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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We experienced 23 cases of venous thrombosis after gynecological surgery for the past 12 years at Tokyo Women's Medical University Hospital, representing 0.345 % of all patients. Eighteen of the 23 cases had deep venous thrombosis (DVT) including five cases followed by pulmonary embolism (PE), and five cases had PE without any symptoms of DVT. The main risk factors for thrombosis in these 23 patients were (1) obesity, DM, hyperlipidemia; (2) huge abdominal tumor, severe adhesion; and (3) hemoconcentration, post-treatment of severe anemia. The onset of PE varied from 1 to 3 postoperative days, when the patients started to walk. Five cases had dyspnea, chest pain, and decreased PaO2 levels without leg pain, while five cases showed only calf pain and tenderness with decreased PaO2 levels. PE was confirmed by immediate diagnostic images such as RI venography with ventilation and perfusion lung scan, pulmonary arterial CT, or pulmonary arteriography. Two patients died and eight patients recovered. The best way of managing venous thrombosis might be as follows: (1) identify the risk factors of thrombosis before surgery; (2) perform prophylactic leg exercises in bed and/or active anticoagulant therapy depending on the degree of risk factors; (3) rapid diagnosis with the images; and (4) proper treatment.
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PMID:Management of venous thrombosis and pulmonary embolism after gynecological surgery. 983 10

Chronic thromboembolism is a frequent cause of progressive hypertension and carries a poor prognosis. Medical treatment is not effective and surgery provides the only potential for a cure at present. We herein report a successful case of thromboendarterectomy treated via a median sternotomy with intermittent circulatory arrest. A 43-year-old man was admitted to our hospital complaining of progressive dyspnea, edema of the lower extremities, and a fever with an unknown origin. A subsequent definitive evaluation showed him to be suffering from surgically accessible chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle. He underwent a pulmonary thromboendarterectomy and thrombectomy via a median sternotomy with intermittent circulatory arrest on November 24, 1994. Postoperatively he showed a marked improvement in his hemodynamic status and blood gas analysis. He has also returned to work with no trouble. Deep vein thrombosis appeared to be the pathogenesis of this case, but we could not find the origin of his unknown fever. He is currently being controlled by treatment with methylprednisolone as before.
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PMID:A successful case of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle. 1033 25

It is a common tradition to admit patients with deep vein thrombosis (DVT) to the hospital and put them to bed for several days because of fear from pulmonary embolism, even if they are mobile. Between May 1994 and December 1997 929 patients were admitted to our department who were treated by subcutaneous injections of low-molecular-weight heparin (mainly 200 IU dalteparin per kilogram body-weight per 24 hours), got firm compression bandages and were encouraged to walk as much as possible. On admission DVT propagated into the pelvis in 268 patients, into the thigh in 480 and below the popliteal level in 181 patients. V/Q-lung scans were performed at baseline and repeated after 10 days on average. In these three groups primary pulmonary embolism was diagnosed in 49.4%, 50% and 34% respectively, new emboli after 10 days were found in 6.1%, 5.7% and 3.9%. Only one third of the patients with embolism on admission and 5 from 50 patients who developed new emboli showed some dyspnoea. 12 patients died and underwent autopsy, 3 fatal events were caused by pulmonary embolism. With out management the incidence of thromboembolic complications is statistically significantly lower than data from the literature. Preliminary results from an ongoing randomised trial comparing bed-rest, compression bandages and compression stockings in the acute phase of proximal DVT demonstrate faster improvement of swelling and of pain in the compression-groups. Low-molecular-weight heparin has greatly facilitated therapy of DVT since effective anticoagulation can be obtained by subcutaneous injections of fixed doses without the need of laboratory monitoring. For the future development of conservative management mechanical prophylaxis of thrombus extension by acceleration of venous flow using leg compression and walking will probably become as important as exact anticoagulation.
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PMID:[Thrombophlebitis: bed rest or walking exercise?]. 1037 23

The symptomatology of PTE is good for the suspicion of PTE only. Symptoms are mainly based on dyspnoea (respiratory rate) and pain in the chest. Clinical diagnostic procedures, on the other hand, are backed up by evaluation of specific risk factors (previous thrombosis, post-operative state, immobilisation) and search for deep venous thrombosis (DVT). Blood gas analysis is very sensitive to unravel (latent) respiratory failure, along with established routine measures (blood pressure, ECG, chest-film) and additional echocardiography. Most important in our experience is a perfusion scan at the earliest opportunity. Spiral-CT angiography is indicated in special cases only. We looked at 115 consecutive patients with suspected PTE and found close correlations between risk profiles of thrombosis, pathological BGA and high probability perfusion scans. DVT was detected in 50% only. Positive predictive values for high risk and pathological BGA were 86 and 92%, respectively. An algorithm for diagnostical/therapeutical strategies is presented. The early application of an heparin-bolus is stressed.
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PMID:[Clinical aspects and diagnosis of pulmonary thromboembolism]. 1037 30

A 85-year-old woman was admitted to our hospital because of a presumtive diagnosis of pulmonary thromboembolism. The patient presented with a history of progressive dyspnoea and retrosternal pain. 3-4 weeks ago she had noticed a swollen left leg. On examination a 4/6-pansystolic murmur was found. An arterial blood gas analysis showed a reduced oxygen saturation. An electrocardiogram revealed deep S-waves in lead I and pathological Q-waves in lead III. The chest X-ray showed cardiomegaly, a pulmonary nodule and an ill-defined opacity inferioposteriorly. Ventilation-perfusion mismatch was demonstrated by lung ventilation-perfusion scanning. Transthoracic echocardiography showed pulmonary hypertension and tricuspid regurgitation. On the 20th hospital day the patient died from multi organ failure. Pulmonary thromboembolism secondary to deep venous thrombosis of the lower extremities was the most likely diagnosis. In view of the patients' history of night sweat, loss of appetite and weight loss a malignant process had to be taken into consideration. A tumor originating from the right ventricle, the right ventricular outflow tract or the pulmonary artery was compatible with the clinical picture of multiple pulmonary emboli. On autopsy a polymorph cellular sarcoma measuring 6 x 3 x 3 cm was found in the right ventricular outflow tract. Section of the lung revealed a single pulmonary metastasis and multiple thromboemboli of various age. Pulmonary artery sarcomas, as described in our case, are extremely rare. The prognosis is poor and often the diagnosis is only made on autopsy.
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PMID:[A "typical" case of pulmonary embolism]. 1051 85

Acute lung embolism is an uncommon but recognised complication of deep venous thrombosis. The parameters RTG, ECG, PaO2, PaCO2, LDH, CPK, SGOT, SGPT and pulmonary ventilation/perfusion scan have been examined in 200 patients with pulmonary thromboembolism. For that purpose discrimination values of synopticly relevant RTG findings, arterial blood gas and enzymes analysis results and pulmonary ventilation/perfusion scintigraphy, were observed in a comparative analysis of numerous data that could be integrated as an unique finding in sense of qualitative diagnosis. The most frequent symptom was dyspnea and tachypnea, often accompanied with other symptoms (84%), chest pain (65%), cough (53%), tachycardia (41%), hemoptysis (26%). In 74% of patients pulmonary thromboembolism the significant simultaneous increase of all the mentioned enzymes, except CPK, was found 75%. However, according to the results in 58% of the examined persons the pathologic changes on RTG (infiltrates of the lung, with or without affection of the pleura and changed position of diaphragma) were found, and 71% on ECG. Pulmonary ventilation/perfusion scintigraphy is the precise examination for acute lung embolia. For the routine clinical examination measurement of PaO2, PaCO2, LDH, ECG, x-rays is sufficient (correlation test + 0.56). In this paper we have presented our own diagnostic-therapeutic protocol in of lung emboly.
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PMID:[Diagnosis and treatment of acute pulmonary embolism]. 1054 64

Deep vein thrombosis, pulmonary embolism, and pulmonary thrombosis in situ are rare in childhood and adolescence [1,2]. Unfortunately, these diagnoses may be unsuspected in a pediatric patient with dyspnea and chest pain. This article illustrates the diagnostic and therapeutic challenges that arose from unrecognized chronic thrombotic disease in an adolescent.
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PMID:Pulmonary thrombosis, homocysteinemia, and reperfusion edema in an adolescent. 1081 82

The authors describe a 24-year-old man who reported the sudden onset of dyspnea and swelling of his left upper arm. An area of increased activity in the left axillosubclavian region evident on pulmonary perfusion scintigraphy with Tc-99m MAA suggested Paget-Schroetter syndrome (primary deep venous thrombosis of the upper extremity).
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PMID:Acute axillosubclavian vein thrombosis (Paget-Schroetter syndrome) detected by Tc-99m MAA during pulmonary perfusion scintigraphy. 1083 88

Pregnancy is an important risk factor for venous thrombosis, and venous thromboembolism is a leading cause of preventable death in pregnancy. Diagnosis of venous thromboembolism is complicated in that the symptoms of dyspnea and lower extremity edema are relatively common complaints of pregnant patients. Physicians should maintain an appropriately high index of suspicion and request diagnostic imaging in a timely manner. Diagnosis of deep venous thrombosis with Doppler ultrasonography of the lower extremity poses no health risk to the fetus, but other radiographic studies pose a low radiation risk to the fetus. Because anticoagulant therapy poses a greater health risk to mother and fetus than does the radiation required for the diagnosis of pulmonary embolism, clinicians should aggressively pursue objective evidence of venous thromboembolism. Once the diagnosis is made, anticoagulation with intravenous unfractionated heparin or subcutaneous low-molecular-weight heparin should be used prepartum followed by warfarin therapy after delivery.
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PMID:Thromboembolism during pregnancy. Risks, challenges, and recommendations. 1102 Dec 60

We report 3 patients with Proteus syndrome (PS) who died suddenly from pulmonary embolism (PE). The first patient was a male diagnosed with PS at 12 years who had varicose veins, portal vein thrombosis, right iliac vein occlusion and recurrent PE. At age 25 years, he was admitted to the hospital with a severe headache. Despite therapeutic doses of warfarin, investigations for an acute episode of breathlessness showed PE and he was unable to be resuscitated. The second case was a 9-year-old male with PS who collapsed at home and could not be revived. Autopsy revealed that the cause of death was a PE associated with thrombosis of the deep veins (DVT). The third patient was a 17-year-old female undergoing inpatient treatment for sinusitis when she unexpectedly arrested. She could not be revived and a full autopsy revealed a large PE with no identified DVT. We conclude that PE is a serious complication of PS and recommend vigilance concerning the signs and symptoms of thrombosis and PE in individuals with PS, including children. Aggressive evaluation and treatment should be considered urgently in patients with PS and signs or symptoms of DVT.
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PMID:Sudden death caused by pulmonary thromboembolism in Proteus syndrome. 1114 Aug 39


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