted with acute symptoms, mainly abdominal pain, fever, and vomiting 1 week postpartum. Clinical picture and biochemical profile did not exhibit a recognizable pattern. Ultrasonography excluded retained products of conception. Computerized scan for abdomen and pelvis with oral and intravenous contrast reported a dilated tubular structure in the right adnexa extending up to the right renal hilum level with surrounding inflammation. Those findings were consistent with the thrombophlebitis of the right ovarian vein. Blood cultures and sensitivity showed group A β-hemolytic streptococci sensitive to penicillin G and clindamycin. The patient was treated successfully with antibiotics and therapeutic anticoagulants and discharged home 3 days later; follow-up was arranged. Conclusion This pathology is an exceptional entity in Oman. Therefore, awareness of this unique condition is required so that clinicians will be vigilant, exploring similar cases with imaging and avoiding unnecessary surgical interventions.

scholarly journals Portal Vein Thrombosis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ronny Cohen ◽  
Thierry Mallet ◽  
Michael Gale ◽  
Remigiusz Soltys ◽  
Pablo Loarte
Keyword(s):  
Liver Disease ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Left Renal Vein ◽  
Splenic Vein ◽  
Young Male ◽  
Medical Community ◽  
Vein Thrombosis ◽  
Abdominal Symptoms ◽  
The Right

Portal vein thrombosis (PVT) is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community.

Erythrocytes and Platelets May Contribute to Hypercoagulability In Nephrotic Syndrome Through Enhanced Phosphatidylserine Exposure and Microparticles Release

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 36-36
Author(s):  
Chunyan Gao ◽  
Rui Xie ◽  
Jing Wang ◽  
Chengyuan Yu ◽  
Xiaoyan Tan ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Laser Scanning ◽  
Conflicts Of Interest ◽  
Minimal Change Nephrotic Syndrome ◽  
Renal Vein Thrombosis ◽  
Confocal Laser Scanning Microscope ◽  
Significant Inhibition ◽  
Hypercoagulable State ◽  
Confocal Laser ◽  
Vein Thrombosis

Abstract Abstract 36 Background. Nephrotic syndrome (NS) is frequently accompanied by thromboembolic complications such as renal vein thrombosis, deep vein thrombosis and pulmonary embolism. However, the cause of the hypercoagulable state in NS patients is not understood. In contrast to quiescent cells, membrane-derived microparticles have exposed phosphatidylserine which may support procoagulant enzyme complexes in thrombosis. Objectives. The aim of this work was to measure the type and quantity of MPs that expose PS in NS patients, and to evaluate the associated procoagulant activity (PCA). Methods. The subjects with membranous nephropathy (MN) or minimal change nephrotic syndrome (MCNS) were compared to healthy controls. Flow cytometry and confocal microscopy was used to evaluate microparticles. PCA was determined by clotting time and purified coagulation complex assays. Results. We found that the number of lactadherin+ MPs was significantly higher in each NS group MCNS (3230 ± 536)/MN (4642 ± 697) than that in the controls (1748 ± 239), furthermore, MPs in MN patients are significantly higher than ones in MCNS (P < 0.05; Table 1), which mostly derived from RBC and platelet membranes. The percentage of lactadherin+ RBCs was also significantly increased in each NS group, MN (9.7 ± 3.2%)/MCNS (5.1 ± 2.4%) patients compared to the controls (0.5 ± 0.2%). In addition, the mean percentage of lactadherin+ RBCs in MN showed significantly higher than that in MCNS (P < 0.05). In both NS groups, the percentage of lactadherin+ platelets was significantly higher than that in healthy control subjects (4.1 ± 1.1%) (P < 0.05 for both). Furthermore, patients in MN (11.5 ± 3.1%) also had significantly increased lactadherin+ platelets than in MCNS (7.3 ± 2.3%) (P < 0.05). By confocal laser-scanning microscope, nearly no staining by Alexa Fluro 488-lactadherin could be detected on RBCs or platelets membranes in healthy subjects, whereas a light green fluorescence on RBC and platelet with lactadherin accompanying vesiculation were observed in NS patients. PCA of RBCs/platelets from healthy individuals and NS patients was assessed by recalcification time assays, intrinsic, extrinsic FXa and prothrombinase assays. MPs shedding and PS exposure of RBCs/platelets were highly procoagulant in NS patients and blockade of PS with lactadherin inhibited over 90% of PCA. However, an anti-TF antibody had no significant inhibition effect (Figure 1). Conclusions. This is the first study to show that loss of RBCs/platelets membrane phospholipid asymmetry with increased PS exposure and MPs release may contribute to the hypercoagulable state of NS patients. The extent of PS exposure on cells and MPs may be a marker of thromboembolic risk in these patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Case of Newly Diagnosed Klippel Trenaunay Weber Syndrome Presenting with Nephrotic Syndrome

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Egemen Cebeci ◽  
Secil Demir ◽  
Meltem Gursu ◽  
Abdullah Sumnu ◽  
Mehmet Yamak ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Soft Tissues ◽  
Case Reports ◽  
Renal Involvement ◽  
The Body ◽  
Laboratory Findings ◽  
Weber Syndrome ◽  
Av Malformation ◽  
The Right ◽  
Physical Findings

Klippel Trenaunay Weber syndrome (KTWS) is a rare disease characterized by hemihypertrophy, variceal enlargement of the veins, and arteriovenous (AV) malformations. Renal involvement in KTWS is not known except in rare case reports. Herein, we present a case of KTWS with nephrotic syndrome. A 52-year-old male was admitted due to dyspnea and swelling of the body for the last three months. The pathological physical findings were diffuse edema, decreased lung sounds at the right basal site, increased diameter and decreased length of the left leg compared with the right one, diffuse variceal enlargements, and a few hemangiomatous lesions on the left leg. The pathological laboratory findings were hypoalbuminemia, hyperlipidemia, increased creatinine level (1.23 mg/dL), and proteinuria (7.6 g/day). Radiographic pathological findings were cystic lesions in the liver, spleen, and kidneys, splenomegaly, AV malformation on the left posterolateral thigh, and hypertrophy of the soft tissues of the proximal left leg. He was diagnosed to have KTWS with these findings. Renal biopsy was performed to determine the cause of nephrotic syndrome. The pathologic examination was consistent with focal segmental sclerosis (FSGS). He was started on oral methylprednisolone at the dosage of 1 mg/kg and began to be followedup in the nephrology outpatient clinic.

scholarly journals Characteristics of adverse side effects of corticosteroid therapy in children with nephrotic syndrome and methods of pharmacological correction

2019 ◽  
Vol 5 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Galina A. Batishcheva ◽  
Olga A. Zhdanova ◽  
Tatyana L. Nastausheva ◽  
Yury N. Chernov
Keyword(s):  
Nephrotic Syndrome ◽  
Side Effects ◽  
Clinical Laboratory ◽  
Case Reports ◽  
Growth Failure ◽  
Overweight And Obesity ◽  
Excess Body Weight ◽  
Adverse Side Effects ◽  
Steroid Dependent

Introduction: The article discusses the issues of the long-term glucocorticosteroid therapy in children with nephrotic syndrome that results in severe adverse side effects. Methods: This retrospective study included 89 case reports of patients with nephrotic syndrome, aged 1–18, who received treatment at Voronezh Regional Pediatric Hospital №1 in 1999–2014. The children’s BMI Z-score was calculated from neasured height and weight. The authors considered therapeutical complications revealed through clinical-laboratory and instrumentation examination. Results and discussion: Long-term administration of glucocorticosteroids in patients with steroid-dependent nephrotic syndrome caused overweight and obesity. The patients who had received glucocorticosteroids for 6 months prior to the examination were overweight or obese (78%), had reactive pancreatitis (72%), leukemoid reactions (67%), liver damage (50%), Cushing’s syndrome (44%), chronic gastroduodenitis (33%), hyperglycemia (11%), arterial hypertension (6%), or infectious diseases (6%). The children observed during the period of prolonged remission of nephrotic syndrome had neither overweight, nor obesity or growth failure; signs of chronic gastroduodenitis were observed in 15% of the children. Conclusion: The long-term glucocorticosteroid therapy in children with nephrotic syndrome caused the excess body weight or obesity and gastro-intestinal disorders. So, proton pump inhibitors should be applied simultaneously with glucocorticosteroids to prevent gastro-intestinal disorders.

scholarly journals A Left-Sided Approach for Resection of Hepatic Caudate Lobe Hemangioma: Two Case Reports and a Literature Review

2015 ◽  
Vol 100 (6) ◽  
pp. 1054-1059 ◽  
Author(s):  
Xielin Feng ◽  
Yong Hu ◽  
Junping Peng ◽  
Aixiang Liu ◽  
Lang Tian ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Case Reports ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
Caudate Lobe ◽  
Biliary Fistula ◽  
Hepatic Veins ◽  
Hepatic Hemangioma ◽  
Caudate Lobectomy ◽  
The Right

Resection of the hemangioma located in the caudate lobe is a major challenge in current liver surgery. This study aimed to present our surgical technique for this condition. Two consecutive patients with symptomatic hepatic hemangioma undergoing caudate lobectomy were investigated retrospectively. First, all the blood inflow of hemangioma from the portal vein and the hepatic artery at the base of the umbilical fissure was dissected. After the tumors became soft and tender, the short hepatic veins and the ligaments between the secondary porta hepatis were severed. At last the tumors were resected from the right lobe of the liver. The whole process was finished by a left-sided approach. Blood lost in Case 1 was 1650 mL because of ligature failing in one short hepatic vein, and in the other case, 210 mL. Operation time was 236 minutes and 130 minutes, respectively. Postoperative hospital stays were 11 and 5 days, respectively. The diameter of tumors was 9.0 cm and 6.5 cm. Case 1 required blood transfusion during surgery. No complications such as biliary fistula, postoperative bleeding, and liver failure occurred. The left-sided approach produced the best results for caudate lobe resection in our cases. The patients who recovered are living well and asymptomatic. Caudate lobectomy can be performed safely and quickly by a left-sided approach, which is carried out with optimized perioperative management and innovative surgical technique.

scholarly journals Unilateral Internal Cerebral Vein Thrombosis: Case Reports and Review of the Literature

2021 ◽  
Vol 3 (2) ◽  
pp. 675-683
Author(s):  
Ashley Hu ◽  
Mariam Thomas ◽  
Saadia Chaudhary ◽  
Gasser Hathout
Keyword(s):  
Clinical Presentation ◽  
Case Reports ◽  
Delayed Diagnosis ◽  
Cerebral Vein ◽  
Thalamic Lesion ◽  
Cerebral Vein Thrombosis ◽  
Internal Cerebral Vein ◽  
Vein Thrombosis ◽  
The One ◽  
The Right

AbstractThe purpose of this manuscript is to present two cases of unilateral internal cerebral vein thrombosis (UICVT) and use them to review the typical imaging findings and clinical presentation, provide a differential diagnosis when presented with a unilateral thalamic lesion, and discuss current literature findings of internal cerebral vein thrombosis, including the interesting trend of left-sided involvement. Two cases of UICVT were gathered from our institutions. A literature review was then conducted, and cases in the literature were compared to look for common features. Both of our cases involved the left internal cerebral vein. A total of 7 cases of unilateral and 8 cases of bilateral internal cerebral vein thrombosis were reviewed from the literature. Of the unilateral cases, all but one were on the left, and the one on the right was in a patient with right-sided malignancy after surgical resection. Most of these cases completely resolved with anticoagulation. UICVT is an extremely rare entity, with less than 10 cases reported in the literature. The prognosis of this disease is excellent if diagnosed and treated early; however, with delayed diagnosis and treatment, this process can be fatal. This highlights the importance of keeping this diagnosis on the differential when presented with a unilateral thalamic lesion.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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