scholarly journals Did we turn a blind eye? The answer is simply there. Peripheral pulmonary vascular thrombosis in COVID-19 patients explains sudden worsening of clinical conditions

Imaging ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 4-7 ◽  
Author(s):  
Pierleone Lucatelli ◽  
Maurizio Del Monte ◽  
Gianluca De Rubeis ◽  
Giulia Cundari ◽  
Marco Francone ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Vascular Thrombosis ◽  
Pulmonary Angiogram ◽  
Pulmonary Arterial ◽  
Clinical Conditions ◽  
Pulmonary Arterial Obstruction

AbstractCOVID-19 patients suffering sudden worsening of clinical conditions have an atypical peripheral pulmonary arterial obstruction at computed tomography pulmonary angiogram (CTPA), poorly associated to deep venous thrombosis (DVT), suspicious for thrombotic in situ nature rather than embolic.

Deep venous thrombosis. The dilemma of diagnosis

1997 ◽  
Vol 87 (5) ◽  
pp. 224-232 ◽  
Author(s):  
P Servatjoo
Keyword(s):  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Fatal Outcome ◽  
Clinical Manifestations ◽  
Bed Rest ◽  
Advanced Medical Technology ◽  
Podiatric Surgery ◽  
Postsurgical Complication ◽  
Clinical Conditions

Despite advanced medical technology, deep venous thrombosis continues to be a seriously underdiagnosed common postsurgical complication of the patient, particularly of lower extremity procedures, often requiring postoperative bed rest as in any routine podiatric surgery. Deep venous thrombosis and its complication, pulmonary embolism, are elusive clinical conditions since patients often tend to exhibit neither specific nor reliable signs or symptoms. However, the suspicion of the surgeon, generally based on subtle clinical manifestations, is the most important step in the diagnosis. Diagnosis will never be made unless he or she entertains the possibility. Since prevention of the potentially fatal outcome of pulmonary emboli secondary to deep venous thrombosis and possibly the serious morbidity caused by long-term sequelae in the lower extremity is now possible, the importance of an early, adequate diagnosis is indisputable. Diagnosis on clinical grounds alone is notoriously unreliable and objective tests are necessary to avoid overtreatment or undertreatment.

Computed Tomography in Deep Venous Thrombosis with Limb Oedema

1985 ◽  
Vol 26 (6) ◽  
pp. 727-730 ◽  
Author(s):  
E. Seem ◽  
E. Stranden ◽  
M. G. Stiris
Keyword(s):  
Computed Tomography ◽  
Hydrostatic Pressure ◽  
Soft Tissue ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Interstitial Fluid ◽  
Lower Limbs ◽  
Compartment Syndromes ◽  
Tissue Compliance ◽  
Tissue Compartments

Computed tomography was used in 12 patients to investigate the distribution of oedema in the soft tissue compartments of lower limbs with deep venous thrombosis. Oedema was evenly distributed throughout the subcutis and the muscular compartments in tomograms obtained 25 cm proximal to the ankle. Significantly less swelling in the muscular compartments was found 10 cm proximal to the ankle. Interstitial fluid hydrostatic pressure was measured in the subcutis, and in anterior and posterior muscular compartments, and was significantly increased in all cases. Except for one case, the recorded pressures were well below 30 mmHg, which is considered the limit above which compartment syndromes occur. Tissue compliance was significantly lower in muscular compartments than in the subcutis.

scholarly journals ADRENAL INSUFFICIENCY SECONDARY TO BILATERAL ADRENAL HEMORRHAGE ASSOCIATED WITH ANTIPHOSPHOLIPID SYNDROME

2020 ◽  
Vol 6 (2) ◽  
pp. e65-e69
Author(s):  
Rashika Bansal ◽  
Priti V. Nath ◽  
Thanh D. Hoang ◽  
Mohamed K.M. Shakir
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Adrenal Insufficiency ◽  
Lupus Anticoagulant ◽  
Serum Cortisol ◽  
Adrenal Hemorrhage ◽  
Bilateral Adrenal Hemorrhage ◽  
Prompt Diagnosis

Objective: Antiphospholipid syndrome (APS) can involve multiple organ systems but endocrine manifestations are rare. In most cases adrenal insufficiency (AI) is the first endocrine manifestation of APS. The prompt diagnosis of AI is critical as this disorder is a life-threatening disease that may lead to fatal outcomes if left untreated. We present a case of AI associated with APS the patient was diagnosed promptly and managed successfully. Methods: The diagnosis of APS was based on a combination of clinical features (deep venous thrombosis and pulmonary embolism) and laboratory findings (lupus anticoagulant, anticardiolipin antibody, anti-beta-2 glycoprotein-I antibody), without alternative diagnosis to explain the clinical findings. AI was diagnosed by low morning serum cortisol with elevated adrenocorticotropic hormone (ACTH) level as well as an ACTH stimulation test. Results: A 50-year-old male presented with deep venous thrombosis of the left extremity diagnosed by compressive ultrasound, and was subsequently diagnosed with a pulmonary embolism by computed tomography angiography and treated with heparin. Two days later, he developed hypotension and bilateral flank pain, and an abdominal computed tomography scan revealed bilateral adrenal hemorrhage. Laboratory results showed a serum cortisol of 3.3 mcg/dL (stress normal, 25 to 35 mcg/dL) and ACTH of 319 pg/mL (stress normal, 128 to 218 pg/mL), consistent with primary AI. Symptoms improved quickly with hydrocortisone therapy. The patient still required glucocorticoid therapy for at least 4 years thereafter. Conclusion: In all cases of adrenal hemorrhage and infarction with unknown etiology, screening with lupus anticoagulant and anticardiolipin antibodies is imperative. Recognition of this high-mortality condition allows for appropriate screening and confirmatory tests leading to a prompt diagnosis and timely management.

scholarly journals Rectus sheath hematoma associated with apixaban

2017 ◽  
Vol 7 (3) ◽  
Author(s):  
Kulothungan Gunasekaran ◽  
Amanda R. McFee Winans ◽  
Swetha Murthi ◽  
Mudassar Raees Ahmad ◽  
Scott Kaatz
Keyword(s):  
Computed Tomography ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Early Recognition ◽  
Rectus Sheath ◽  
Factor Xa ◽  
Bleeding Complications ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Rectus Sheath Hematoma

Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in non-valvular atrial fibrillation. Rectus sheath hematoma is a rare, life-threatening complication of anticoagulant treatment. We describe a case of an elderly patient on apixaban for the treatment of deep venous thrombosis who developed severe abdominal pain during hospitalization. Computed tomography of the abdomen revealed left rectus sheath hematoma. Apixaban was discontinued and the patient was monitored for extension of the hematoma. After 2 days she was discharged home. Outpatient computed tomography 1 month later showed complete resolution of the rectus sheath hematoma. We recommend that clinicians become aware of the potential for rare and serious bleeding complications of anticoagulants and identify the need for early recognition and prompt management.

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