scholarly journals Large diverticulum of the urinary bladder: A rare cause of deep vein thrombosis with consecutive pulmonary embolism

2015 ◽  
Vol 9 (5-6) ◽  
pp. 321
Author(s):  
Oliver Zimmermann ◽  
Jan Torzewski ◽  
Ekkehard Reichenbach-Klinke ◽  
Christine Zenk
Keyword(s):  
Pulmonary Embolism ◽  
Urinary Bladder ◽  
Left Kidney ◽  
Pulmonary Arteries ◽  
Vein Thrombosis ◽  
Progressive Dyspnea ◽  
Vena Femoralis ◽  
The Right ◽  
Deep Vein ◽  
Vena Femoralis Superficialis

A 73-year-old man was admitted with progressive dyspnea; he also had benign prostatic hyperplasia (BPH). An angio computed tomography scan showed pulmonary embolism with thrombi in both main pulmonary arteries. By duplex ultrasonography, we detected a thrombus in the right vena femoralis superficialis and vena femoralis communis. Simultaneously, we also noticed a large diverticulum on the right side of the urinary bladder and urinary stasis II of the left kidney. We consider the BPH as the trigger for a secondary diverticulum of the urinary bladder. As a result of its large dimensions, mechanical compression of the deep right pelvic veins resulted in thrombosis which finally caused the pulmonary embolism. With respect to the urinary stasis II, surgical excavation of the diverticulum with infravesical desobstruction was planned. The potentially lethal course of large diverticula may require surgery.

Saddle pulmonary embolism with fluorouracil: A case report

2020 ◽  
Vol 26 (7) ◽  
pp. 1769-1773
Author(s):  
Kylee E White ◽  
Christopher T Elder
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Case Report ◽  
Single Agent ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Additive Risk ◽  
The Right ◽  
Deep Vein ◽  
To Receive

Introduction As a single agent, fluorouracil has been documented to have a small but present chance of causing extravasation of the port when not properly administered. It has also been shown that cancer patients receiving chemotherapy are at increased risk of deep vein thrombosis, symptomatic or silent. Case report A 43-year-old male patient with stage III colon cancer receiving FOLFOX developed a saddle pulmonary embolism involving possible extravasation that was discovered following cycle 3 of chemotherapy. CT scan and lower extremity Doppler confirmed non-occlusive deep vein thrombosis along with saddle pulmonary embolism. Management and outcome: For acute management, patient underwent bilateral pulmonary artery thrombolysis. Following this, the patient was initiated on rivaroxaban indefinitely. The right subclavian port was removed, and a new port was placed in the left subclavian. Patient went on to receive three more cycles of chemotherapy. Discussion Fluorouracil, an inflammitant, has been shown to have damaging potential, especially in terms of the integrity of the endothelium. Over time, this can lead to serious complications such as cardiotoxicity, including deep vein thrombosis formation. Based on how and when the thrombi were discovered, it is not possible to deduce whether the port, the 5-FU, extravasation or other factors were the precipitators of the formation of the thrombi. The combination of chemotherapy treatment along with CVC placement appears to have an additive risk to the formation of a thrombus. Practitioners should take caution when evaluating for extravasation and CVC integrity and note other potential differentials for causes, including deep vein thrombosis/saddle pulmonary embolism formation.

scholarly journals P1267 Negative baseline diagnostic imaging does not exclude pulmonary embolism in patients with reccurrent syncope

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
U Kocabas ◽  
H Altay ◽  
F Ozkalayci ◽  
I Isiklar ◽  
S Pehlivanoglu
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Doppler Ultrasound ◽  
Ultrasound Imaging ◽  
Normal Sinus Rhythm ◽  
Pulmonary Arteries ◽  
Vein Thrombosis ◽  
Normal Sinus ◽  
Doppler Ultrasound Imaging ◽  
Deep Vein

Abstract INTRODUCTION In patients who are admitted to a hospital due to episode of syncope, acute pulmonary embolism (PE) is rarely considered as a possible cause. This report presents two cases illustrating PE as a cause of syncope with elevated cardiac troponin (cTn) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels despite normal echocardiographic examination and negative Doppler ultrasound imaging. Case 1: An 83-year-old woman admitted to the ER due to episodes of recurrent syncopes. According to her anamnesis, she had four episodes of syncopes during last three weeks without chest pain, dyspnea, palpitation or hemoptysis. ECG revealed a normal sinus rhythm with a heart rate of 70 bpm without ischemic changes. Laboratory tests revealed raised levels of cTn and NT-proBNP. Transthoracic echocardiography (TTE) demonstrated preserved left and right ventricular systolic functions without any cardiac chamber enlargement and mild tricuspid regurgitation with a PAP of 35 mmHg. Patient’s pre-test probability for pulmonary embolism was low (Wells’ score < 2) but D-dimer level was elevated. Doppler imaging for detection of deep vein thrombosis was negative. Computed tomography pulmonary angiography (CTPA) showed filling defects in the pulmonary arteries consistent with pulmonary embolism (Panel A). The patient was discharged with rivaroxaban therapy without any complication. Case 2: A 69- year-old woman presented to ER with symptoms of chest pain and recurrent episodes of syncope for the last 2 days. Her medical history revealed hypertension and hyperlipidemia. On admission ECG showed a normal sinus rhythm with a heart rate of 105 bpm and T-wave inversions in inferior leads. Laboratory tests showed elevated levels of cTn and NT-proBNP. TTE demonstrated normal left ventricular systolic function with an ejection fraction of 55% and normal right ventricular function and chamber size with a tricuspid annular plane systolic excursion of 22 mm. Diagnostic coronary angiography was performed to exclude acute ischemia revealed non-significant coronary artery stenosis. Doppler ultrasound imaging for detection of deep vein thrombosis was negative. CTPA showed filling defects in the bilateral main pulmonary arteries consistent with acute bilateral pulmonary embolism (Panel B-C). The patient was discharged with rivaroxaban therapy after four days of hospitalization period without any complication. CONCLUSION Elevated cTn and NT-proBNP leves on admission strongly suggest transient hemodynamic impairment causing cardiac injury and syncope. Normal admission ECG and TTE can exclude most possible acute cardiac causes of syncope. Although acute right ventricular dsyfunction is the most frequent finding of acute massive PE causing hemodymanic impairment resulting with syncope, diagnosis of acute PE should only be excluded with CTPA in patients with similar clinical characteristics despite normal TTE and negative venous Doppler ultrasound imaging. Abstract P1267 Figure

scholarly journals Recurrent pulmonary embolism related with Paget–Schroetter syndrome: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Yuki Sahashi ◽  
Junko Naito ◽  
Masanori Kawasaki
Keyword(s):  
Pulmonary Embolism ◽  
Lifestyle Modification ◽  
Axillary Vein ◽  
Vein Thrombosis ◽  
Cardiology Department ◽  
Recurrent Pulmonary Embolism ◽  
The Right ◽  
Contrast Ct ◽  
First Rib Resection ◽  
Deep Vein

Abstract Background Paget–Schroetter syndrome (PSS) is an unusual cause of venous thromboembolism, which is frequently misdiagnosed and undiagnosed in clinical settings. Although axillary-subclavian vein thrombosis is related with PSS typically presents in healthy young athletes, it is possible for this phenomenon to occur in various age settings. Case summary We present a case of recurrent pulmonary embolism caused by a thrombus in dilated axillary vein related with PSS. A 74-year-old man was referred to our cardiology department for chest discomfort and hypoxaemia. The contrast computed tomography (CT) revealed that he suffered from bilateral pulmonary embolism. However, we could not find the source of embolism despite other examinations such as ultrasonography of the inferior limb deep vein. Three months later, the patient complained of dyspnoea for a second time, and a contrast CT scan was subsequently performed revealing a new pulmonary embolism. Surgical resection of the giant thrombus was performed, resulting in a good clinical course without recurrence. Discussion We experienced a case of recurring pulmonary embolism in a patient with undiagnosed PSS, which was related to the active and vigorous movement of the right arm during his working. Although there are various treatments for PSS including anticoagulation, first rib resection, and lifestyle modification, we need to consider what is the best treatment individually.

Temporary caval filter in the prevention of pulmonary embolism during delivery and postpartum

2005 ◽  
Vol 20 (4) ◽  
pp. 183-189
Author(s):  
G Pagliariccio ◽  
L Carbonari ◽  
C Grilli Cicilioni ◽  
A Angelini ◽  
E Gatta ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Lower Limbs ◽  
X Ray ◽  
Vein Thrombosis ◽  
Caval Filter ◽  
Prophylactic Use ◽  
The Right ◽  
Deep Vein ◽  
Mean Time

Objectives: The treatment of deep vein thrombosis (DVT) of the lower limbs during pregnancy remains controversial. There are a lot of problems related to anticoagulant therapy for the safety of the fetus; the use of caval filters rarely appears in the literature and it is not yet codified. So the choice of the right treatment is often difficult. The authors review their experience with a prophylactic use of a temporary caval filter for patients with proximal DVT of the last period of pregnancy, in order to avoid the inherent risk of major pulmonary embolism during delivery and postpartum. Methods: Ten women with proximal DVT were treated. The diagnosis was performed by Doppler ultrasonography (DU) and magnetic resonance (MR). At the end of pregnancy, a temporary caval filter (eight Prolyser and two Tempofilter) was percutaneously inserted under X-ray control. The patients were then subjected to a planned caesarean section. After 15 days, all filters were removed after a phlebography to check the absence of clots. Results: The mean time of X-ray exposure was about 1 min and 30 s. None of the patients suffered a major pulmonary embolism. All fetuses were born without problems or malformations. There were no complications related to the filters. No caval thrombosis or filters clots were found at the phlebography. The follow-up registered no pulmonary embolism episodes. Conclusions: The use of a temporary caval filter in pregnancy is safe and does not introduce any additional risk. It could be suggested for pregnant patients with proximal DVT beginning in the last period of pregnancy.

scholarly journals Percutaneous Thrombus Removal in COVID-19–Infected Patient with Pulmonary Embolism

2021 ◽  
Vol 17 (2) ◽  
pp. e33-e36
Author(s):  
Angelo Nascimbene ◽  
Sukhdeep Basra ◽  
Kha Dinh ◽  
Jayeshkumar Patel ◽  
Igor Gregoric ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Percutaneous Treatment ◽  
Vein Thrombosis ◽  
Left Lower Extremity ◽  
Transcatheter Aortic Valve ◽  
Thrombus Removal ◽  
The Right ◽  
In Transit ◽  
Deep Vein ◽  
Large Clot

We present a case describing the use of the AngioVac system (AngioDynamics, Inc.) and SENTINEL™ cerebral protection system (SCPS; Boston Scientific) in a patient with COVID-19 who initially presented with a large deep-vein thrombosis of the left lower extremity, complicated by a pulmonary embolism. Although he initially improved with systemic alteplase, he later developed a second large clot diagnosed in transit in the right atrium. Within 12 hours from initial thrombolysis, this large clot wedged across an incidental patent foramen ovale (PFO), the atrial septum, and the cavotricuspid annulus. We emergently performed a percutaneous clot extraction with preemptive placement of the SCPS in anticipation of cardioembolic phenomenon. A large (> 10 cm) clot was extracted without complication, and the patient was discharged home. The combined use of SCPS and AngioVac in this case suggests a potential role for percutaneous treatment of severe and consequential thromboembolic disease, especially in patients with a PFO, and may be considered as an alternative and less-invasive option in patients with COVID-19. While cerebral embolic protection devices are approved for and widely used in transcatheter aortic valve replacement procedures, there is a theoretical benefit for use in percutaneous thrombolectomies as well.

scholarly journals Thrombosis in Rheumatological Diseases

2021 ◽  
pp. 263-289
Author(s):  
Fozya Bashal
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Blood Coagulation ◽  
Thirteenth Century ◽  
Vein Thrombosis ◽  
The Right ◽  
Deep Vein ◽  
Rheumatological Diseases

AbstractVenous thromboembolism (VTE) is a disease of blood coagulation that occurs in the veins, most often in the calf veins first, from where it may extend and cause deep vein thrombosis (DVT) or pulmonary embolism (PE). The first described case of venous thrombosis that we know of dates back to the thirteenth century, when deep vein thrombosis was reported in the right leg of a 20-year-old man [1].

scholarly journals Incidental venous thromboembolism: is anticoagulation indicated?

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 121-127 ◽  
Author(s):  
Marcello Di Nisio ◽  
Marc Carrier
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Pulmonary Arteries ◽  
Bleeding Risk ◽  
Preliminary Evidence ◽  
Vein Thrombosis ◽  
Incidental Pulmonary Embolism ◽  
Recurrent Vte ◽  
Deep Vein

Abstract Patients with cancer have a high risk of venous thromboembolism (VTE) and about one-half of these events are incidentally detected. The prognosis of incidental VTE appears to be similar to symptomatic events, with comparably high rates of recurrent VTE in this patient population. In the absence of major contraindications, anticoagulant treatment with low-molecular-weight heparin for 3 to 6 months is generally recommended for incidental proximal deep vein thrombosis as well as for incidental pulmonary embolism that involves multiple subsegmental or more proximal pulmonary arteries. The decision of whether to extend treatment beyond 3 to 6 months should be evaluated on a case-by-case basis after periodic reassessment of the risks factors for bleeding and recurrent VTE while also taking into account patient preferences. The clinical relevance of a single incidental subsegmental pulmonary embolism without concomitant deep vein thrombosis is uncertain and either a watchful approach or a shorter course of anticoagulation to minimize the bleeding risk may also be considered. Preliminary evidence suggests that anticoagulation treatment may be beneficial for cancer patients with incidental distal deep vein thrombosis or incidental splanchnic vein thrombosis.

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