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

Unusual complications of warfarin therapy include cutaneous necrosis and the "purple toe syndrome." The latter is more common in men and is not associated with vascular compromise; it usually occurs 3 to 8 weeks after warfarin therapy is begun and may persist for many months after the medication is discontinued. The following is a case of a 63-year-old woman who received warfarin therapy in conjunction with heparin for treatment of a left leg deep vein thrombosis. Approximately 8 hours after receiving her first dose of warfarin (15 mg), she developed acute pain, edema, and discoloration of the entire left leg to the mid-thigh, most prominent in the left great toe. After discontinuation of warfarin therapy, her symptoms completely resolved within 48 hours. This may be a report of a new cutaneous lesion associated with anticoagulant therapy.
Mil Med 1994 Mar
PMID:An unusual cutaneous reaction to anticoagulant therapy. 751 93

Using an illustrative case, this report reviews the entity of primary upper-extremity deep venous thrombosis, also known as Paget-Schroetter syndrome. The entity of Paget-Schroetter syndrome is important to military physicians because of its occurrence in young, healthy, active individuals such as those in our active duty population. A review of the literature was performed and it was concluded that a multimodal approach to therapy, as was done in this case, gives the best overall results.
Mil Med 1997 Dec
PMID:Primary upper-extremity deep venous thrombosis. 943 93

Focal increased enhancement or radiopharmaceutical uptake in the liver has been associated with superior vena cava syndrome. This report describes the finding in a patient imaged with a relatively new agent, Tc-99m Apcitide. The collateral pathways responsible for the liver "hot spot" are reviewed, as is the role of Tc-99m Apcitide in deep venous thrombosis imaging.
Mil Med 2002 Jan
PMID:Focal accumulation of a radiopharmaceutical in the liver on technetium-99m gated blood pool and Apcitide scintigraphy leading to the diagnosis of superior vena cava obstruction. 1179 21

Deep venous thrombosis (DVT) tops the differential diagnosis list for unilateral lower extremity edema, but another entity could imitate or even cause a DVT. May-Thurner syndrome is caused by compression of the left common iliac vein by the overlying right iliac artery, resulting in impeded venous blood flow from the left lower extremity. The left leg becomes edematous, causing discomfort and concern. Early recognition of May-Thurner could prevent a DVT and provide symptomatic relief.
Mil Med 2004 Dec
PMID:Unilateral lower extremity edema in May-Thurner syndrome. 1564 88

This report illustrates how newer imaging techniques are identifying vasculopathies as risk factors for deep venous thrombosis (DVT). In this case, a healthy young man presented with a straightforward DVT but without traditional risk factors. Doppler ultrasonography confirmed a proximal clot, and contrast-enhanced computed tomography identified a hypoplastic inferior vena cava (IVC). DVTs cause considerable morbidity and death each year, including approximately 200,000 fatal pulmonary embolisms. Specific treatment of DVTs and long-term management and prevention strategies are contingent on the etiology, which can be determined in approximately 85% of cases. A hypoplastic IVC was discovered during efforts to find the cause of thrombosis, and a Medline search suggests that this anomaly should be considered for young persons with DVTs. DVTs are common and their underlying etiology should be identified to help guide long-term management. Evidence is emerging that an anomalous IVC should be ruled out as a cause of DVT among young patients.
Mil Med 2005 Sep
PMID:Congenital hypoplasia of the inferior vena cava: an underappreciated cause of deep venous thromboses among young adults. 1626 76

The upper extremity is an uncommon site for deep vein thrombosis and, although most of these thrombotic events are secondary to catheters or indwelling devices, venous thoracic outlet syndrome is an important cause of primary thrombosis. Young, active, otherwise healthy individuals that engage in repetitive upper extremity exercises, such as those required by a military vocation, may be at an increased risk. We present the case of a Naval Officer diagnosed with venous thoracic outlet syndrome whereby a multimodal approach with early surgical decompression was used. Although thoracic outlet decompression by means of first rib resection is the standard of care, timing of first rib resection after thrombolysis is debated. With respect to the active duty service member, the optimal timing of additional postoperative interventions for residual venous defects and duration of anticoagulation remain in question. A more streamlined perioperative treatment regimen may benefit the military patient without jeopardizing the quality of care and allow more expeditious return to full duty.
Mil Med 2016 11
PMID:Venous Thoracic Outlet Syndrome: The Role of Early Rib Resection. 2784 13

Phlegmasia cerulea dolens (PCD) is a rare entity that refers to a painful, edematous, and cyanotic limb due to a massive deep vein thrombosis (DVT). Due to its rarity, the exact incidence is unknown; however, it is vital that the military health care provider recognize it as the condition can be limb and life threatening. Due to the recent increase in combat-related operations, DVT has had a steady increase in the past 10 years in the military population, and as such has become a condition of special interest and surveillance in the armed forces. PCD is part of a spectrum that consists of distal DVT, more proximal DVT, phlegmasia alba dolens (PAD), and finally PCD with venous gangrene. PAD is an early stage of PCD, in which although there is a massive DVT present, the collateral and superficial circulation are not yet involved; this in turn results in a painful, edematous, white leg. PCD is preceded by PAD in approximately 50% to 60% of the cases. PCD has an amputation rate of up to 50% and a mortality rate of up to 40%. The patient will present with a swollen, cyanotic, painful leg that may or may not show signs of venous gangrene. In PCD, the collateral circulation is not spared and this causes severe congestion and fluid sequestration in the limb leading to venous hypertension. This can lead to circulatory shock and arterial insufficiency as it progresses. We review a case report of a 66-year-old woman that presented to small community army hospital after a 26-hour bus drive with knee pain and leg swelling. The diagnosis of PCD was made after Doppler ultrasonography showed bilateral iliofemoral, common, femoral, and saphenous veins thrombosis. The patient's left lower extremity was discolored, tender, and swollen, although it had not progressed to venous gangrene or dermal necrosis. While the management of PCD is not standardized due to the rarity of the condition, several options are available. These options include anticoagulation, minimally invasive procedures such as catheter-directed thrombolysis, or more invasive procedures such as surgical thrombectomy. In the active duty military population, clot reduction techniques would be preferred to long-standing anticoagulation, as the morbidity is greater with anticoagulation alone as well as the probability of major hemorrhage. Besides pulmonary embolism, which is a complication in up to 30% of the patients with PCD, one must keep in mind the extent and duration of the thrombus when choosing a treatment method, as these factors are directly related to the morbidity associated with post-thrombotic syndrome. Functional impairment after a massive DVT or PCD is an important factor that must be kept in mind for troop readiness.
Mil Med 2017 05
PMID:Rare Case of Unilateral Phlegmasia Cerulea Dolens With Bilateral Deep Vein Thrombosis at a Community Military Hospital Emergency Department. 2908 34

The purpose of this case presentation is to discuss right upper quadrant pain as an atypical presenting symptom in pulmonary infarction and review the typical computed tomography (CT) imaging features of pulmonary infarction to improve diagnostic accuracy. Pulmonary infarction results from occlusion of distal arterial vasculature within the lung parenchyma leading to ischemia, hemorrhage, and ultimately necrosis. Patients with lung infarction typically present with pleuritic chest pain and may have associated signs or symptoms of pulmonary thromboembolism or deep vein thrombosis. In this case study, a 34-yr-old female devoid of any symptoms indicative of either pulmonary embolism or deep vein thrombosis presented with right upper quadrant pain 1 mo status post open reduction internal fixation for a left ankle fracture. Multiple clinic visits spanning approximately 7 d were significant for a right lower lobe opacity seen on CT of the abdomen which was presumed to represent community acquired pneumonia as a source for the patient's RUQ pain. The patient presented to the emergency department 1 wk later (6 wk following her initial surgery) complaining of left lower extremity swelling and was subsequently diagnosed with a left lower extremity DVT via ultrasound. CT of the pulmonary arteries was negative for PE but identified a right lower lobe opacity which in retrospect was consistent with pulmonary infarction.
Mil Med 2018 11 01
PMID:Pulmonary Infarction: Right Upper Quadrant Pain as a Presenting Symptom With Review of Typical Computed Tomography Imaging Features. 2988 60

The nature of many combat wounds puts patients at a high risk of developing deep venous thrombosis (DVT) and pulmonary embolism (PE), which fall under the broader disease category of venous thromboembolism (VTE). In addition to the hypercoagulable state induced by trauma, massive injuries to the extremities, prolonged immobility, and long fixed wing transport times to higher echelons of care are unique risk factors for venous thromboembolism in the combat-injured patient. These risk factors mandate aggressive prophylaxis for DVT and PE that can effectively be achieved by the use of lower extremity sequential compression devices and low dose unfractionated heparin or low molecular weight heparin. In addition, inferior vena cava filters are often used for PE prophylaxis when chemical DVT prophylaxis fails or is contraindicated. The following Department of Defense (DoD) Joint Trauma System (JTS) Clinical Practice Guideline (CPG) discusses the current recommendations for the prevention of DVT and PE including the use of inferior vena cava filters (IVCFs).
Mil Med 2018 09 01
PMID:Prevention of Deep Venous Thromboembolism. 3018 59