Deep Vein Thrombosis of the Left Lower Limb in a 12 Year-Old Female Child with Ulcerative Colitis – Case Report

Acute pulmonary embolism is one of the most common causes of vascular death after myocardial infarction and cerebrovascular accidents. It usually presents with severe chest pain and shortness of breath and occasionally occurs in the background of deep vein thrombosis. A 32-year-old male presented with swelling of left lower limb and shortness of breath. Subsequent investigations revealed that he developed DVT of left lower limb and pulmonary embolism. However, in general, if left untreated, pulmonary embolism is associated with an overall mortality of up to 30 percent compared with 2 to 11 percent in those treated with anticoagulation. Early diagnosis by D-dimer, computed tomograpgy pulmonary angiogram and doppler study of the left lower limb and prompt intervention through low molecular weight heparin and rivaroxaban led to a successful outcome in our case. Birdem Med J 2021; 11(2): 142-144

Download Full-text

Successful use of rivaroxaban in postoperative deep vein thrombosis of the lower limb following instability with warfarin: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-016-1058-5 ◽

2016 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

Mario Schiavoni ◽

Antonella Coluccia

Keyword(s):

Deep Vein Thrombosis ◽

Case Report ◽

Lower Limb ◽

Vein Thrombosis ◽

Postoperative Deep Vein Thrombosis ◽

Deep Vein

Download Full-text

Deep Vein Thrombosis Secondary To Graves' Disease-A Case Report

Community Based Medical Journal ◽

10.3329/cbmj.v5i1.53919 ◽

2016 ◽

Vol 5 (1) ◽

pp. 33-41

Author(s):

Md Aminul Islam ◽

Ayesha Beg ◽

Md Sultan Ahmed ◽

Sayed Chowdhury ◽

Mirza Manjurul Haque

Keyword(s):

Deep Vein Thrombosis ◽

Case Report ◽

Thyroid Hormone ◽

Thyroid Gland ◽

Lower Limb ◽

Graves Disease ◽

Pathophysiological Mechanism ◽

Vein Thrombosis ◽

Deep Vein ◽

Overt Hyperthyroidism

Deep Vein thrombosis (DVT) is the formation of a blood clot within a deep vein, most commonly the legs. The incidence of a first venous thrombosis is 1-3 per 1000 persons per year, around two-thirds manifest as DVT of the leg, and one-third as pulmonary embolism (PE). Graves' disease, also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid which frequently results in and is the most common cause of hyperthyroidism, often results in an enlarged thyroid. The disorder results from an antibody, called thyroid stimulating immunoglobulin (TSI), that has a similar effect to thyroid stimulating hormone (TSH) which cause the thyroid gland to produce excess thyroid hormone. Graves' disease will develop in about 0.5% of males and 3% of females, approximately 7.5 times more often in women than men. Various changes in the coagulation- fibrinolytic system have been described in patients with an excess thyroid hormones particularly procoagulant and antifibrinolytic effects. Review analysis confirmed that clinically overt hyperthyroidism modify the coagulation-fibrinolytic balance, indicating that thyroid hormone excess is the probable main pathophysiological mechanism. Patients with overt hyperthyroidism appear to have an increased risk of thrombosis. Here we present a case of right sided leg swelling due to deep vein thrombosis with Grave's disease A 30 year old lady admitted in tertiary care hospital with right sided leg swelling for 25 days and protrusion of both eyes for 3 months. Swelling was sudden in onset, painful, red in colour, which involved almost whole right lower limb and it was associated with venous engorgement. Physical examination revealed patient was ill looking, mildly anaemic, tachycardic, normotensive, severe pitting edema on right leg but left was normal. Thyroid gland was diffusely enlarged. She had bilateral exopthalmos with presence of lid retraction and lid lag. Examination of Lower limbs revealed swollen whole right lower limb with engorged veins in the upper part of thigh with raised local temperature, calf muscle tenderness and positive Homan's sign on right side. The purpose of this case report is to establish that Graves' disease is the cause of DVT in this patient. CBMJ 2016 January: Vol. 05 No. 01 P: 33-41

Download Full-text

May–Thurner Syndrome: A Consideration for Deep Vein Thrombosis in Males

Case Reports in Medicine ◽

10.1155/2020/2324637 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Tay Tian En Jason ◽

Tay Jia Sheng ◽

Tieng Chek Edward Choke ◽

Pooja Sachdeva

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Lower Limb ◽

Vena Cava ◽

Postthrombotic Syndrome ◽

Ivc Filter ◽

Vein Thrombosis ◽

Left Lower Limb ◽

Deep Vein

May–Thurner syndrome (MTS) is an underdiagnosed cause of lower limb deep vein thrombosis (DVT). The clinical prevalence of MTS-related DVT is likely underestimated, particularly in patients with other more recognisable risk factors. MTS is classically described in females between the age group of 20–50 years. In patients with acute iliofemoral thrombosis, medical treatment with anticoagulation alone has been associated with higher risk of postthrombotic syndrome (PTS) and lower iliofemoral patency rates, as compared to endovascular correction. We describe a case of MTS-related extensive iliofemoral DVT occurring in a middle age male who presented with acute onset of left lower limb swelling and pain, complicated by pulmonary embolism. Doppler compression ultrasonography of the left lower limb showed partial DVT extending from the left external iliac to the popliteal veins, and contrasted computed tomography (CT) of the thorax abdomen and pelvis established features of MTS, together with right pulmonary embolism. He was started on low molecular weight heparin (LMWH) and then underwent left lower limb AngioJet pharmacomechanical thrombolysis/thrombectomy, iliac vein stenting, and temporary inferior vena cava (IVC) filter insertion. After the procedure, the patient recovered and improved symptomatically with rapid resolution of this left lower limb swelling and pain. He was switched to an oral Factor Xa inhibitor and was subsequently discharged. After 1-month follow-up, he remained well with stent patency visualised on repeat ultrasound and underwent an uneventful elective IVC filter retrieval with subsequent plans for a 1-year follow-up.

Download Full-text

May–Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-02730-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Joel Zhen Khang Hng ◽

Shu Su ◽

Noel Atkinson

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Endovascular Treatment ◽

Computer Tomography ◽

Lower Limb ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Left Lower Limb ◽

Deep Vein

Abstract Background May–Thurner syndrome is an anatomical condition characterized by compression of the left common iliac vein by the right common iliac artery, causing venous outflow obstruction. It is an uncommon cause of deep vein thrombosis and is more prevalent among women. This paper highlights the importance of considering May–Thurner syndrome in young males without risk factors presenting with left lower limb pain, as endovascular treatment may be required. Case presentation A 23 year-old Caucasian male presented with a 1-week history of left lower limb pain, edema, and pallor. He was found to have an unprovoked deep vein thrombosis on Doppler ultrasound involving the left fibular, soleus, gastrocnemius, popliteal, femoral, common femoral, and external iliac veins. A heparin infusion was commenced as the initial treatment for deep vein thrombosis. Further investigation with computer tomography pulmonary angiogram and computer tomography venography of the abdomen and pelvis showed bilateral pulmonary emboli and left common iliac vein compression with left common, internal, and external iliac vein thrombosis. He was diagnosed with May–Thurner syndrome despite having no risk factors. A retrievable Cook Celect Platinum inferior vena cava filter was placed, and thrombus of the left common femoral, external, and common iliac veins was treated successfully with AngioJet thrombectomy, thrombolysis using 200,000 units of urokinase, angioplasty and stenting using two Cook Zilver Vena venous self-expanding stents. Therapeutic enoxaparin was commenced on discharge. His filter was removed after 10 weeks. Hematological follow-up 4 months later showed an overall negative thrombophilia screen, and anticoagulation was switched to apixaban. He has had no recurrent thrombosis. Conclusions Clinicians should have a low threshold to investigate for May-Thurner syndrome in patients with left lower limb venous thrombotic events regardless of risk factors, as endovascular treatment may be required to minimize the long-term sequelae of deep vein thrombosis. Duplex ultrasound can be used initially for diagnosis, and computer tomography venography used subsequently if the common iliac vein is not visualized on ultrasound. Endovascular treatment is preferred over anticoagulation alone, especially in otherwise fit patients presenting early, the aim being to reduce the chances of chronic venous hypertension in the lower limb.

Download Full-text