A 27y/old male with right lower exteremity pain and swelling

 

Images

Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mirhadi Razavian

 

Case Section

Cardiovascular

 

Patient's Information

Gender : Male
Age : 27

 

Clinical Summary

A 27y/old male with right lower exteremity pain and swelling

 

Imaging Findings

CT venography demonstrates cut off of right common and external and internal iliac veins . Also demonstrates superficial collateral veins in right lower quadrant areas and deep collateral veins in right pelvis

 

Differential Diagnosis

A venous thrombus most often occurs in the deep veins of the legs or pelvis and is then called a deep vein thrombosis (DVT). The clot may dislodge and travel to the lungs to cause a pulmonary embolism. A thrombus either arises spontaneously or is predisposed by such conditions as surgery, trauma or prolonged bed rest. They usually form in the deep veins of the lower limbs but may extend higher and into the pelvic veins. The close relationship between DVT and pulmonary embolism (PE) is such that the term venous thromboembolism (VTE) is often used to cover both conditions. Risk factors for VTE
High risk:
• Previous history of VTE.
o A previous episode of DVT is the strongest risk factor for DVT with a five-fold increase over baseline risk.
o Risk of new postoperative DVT rises from 26% to 68%.
o History of previous clinically apparent PE increases the risk of new postoperative DVT to nearly 100%.
• Major surgery or cancer, especially if there was an operation on the abdomen or lower limb.
• Immobilisation is a great risk factor, especially when associated with old age and severe medical problems.[3]
o In patients on bed rest in a general medical ward, the rate of DVT is 10% but in an intensive care unit it is 29%.
o Within five days of a stroke half will have DVT unless prophylaxis is given.
o 40% of postoperative neurosurgical patients develop DVT.
o In patients with a stroke, 60% develop DVT in the paralysed leg compared with just 7% in the contralateral one

 

Final Diagnosis

Iliac vein thrombosis

 

Discussion (Related Text)

A venous thrombus most often occurs in the deep veins of the legs or pelvis and is then called a deep vein thrombosis (DVT). The clot may dislodge and travel to the lungs to cause a pulmonary embolism. A thrombus either arises spontaneously or is predisposed by such conditions as surgery, trauma or prolonged bed rest. They usually form in the deep veins of the lower limbs but may extend higher and into the pelvic veins. The close relationship between DVT and pulmonary embolism (PE) is such that the term venous thromboembolism (VTE) is often used to cover both conditions. Risk factors for VTE
High risk:
• Previous history of VTE.
o A previous episode of DVT is the strongest risk factor for DVT with a five-fold increase over baseline risk.
o Risk of new postoperative DVT rises from 26% to 68%.
o History of previous clinically apparent PE increases the risk of new postoperative DVT to nearly 100%.
• Major surgery or cancer, especially if there was an operation on the abdomen or lower limb.
• Immobilisation is a great risk factor, especially when associated with old age and severe medical problems.[3]
o In patients on bed rest in a general medical ward, the rate of DVT is 10% but in an intensive care unit it is 29%.
o Within five days of a stroke half will have DVT unless prophylaxis is given.
o 40% of postoperative neurosurgical patients develop DVT.
o In patients with a stroke, 60% develop DVT in the paralysed leg compared with just 7% in the contralateral one.
• The antiphospholipid syndrome occurs in a number of conditions, especially systemic lupus erythematosis (SLE).
o 9% of patients with SLE develop spontaneous DVT.
o The lupus anticoagulant responsible is also found in people with AIDS, and with many autoimmune diseases.
o In healthy patients, it can be produced by phenothiazines.
• Increased haematocrit increases viscosity and risk of sludging and thrombosis. 40% of deaths in patients with polycythaemia rubra vera are due to thrombosis but only a third is from venous thrombosis. Not just erythrocytes but white cells and platelets are raised too. Thrombocytosis may increase the risk of thrombosis or bleeding.
• Thrombophilia may be the underlying disease process.
o Malignancy is an important risk and DVT may be the presenting feature of many occult cases.
16% of patients with angiographically proven PE are diagnosed with cancer within two years
o Some types of chemotherapy increase the risk for DVT, either by reducing the level of certain anticoagulants or by increasing the levels of procoagulants.
o Myocardial infarction (MI) and congestive heart failure increase the likelihood of DVT and PE, independent of bed rest or immobilisation.
 In patients with acute myocardial infarction who are not receiving anticoagulation there is a 26-38% rate of DVT, compared with a much lower rate in those in whom MI is suspected but then excluded.
Other risk factors:
• Pregnancy and the puerperium are a time of increased

 

References

1. Venous thromboembolic diseases; NICE Clinical Guideline (June 2012)
2. Pulmonary embolism; NICE CKS, February 2011 (UK access only
3. Ageno W, Agnelli G, Imberti D, et al; Risk factors for venous thromboembolism in the elderly: results of the master registry. Blood Coagul Fibrinolysis. 2008 Oct;19(7):663-7.
4. Nijkeuter M, Ginsberg JS, Huisman MV; Diagnosis of deep vein thrombosis and pulmonary embolism in pregnancy: a systematic review. J Thromb Haemost. 2006 Mar;4(3):496-500. Epub 2005 Dec 23.
5. Palareti G, Legnani C, Cosmi B, et al; Risk of venous thromboembolism recurrence: high negative predictive value of D-dimer performed after oral anticoagulation is stopped. Thromb Haemost. 2002 Jan;87(1):7-12.

 

end faqaq

 

Go to top