scholarly journals An oral combined contraceptive user with elevated D-dimer post COVID-19: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nada A. Alyousefi
Keyword(s):  
Emergency Room ◽  
Lower Limb ◽  
Varicose Veins ◽  
Hormonal Contraception ◽  
Oral Contraception ◽  
Contraceptive User ◽  
Lower Limb Pain ◽  
The Right ◽  
D Dimer ◽  
Ethinyl Oestradiol

Abstract Background This case discusses the challenges created by COVID-19 (coronavirus disease 2019) in the area of hormonal contraception, highlighting the contraception knowledge gap for women in their post COVID-19 period, especially if they had high D-dimer levels. Case presentation This case involves a thirty-eight-year-old woman taking combined oral contraception (desogestrel/ethinyl oestradiol tablets) with a history of varicose veins. She recovered from a COVID-19 infection in November 2020. She presented to the emergency room with right lower-limb pain below the knee and progressive swelling for five days in February 2021. Physical examination of the lower limb showed mild swelling and tenderness of the right leg compared to the left leg. D-Dimer was elevated (1.06 mcg/mL FEU). COVID-19 screening was negative. A Doppler scan to exclude DVT was performed considering the clinical picture and high D-dimer level. There was no evidence of DVT in the right limb. She was reassured and discharged with instructions on when to visit the emergency room. The D-dimer had decreased to 0.53 mcg/mL FEU in March 2021. She booked an appointment with family medicine clinics because she was concerned about the continuation of combined oral contraception (desogestrel/ethinyl oestradiol tablets) with high D-dimer and risk of thrombosis. The follow-up D-dimer level in May 2021 was normal (0.4 mcg/mL FEU). The patient preferred to continue taking oral contraception. Conclusion An evidence-based consensus is needed to guide clinicians in providing contraception counselling for such patients.

scholarly journals Psoas hematoma as a rare complication of posterior lumbar interbody fusion: a case report

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bo Deng ◽  
Hai Nan Hong ◽  
Xin Bing Feng ◽  
Zheng Hua Hong ◽  
Guo Ping Cai ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lower Limb ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Psoas Muscle ◽  
Lumbar Interbody Fusion ◽  
Segmental Artery ◽  
Post Surgery ◽  
Lower Limb Pain ◽  
The Right

Abstract Background Psoas hematoma rarely occurs in patients with spondylolisthesis who undergo posterior lumbar interbody fusion (PLIF) surgery. Case presentation Here we reported a case of a 57-year-old male patient diagnosed with spondylolisthesis who underwent PLIF at the local hospital. Seven days post-surgery, abdominal pain occurred, and the pain in the right lower limb gradually increased. The computerized tomography (CT) indicated a formation of hematoma around the psoas muscle. Digital-subtraction angiography (DSA) suggested a vascular injury, a rupture of the right segmental artery of the lumbar vertebral level 4. The patient then received DSA vascular embolization, after which the lower lumbar segmental artery active bleeding was stopped. One month after discharge, the abdominal hematoma was gradually absorbed, and the pain in the waist, leg, and abdomen disappeared. Conclusion Symptoms such as abdominal pain, abdominal distension, and exacerbation of lower limb pain, may suggest the occurrence of psoas hematoma after PLIF. DSA vascular embolization is suggested as the first treatment approach for this type of complication.

Arteries masquerading as varicose veins: A trap for phlebologists

2014 ◽  
Vol 30 (10) ◽  
pp. 729-735 ◽  
Author(s):  
L Jones ◽  
K Parsi
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Tissue Loss ◽  
Injection Sclerotherapy ◽  
Ultrasound Guided ◽  
History Of ◽  
The Right

Ultrasound guided sclerotherapy may be complicated by intra-arterial injections resulting in significant tissue necrosis. Here, we present a 69-year-old man with a history of right small saphenous vein “stripping”, presenting for the treatment of symptomatic lower limb varicose veins. Duplex ultrasound of the right lower limb outlined the pathway of venous incompetence. Despite the history of “stripping”, the small saphenous vein was present but the sapheno-popliteal junction was ligated at the level of the knee crease. No other unusual findings were reported at the time. During ultrasound guided sclerotherapy, subcutaneous vessels of the right posterior calf were noted to be pulsatile on B-mode ultrasound. Treatment was interrupted. Subsequent angiography and sonography showed absence of the right distal popliteal artery. A cluster of subcutaneous vessels of the right medial and posterior calf were found to be arterial collaterals masquerading as varicose veins. Injection sclerotherapy of these vessels would have resulted in significant tissue loss. This case highlights the importance of vigilance at the time of treatment and the invaluable role of ultrasound in guiding endovenous interventions.

scholarly journals Diagnosis of stenosis within the popliteal–femoral venous segment upon clinical presentation with a venous ulcer and subsequent successful treatment with venoplasty

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774051
Author(s):  
Emma Dabbs ◽  
Alina Sheikh ◽  
David Beckett ◽  
Mark S Whiteley
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Venous Ulcer ◽  
Distal Region ◽  
Duplex Ultrasonography ◽  
Venous Ulceration ◽  
Venous Collaterals ◽  
The Right ◽  
Venous Segment

This case study reports the diagnosis and treatment of a lower limb venous ulcer with abnormal underlying venous pathology. One male patient presented with bilateral varicose veins and a right lower limb ulcer. Upon investigation, full-leg duplex ultrasonography revealed total incompetence of the great saphenous vein in the left leg. In the right leg, duplex ultrasonography showed proximal incompetence of the small saphenous vein, and dilation of the anterior accessory saphenous vein, which remained competent. Incidentally, two venous collaterals connected onto the distal region of both these segments, emerging from a scarred, atrophic popliteal–femoral segment. An interventional radiologist performed venoplasty to this popliteal–femoral venous segment. Intervention was successful and 10 weeks post procedure ulceration healed. Popliteal–femoral venous stenosis may be associated with venous ulceration in some cases and may be successfully treated with balloon venoplasty intervention.

scholarly journals Aspergillus endocarditis presenting as acute right lower limb pain

2013 ◽  
Vol 3 (6) ◽  
pp. 502-504
Author(s):  
P Ghosh ◽  
K Saha
Keyword(s):  
Lower Limb ◽  
Poor Prognosis ◽  
Rare Case ◽  
Limb Pain ◽  
Common Cause ◽  
Valve Tissue ◽  
Fungal Endocarditis ◽  
Lower Limb Pain ◽  
Cardiac Valve Replacement ◽  
The Right

Corrigendum: On 31/10/2013 the name of the author K. Shah was corrected to read K. Saha.Aspergillus endocarditis is an 2nd most common cause of endocarditis having poor prognosis. We report a rare case of fungal endocarditis following cardiac valve replacement presenting as acute pain in the right lower limb. Embolism and endocarditis were primarily detected by CT angiography and echocardiography respectively. Diagnosis was established by histopathology and culture of the emboli and was confirmed later by isolation of the Aspergillus species from the resected valve tissue. DOI: http://dx.doi.org/10.3126/jpn.v3i6.9002   Journal of Pathology of Nepal (2013) Vol. 3, 502-504

scholarly journals REHABILITATION OF PATIENT WITH VARICOSE VEIN ALONG WITH SUBCUTANEOUS CALCANEAL BURSITIS

2021 ◽  
pp. 2874-2876
Author(s):  
Pratik Phansopkar
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Neck Region ◽  
Cervical Radiculopathy ◽  
Achilles Tendinopathy ◽  
Heel Spur ◽  
Calcaneal Spur ◽  
Lower Limb Pain

Varicose veins are permanently dilated tortuous and elongated path causing abnormal circulation. The varicose vein is the most common condition among females. The prevalence of varicose veins shows that females are more affected by it. In India, it is most common in females due to long-standing household work. Varicose veins are classified according to the long great saphenous vein varicosity, short/small saphenous vein varicosity, and varicose veins due to perforator incompetence. The calcaneal spur is also known as a heel spur and it occurs due to a bony outgrowth that is present in the heel bone. The heel spur is located at the back of the heel or under the sole. The spur occurring in the back of the heel is often associated with Achilles tendinopathy and the spur under the sole is associated with plantar fasciitis. A 55-year-old female with right-hand dominance came with complaints of pain in both the lower limb, pain in the neck region, and heel pain with these complaints patient was referred for physiotherapy after Ayurveda treatment. The patient presented with a history of osteoarthritis 5 years back, following which she started having pain in both the lower limb and heel. Patient were diagnosed with varicose vein and calcaneal spur with cervical radiculopathy. Therapeutic intervention for the patient comprised of patient education, thermotherapy, ultrasound, TENS, strengthening exercises, and range of motion exercises. The outcome of all this intervention showed improvement in function. Early physiotherapy intervention after diagnosis should be started to improve quality of life, activities of daily living, and prevent chronic disability.

Prevalence and management of ovarian venous insufficiency in the presence of leg venous insufficiency

2007 ◽  
Vol 22 (1) ◽  
pp. 29-33 ◽  
Author(s):  
R Sutaria ◽  
A Subramanian ◽  
B Burns ◽  
H Hafez
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Vena Cava ◽  
Vascular Surgeon ◽  
Venous Surgery ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Superficial Venous Insufficiency

Objective: The correlation between ovarian venous insufficiency and lower limb venous insufficiency remains poorly understood. Clinically, incompetent ovarian veins in association with lower extremity varicose veins are suspected when leg varicose veins are found in atypical distributions. Such distributions include upper lateral or posterior thigh, on the buttocks, crossing the inguinal ligament, and also in the vulval or perineal regions. The aim of this study was to determine the prevalence of ovarian venous insufficiency in those with clinically suspicious varicose veins, and to assess the effectiveness of ovarian venous embolization/ligation in treating this condition. Methods: Between June 2001 and December 2004, 424 female patients with lower limb superficial venous insufficiency were seen by a single vascular surgeon. These patients were clinically assessed, and those with atypical varicose veins were investigated with venous duplex examination and magnetic resonance imaging (MRI) venography. Patients with proven ovarian venous insufficiency were offered venography with a view to embolization or laparoscopic ligation. Results: A total of seven patients were clinically suspected of having ovarian venous insufficiency, of which three had recurrent varicose veins (42.9%). Of these, six were confirmed on MRI venography with the left side being more affected than the right; one of them had an occluded vena cava, three were treated by embolization, and two had laparoscopic ligation. Discussion: The prevalence of clinically detectable ovarian venous insufficiency in association with lower extremity varicose veins is in the region of 1.65%. Compared with the estimated prevalence of incidental ovarian venous insufficiency of 10–47%, this suggests that only a minority of incompetent ovarian veins will present with clinically detectable lower limb venous insufficiency. In our opinion, patients with signs suggestive of ovarian venous insufficiency in association with lower limb venous insufficiency should have their ovarian insufficiency controlled prior to embarking on limb venous surgery.

Do Compression Stockings Potentiate the Fibrinolytic Capacity of the Lower Limbs?

1989 ◽  
Vol 4 (3) ◽  
pp. 161-166 ◽  
Author(s):  
D.C. Berridge ◽  
J.C. Westby ◽  
G.S. Makin ◽  
B.R. Hopkinson
Keyword(s):  
Hydrostatic Pressure ◽  
Lower Limb ◽  
Fibrinolytic Activity ◽  
Varicose Veins ◽  
Bed Rest ◽  
Lower Limbs ◽  
Clot Lysis ◽  
Compression Stockings ◽  
Occlusion Time ◽  
The Right

Patients with varicose veins and liposclerosis have been shown to have impaired fibrinolytic activity1. Furthermore, fibrinolytic activity is much reduced in the lower than in the upper limbs, probably due to the difference in hydrostatic pressure. After 2–10 days bed rest a significant increase in potential is observed2. Compression support stockings can exert 30–40 mmHg of pressure which is 50% of the normal hydrostatic pressure. Therefore does the long term use of such stockings cause a significant increase in fibrinolytic potential? Seventeen patients (10 male, 7 female; mean age 52.8 +/— 9.8 yrs) with features of liposclerosis were studied. Pre- and post-euglobulin clot lysis times (ELT) were measured in the right arm and both legs using a 10 min occlusion time. The patients contralateral leg served as the control. Sigvaris stockings were made for each patient to wear on the designated leg only. Measurements were repeated after 1 and 3 months of use with the stocking in situ and after 30 min bed rest. Patients were instructed to wear the stockings at all times during the day. There were no significant differences in the pre-occlusion values between the arm or the lower limb groups throughout the study. Lower limb post occlusion ELT values were significantly higher in both the affected limb ( p < 0.002) and the patients control limb ( p < 0.002), than in the arm. This relationship was constant throughout the study period. No significant potentiation was seen after either 1 or 3 months of use. There were no new areas of ulceration throughout the study period. Thus any clinical benefit arising from the use of compression stockings is not from potentiation of local fibrinolysis.

scholarly journals A complete duplication of the right and a segmental duplication of the left great saphenous vein - a case report

2015 ◽  
Vol 04 (02) ◽  
pp. 93-97
Author(s):  
Mehandi V Mahajan ◽  
Durga Devi ◽  
Kalpana R.
Keyword(s):  
Case Report ◽  
Saphenous Vein ◽  
Segmental Duplication ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Medial Malleolus ◽  
Vein Thrombosis ◽  
The Right ◽  
Complete Duplication

AbstractAbnormalities of the lower limb veins lead to venous disorders such as obstructive or the ones associated with venous insufficiency. Varicose veins, deep vein thrombosis and ulcers are the common disorders. As many variations are noted in veins in comparison to arteries, the present case report expresses the need for a detailed evaluation of the veins of the lower limb. During the routine dissection of a 65 year old male cadaver, a complete duplication of the Great Saphenous vein (GSV) was noted from the medial malleolus of the tibia till the saphenofemoral junction in the right lower limb and a segmental duplication was noted in the thigh region of left lower limb. Such findings would be of great value to surgeons, orthopaedicians and interventional radiologists as iatrogenic varicosity can be prevented and for cardiovascular surgeons who can use the duplicated vein as vascular grafts in cases of Ischemia and arterial blocks.

scholarly journals Idiopathic spontaneous compartment syndrome of the right lower limb: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Sareesh Bandapaati ◽  
Rayno Navinan Mitrakrishnan
Keyword(s):  
Risk Factors ◽  
Compartment Syndrome ◽  
Lower Limb ◽  
Clinical Signs ◽  
Acute Compartment Syndrome ◽  
Gradual Evolution ◽  
Lower Limb Pain ◽  
History Of ◽  
Extrinsic Risk ◽  
The Right

Abstract Background Acutely painful lower limb is a common presentation to the emergency department, and acute compartment syndrome is an important differential diagnosis to consider given the correct predisposing history and clinical presentation. However, idiopathic spontaneous compartment syndrome is an uncommon occurrence. Case presentation A 54-year-old Caucasian man with no previous comorbidities presented with acute right-sided lower limb pain with classical symptoms showing gradual evolution. He had no other history of medical relevance and no preceding injury. Examination showed a marginally enlarged right lower limb with stretched skin and tenderness. Routine blood tests were normal including D-dimer levels. However, in the absence of any underlying risk factors, acute compartment syndrome was suspected on clinical merit and confirmed with magnetic resonance imaging. He underwent successful surgical intervention with fasciotomy and achieved good recovery. Discussion Acute compartment syndrome, though commonly attributed to trauma, can occur due to varied causes. Spontaneous acute compartment syndrome is attributed to diabetes mellitus. Idiopathic acute spontaneous compartment syndrome occurs in the absence of either intrinsic or extrinsic risk factors and is rarely documented in the literature. This case highlights the importance of appreciating classical clinical signs and having the clinical acumen to consider an obvious diagnosis even in its rarer form of presentation.

scholarly journals Diagnostic Accuracy of D-dimer Testing and the Revised Geneva Score in the Prediction of Pulmonary Embolism

2020 ◽  
Author(s):  
Mostafa A. Abolfotouh ◽  
Khaled Almadani ◽  
Mohammed A. Al Rowaily
Keyword(s):  
Pulmonary Embolism ◽  
Lower Limb ◽  
Predictive Accuracy ◽  
Previous History ◽  
High Sensitivity ◽  
Signs And Symptoms ◽  
Number Of Patients ◽  
Lower Limb Pain ◽  
Revised Geneva Score ◽  
D Dimer

Abstract Background. Pulmonary embolism (PE) diagnosis can sometimes be challenging due to the disease having nonspecific signs and symptoms at the time of presentation. The aim of the present study was to evaluate the validity of the D-dimer in combination with the revised Geneva score (RGS) in prediction of Pulmonary embolism.Methods. This is a retrospective study of 2010 patients with suspected PE who had undergone both D-dimer testing followed by chest CT angiography (CTPA). The predictive accuracy of D-dimer, adjusted D-dimer and the revised Geneva score were calculated. ROC curve was applied to allocate the optimum RGS cutoff for PE prediction.Results. Of all patients, the mean age was 52.2±20.2 years, two-thirds (65.1%) were females, with previous history of; DVT or PE (2%), surgery and/or fracture of lower limb (6.9%), active malignant conditions (14.4%), unilateral lower limb pain (0.6%), and hemoptysis (0.7%).The overall prevalence of PE was 16%. It was 0% in the low, 25.8% in intermediate and 88.9% in high clinical probability categories of RGS. Both conventional and age-adjusted D-dimer thresholds showed significant level of agreement (kappa=0.081, p<0.001), high sensitivity (94% & 92.8%), high NPV (91.2% & 91.4%), low specificity (12.3% & 15.3) and low PPV (17.5% & 17.8%), respectively. Combination of the age-adjusted D-dimer threshold and RGS at a cut-off of 5 points would provide 100% sensitivity and 61.7% specificity 34.1% PPV, 100% NPV and 0.87 AUC. At a RGS cutoff <5 points, PE could be have been excluded in 64.2% of patients with an abnormal age-adjusted D-dimer threshold without further imaging.Conclusion. Conventional and age-adjusted D-dimer tests showed high levels of agreement in prediction of PE, high sensitivity and low specificity. RGS has a good performance in PE prediction. Application of a clinical decision rule, using the revised Geneva score, and age adjusted D-dimer threshold could increase the number of patients in whom PE could be excluded without further imaging.

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