deep vein thrombosis (dvt)

深静脉血栓形成 (DVT)
  • 文章类型: Case Reports
    上肢(UE)深静脉血栓形成(DVT)是一种罕见但重要的并发症,可在心脏骤停(CA)后发生。CA通过各种过程启动血栓前状态,包括停滞,内皮损伤,血栓形成和纤维蛋白溶解之间的平衡受损,这可能有助于形成UEDVT。该领域的心肺复苏(CPR)不足可能会进一步加剧血液淤滞和凝块形成。该病例报告描述了一名80岁的男性,有膀胱癌病史,他经历了两次心脏骤停事件,随后发展为广泛的左UEDVT。尽管用肝素滴注和其他支持措施治疗,病人的病情恶化,他在住院的第十天去世了。这种情况是第一个描述CA后的UEDVT。它强调了认识和积极管理CA后高凝状态的重要性,这可能导致严重的DVT在非典型的位置,可能演变成危及生命的条件。
    Upper extremity (UE) deep vein thrombosis (DVT) is a rare yet significant complication that can occur following cardiac arrest (CA). CA initiates a prothrombotic state via various processes, including stasis, endothelial damage, and an impaired balance between thrombogenesis and fibrinolysis, which may contribute to UE DVT formation. Inadequate cardiopulmonary resuscitation (CPR) in the field may further exacerbate blood stasis and clot formation. This case report describes an 80-year-old male with a history of bladder cancer who experienced two cardiac arrest events and subsequently developed an extensive left UE DVT. Despite treatment with a heparin drip and other supportive measures, the patient\'s condition deteriorated, and he passed away on the tenth day of hospitalization. This case is the first to describe UE DVT post-CA. It underscores the importance of recognizing and proactively managing hypercoagulable states post-CA, which can lead to significant DVTs in atypical locations that may evolve into life-threatening conditions.
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  • 文章类型: Case Reports
    Biermer病(BD)或恶性贫血(PA)是一种自身免疫性萎缩性胃炎,其特征是缺乏内在因子(IF)分泌。导致回肠中维生素B12吸收不良。其临床表现以血液学为主,神经精神和心血管表现不太常见。我们介绍了基于神经和心血管并发症诊断的PA患者的情况。病人,一名56岁的男子,没有特定的病史,出现黑便发作,没有其他相关的消化症状。他还抱怨记忆和步态障碍。临床检查显示小脑共济失调,本体感觉和振动敏感性受损,右下肢肿胀红色,霍曼征阳性。血细胞计数显示大红细胞性贫血。胃镜检查显示扁平的眼底褶皱,类似于眼底外观,组织病理学检查证实胃底萎缩性胃炎伴假性上皮化生和淋巴浆细胞浸润。抗内在因子抗体阳性,而抗壁细胞抗体为阴性。维生素B12水平非常低,维生素B9水平正常。TSH和HbA1c水平在正常范围内。腹部CT扫描未见异常。下肢多普勒超声证实诊断为深静脉血栓(DVT)。心脏评估显示窦性心动过缓提示继发性自主神经障碍。治疗学上,患者开始补充维生素B12和抗凝治疗DVT,导致良好的临床和生物学结果。
    Biermer\'s disease (BD) or pernicious anemia (PA) is an autoimmune atrophic gastritis characterized by the absence of intrinsic factor (IF) secretion, leading to malabsorption of vitamin B12 in the ileum. Its clinical manifestations are primarily hematological, with neuropsychiatric and cardiovascular manifestations being less common. We present the case of a patient with PA diagnosed based on neurological and cardiovascular complications. The patient, a 56-year-old man with no specific medical history, presented with an episode of melena without other associated digestive symptoms. He also complained of memory and gait disturbances. Clinical examination revealed a cerebellar ataxia with impaired proprioceptive and vibratory sensitivity, and a swollen and red right lower limb with a positive Homan sign. The blood count showed macrocytic anemia. Gastroscopy revealed flattened fundic folds resembling a fundus appearance, and histopathological examination confirmed fundic atrophic gastritis with pseudopyloric metaplasia and lymphoplasmacytic infiltration. Anti-intrinsic factor antibodies were positive, while anti-parietal cell antibodies were negative. Vitamin B12 levels were severely low, and vitamin B9 levels were normal. TSH and HbA1c levels were within normal ranges. The abdominal CT scan showed no abnormalities. Lower limb Doppler ultrasound confirmed the diagnosis of deep vein thrombosis (DVT). Cardiac evaluation revealed sinus bradycardia suggestive of secondary dysautonomia. Therapeutically, the patient was started on vitamin B12 supplementation and anticoagulant therapy for DVT, resulting in a good clinical and biological outcome.
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  • 文章类型: Case Reports
    一名82岁左腿水肿的男子在其先前的医生进行超声检查后被转介到我们部门,显示左股浅静脉深静脉血栓形成(DVT)和左股总动脉瘤(CFAA)。DVT是由CFAA引起的。由于静脉曲张的不规则形状和大量的壁血栓,该患者被判断为外周栓塞的高风险。进行手术以替换人造血管。患者对周围区域显示出牢固的粘附力,明显的淋巴结肿大,肿块中有大量的壁血栓。股浅动脉(SFA)表现出严重的内膜增厚和部分夹层。术后病程良好,病人正在接受康复出院;然而,根据术中提交的肿块壁的病理结果怀疑B细胞淋巴瘤。患者有类风湿性关节炎病史,接受甲氨蝶呤(MTX)治疗。在他生病的过程中,在他的右前臂上发现了一个皮下肿块,皮肤活检显示MTX相关淋巴增生性疾病(MTX-LPD),这已经解决了MTX退出。皮肤活检的组织病理学结果与CFAA壁血栓的结果一致,并观察到EB病毒阳性细胞,导致MTX-LPD的诊断,这被认为是CFAA的原因。在血管壁或壁内血栓中未发现MTX-LPD。我们在此报告一例CFAA,其病因和临床表现极为罕见。
    An 82-year-old man with left leg edema was referred to our department after an ultrasound examination by his previous physician, which revealed deep vein thrombosis (DVT) in the left superficial femoral vein and a left common femoral artery aneurysm (CFAA). The DVT was caused by the CFAA. The patient was adjudged to be at high risk of peripheral embolization due to the irregular shape of the varicose vein and a large amount of mural thrombus. Surgery was performed to replace the artificial blood vessel. The patient displayed firm adhesion to the surrounding area, marked lymph node swelling, and a large amount of mural thrombus in the mass. The superficial femoral artery (SFA) demonstrated severe intimal thickening and partial dissection. The postoperative course was good, and the patient was undergoing rehabilitation to be discharged home; however, B-cell lymphoma was suspected based on the pathology results of the mass wall submitted intraoperatively. The patient had a history of rheumatoid arthritis and was treated with methotrexate (MTX). During the course of his illness, a subcutaneous mass was found on his right forearm, and a skin biopsy revealed MTX-associated lymphoproliferative disease (MTX-LPD), which had resolved with MTX withdrawal. The histopathological results of the skin biopsy matched those of the CFAA mural thrombus, and Epstein-Barr virus-positive cells were also observed, leading to the diagnosis of MTX-LPD, which was considered to be the cause of CFAA. No MTX-LPD was identified in the vessel walls or intramural thrombus. We herein report a case of CFAA with an extremely rare etiology and clinical presentation.
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  • 文章类型: Case Reports
    Prader-Willi综合征(PWS)是一种极为罕见的15号染色体先天性综合征,在所述个体中表现出多种合并症。患有这种疾病的人的相关生活质量往往严重下降;更悲惨的是,与该疾病相关的死亡率也增加。肺栓塞(PE)与死亡率高度相关,并且已被证明在PWS患者中更为普遍。此病例报告详细介绍了一名PWS患者,该患者在急性鞍状PE中幸存下来,并希望带来更多临床知识,可在与PWS患者打交道时应用。
    Prader-Willi syndrome (PWS) is an exceedingly rare congenital syndrome of chromosome 15 that presents multiple comorbidities in said individuals. The associated quality of life for those with the disease is often severely diminished; more tragically, mortality associated with the disease is also increased. Pulmonary embolism (PE) is highly associated with mortality and has been shown to be more prevalent in patients with PWS. This case report details a patient with PWS who survived an acute saddle PE and looks to bring more clinical knowledge that can be applied when dealing with individuals with PWS.
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  • 文章类型: Case Reports
    我们报道了一名20岁的孕妇,她的SARS-CoV-2检测呈阳性,并被诊断患有KILT综合征,一种增加血栓形成事件风险的罕见疾病。患者出现深静脉血栓形成的征象,从双侧髂静脉延伸到下腔静脉(IVC),通过放置IVC过滤器和血管内血栓抽吸/溶栓进行治疗。IVC被成功地重新治疗;然而,在后续行动中,血栓性再狭窄发生在过滤器水平,需要去除过滤器。该病例强调了血管内血栓抽吸/溶栓和IVC过滤器放置在出现急性血栓事件的KILT综合征患者中的潜在益处。
    We report on a 20-year-old pregnant woman who tested positive for SARS-CoV-2 and was diagnosed with KILT syndrome, a rare condition that increases the risk of thrombotic events. The patient showed signs of deep vein thrombosis that extended from the bilateral iliac vein to the inferior vena cava (IVC), which was treated with placement of an IVC filter and endovascular thromboaspiration/thrombolysis. The IVC was successfully recanalized; however, during follow-up, thrombotic restenosis occurred at the filter level, requiring filter removal. This case highlights the potential benefits of endovascular thromboaspiration/thrombolysis and IVC filter placement in patients with KILT syndrome presenting with acute thrombotic events.
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  • 文章类型: Case Reports
    深静脉血栓(DVT)是由深静脉中形成的凝块(血栓)引起的,通常是腿。儿童DVT的发病率明显低于成人。这里,我们报道了1例罕见的DVT病例,该病例为1名8岁女童,有明显的家族史,其中包括母亲姨妈的过早死亡.患儿出现左下肢疼痛和水肿,导致无明显原因固定。临床特征提示DVT的可能性。关于进一步评估和放射学调查,诊断为DVT。进行了完整的血栓形成检查,显示抗凝血酶(AT)III缺乏症。然后患者开始使用低分子量肝素,导致症状的改善。出院时患者继续口服利伐沙班。
    Deep vein thrombosis (DVT) is caused by a clot (thrombus) formed in the deep veins, usually the legs. The incidence of DVT is notably less prevalent in children than in adults. Here, we present a rare case of DVT in an eight-year-old female child with a significant family history involving the untimely death of the maternal aunt. The child presented with pain and edema in the left lower limb causing immobilization without any obvious cause. The clinical features suggested the possibility of DVT. On further evaluation and radiological investigations, the diagnosis of DVT was confirmed. A complete thrombophilia workup was done showing antithrombin (AT) III deficiency. The patient was then started on low-molecular-weight heparin, leading to improvement in the symptoms. Oral rivaroxaban was continued for the patient on discharge.
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  • 文章类型: Case Reports
    在这个案例报告中,我们检查了镰状细胞特征(SCT)患者静脉血栓栓塞(VTE)的风险增加,由SCT患者说明,尽管在常规风险评估工具上得分较低,但仍发生肺栓塞(PE)。此案引发了对该人群的风险评估和管理策略的讨论。
    In this case report, we examine the increased risk of venous thromboembolism (VTE) in patients with sickle-cell trait (SCT), illustrated by a patient with SCT who developed pulmonary embolism (PE) despite low scores on conventional risk assessment tools. The case prompts both a discussion of risk assessment and management strategies in this population.
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  • 文章类型: Case Reports
    梅-瑟纳综合征(MTS),也被称为髂静脉压迫综合征,是一种血管疾病,其特征是在髂静脉区域内的外在静脉压迫。虽然传统上被认为是主要影响女性的疾病,该病例报告显示了一名中年男性患者的非典型表现。患者最初出现左下肢疼痛和肿胀,这归因于左小腿和股静脉的深静脉血栓形成(DVT)。尽管抗凝治疗,他的症状持续存在,导致进一步的诊断评估和MTS的识别。这份报告突出了临床表现,诊断挑战,以及成功管理男性患者的MTS。血管内介入治疗,包括球囊扩张和支架放置,用于解决难治性狭窄和血栓负担。该病例强调了将MTS作为不明原因下肢症状患者的潜在诊断的重要性,无论传统风险因素或性别。早期识别和适当的干预措施可以导致症状缓解,阻塞解决,并改善了MTS患者的长期预后。此病例强调需要提高临床医生对MTS及其对患者护理的潜在影响的认识。
    May-Thurner syndrome (MTS), also known as iliocaval venous compression syndrome, is a vascular condition characterized by extrinsic venous compression within the iliocaval territory. While traditionally considered a condition predominantly affecting women, this case report presents an atypical presentation in a middle-aged male patient. The patient initially presented with left lower extremity pain and swelling, which was attributed to deep venous thrombosis (DVT) in the left calf and femoral vein. Despite anticoagulation therapy, his symptoms persisted, leading to further diagnostic evaluation and the identification of MTS. This report highlights the clinical presentation, diagnostic challenges, and successful management of MTS in a male patient. Endovascular interventions, including balloon dilation and stent placement, were employed to address refractory stenosis and thrombus burden. The case emphasizes the importance of considering MTS as a potential diagnosis in patients with unexplained lower limb symptoms, irrespective of traditional risk factors or gender. Early identification and appropriate interventions can lead to symptom relief, obstruction resolution, and improved long-term outcomes for patients with MTS. This case underscores the need for heightened clinician awareness regarding MTS and its potential impact on patient care.
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  • 文章类型: Case Reports
    起搏器被植入作为包括有症状的心动过缓和某些类型的心脏传导阻滞在内的病症的治疗过程的一部分。与起搏器植入相关的一个并发症是上肢深静脉血栓(UEDVT),随后会导致肺栓塞,肢体丧失,或死亡。我们介绍了一名88岁的男性,他在左锁骨下发展了UEDVT,腋窝,肱,双腔起搏器植入术后不久,保留静脉用于治疗有症状的心脏传导阻滞。患者在住院期间接受静脉肝素抗凝治疗,但在出院前改用口服阿哌沙班。此病例强调了在最近接受起搏器放置的患者中检测和治疗UEDVT的重要性。
    Pacemakers are implanted as part of the treatment process of conditions including symptomatic bradycardia and certain types of heart block. One complication associated with pacemaker implantation is upper extremity deep venous thrombosis (UEDVT), which can subsequently lead to pulmonary embolism, limb loss, or death. We present the case of an 88-year-old male who developed UEDVT in his left subclavian, axillary, brachial, and basilic veins shortly after dual chamber pacemaker implantation for treating symptomatic heart block. The patient received anticoagulation with intravenous heparin while inpatient but was switched to oral apixaban prior to discharge. This case highlights the importance of detecting and treating UEDVT in patients who recently underwent pacemaker placement.
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  • 文章类型: Case Reports
    内脏循环静脉血栓形成的患者是一组具有显著发病率和死亡率的高风险人群。如果治疗延迟。我们介绍了一名门静脉及其支流血栓形成合并下肢深静脉血栓形成(DVT)的患者,该患者已通过保守治疗成功。该病例强调了早期经验性抗炎治疗以及全身抗凝治疗的重要性,以减少肠道炎症和肠炎,并打破恶性回路,导致内脏静脉继发性进行性血栓形成。流体移位,和功能性肠梗阻。病例介绍:一名先前健康的61岁女性患者,无明显病史,因进行性上腹痛入院,恶心和呕吐,低烧,轻度肠梗阻,和不适。影像学检查显示,门静脉扩张达到〜20mm,血栓几乎完全闭塞了管腔。此外,发现肠系膜上静脉和脾静脉血栓形成伴血栓性静脉炎。影像学研究还证实了下肢DVT的存在,包括血栓扩散到髂静脉。立即开始使用肠胃外抗生素治疗,抗炎药,全身性抗凝剂,和静脉输液以恢复循环容量不足并治疗电解质失衡。有了这样的治疗,病人的症状在一个月内解决,她完全康复出院了.开始输注肝素以达到全身抗凝。随着症状的缓解,华法林继续抗凝治疗.当抗磷脂综合征也在鉴别诊断列表中时,我们使用非甾体抗炎药(NSAIDs)作为肠道和全身炎症以及多灶性血栓形成的治疗成分。结论:我们介绍了一名先前无症状的进行性门静脉血栓形成和上行DVT患者。早期诊断和全身抗凝药治疗的开始,抗炎和抗菌药物有助于阻止血栓进展,防止不可逆的肠缺血,并允许闭塞的静脉重新通化。该病例强调了早期干预对改善治疗结果的重要性。
    Patients with venous thrombosis of splanchnic circulation represent a group of high risk with significant morbidity and mortality, if treatment is delayed. We present a patient with thrombosis of portal vein and its tributaries combined with deep venous thrombosis (DVT) of the lower extremities who was successfully treated with conservative management. This patient case highlights the importance of early empiric anti-inflammatory therapy along with systemic anticoagulation to reduce the intestinal inflammation and enteritis and break the vicious circuit resulting in secondary progressive thrombosis of the splanchnic veins, fluid shifts, and functional ileus. Case presentation: A previously healthy 61-years-old female patient with no significant medical history was admitted with progressive upper abdominal pain, nausea and vomiting, low-grade fever, mild signs of ileus, and malaise. Imaging studies revealed portal venous dilation reaching ∼20 mm with near-total obliteration of the lumen by a thrombus. In addition, thrombosis of superior mesenteric and splenic veins with thrombophlebitis was found. Imaging studies also confirmed the presence of DVT of lower extremities including thrombus propagation into the iliac veins. An immediate therapy was started with parenteral antibiotics, anti-inflammatory medications, systemic anticoagulants, and intravenous fluid infusions to restore the circulating volume deficit and treat electrolyte disbalance. With such therapy, the patient\'s symptoms resolved within a month, and she was discharged from the hospital with full recovery. Heparin infusion was started to reach systemic anticoagulation. With resolution of symptoms, anticoagulation was continued with warfarin. We used non-steroidal anti-inflammatory drugs (NSAIDs) as a component in management of intestinal and systemic inflammation and multifocal thrombosis when the antiphospholipid syndrome was also on the list of differential diagnoses. Conclusion: We present a previously asymptomatic patient with progressive portal venous thrombosis and ascending DVT. Early establishment of diagnosis and initiation of therapy with systemic anticoagulants, anti-inflammatory and antibacterial drugs helped to stop thrombus progression, prevent irreversible intestinal ischemia, and allow for re-canalization of the occluded veins. This case highlights the importance of early interventions to improve the treatment outcome.
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