Enfermedad de Mondor del pene en un paciente joven / Mondor disease of the penis in a young patient

Se presenta el caso clínico de un paciente de 21 años de edad, con antecedente de herniorrafia inguinal derecha, quien asistió a consulta de control y refirió presentar una induración y dolor en la región dorsal del pene con 4 días de evolución, que había comenzado después de una relación sexual en la cual consumió marihuana. En el examen físico se encontró la vena dorsal del pene engrosada, dura y dolorosa a la palpación. Se le diagnosticó una enfermedad de Mondor del pene. La ecografía Doppler confirmó la tromboflebitis de esta vena. El paciente recibió tratamiento médico y evolucionó satisfactoriamente.

The case report of a 21 years patient with history of right inguinal herniorrhaphy is presented, who attended control visit and he made reference to an induration and pain in the dorsal region of the penis with 4 days of evolution that had begun after a sexual relationship in which he consumed marihuana. In the physical exam the penis dorsal vein was found thicken, hard and painful to the palpation. He was diagnosed a Mondor disease of the penis. The Doppler scanning confirmed the thrombophlebitis of this vein. The patient received medical treatment and had a favorable clinical course.

Flegmasía cerulea dolens. tratamiento con fibrinolisis sistémica / Phlegmasia cerulea dolens. Treatment with systemic fibrinolysis

Resumen La flegmasia cerulea dolens es una complicación rara y poco frecuente de la trombosis venos a profunda. Los principales factores predisponentes son los procesos neoformativos, estados de hiper coagulabilidad, insuficiencia cardíaca congestiva, embarazo, inmovilización prolongada y cirugías. Se caracteriza por edema masivo, dolor intenso y cianosis. Sin tratamiento evoluciona con isquemia, necrosis y amputación del miembro comprometido. No existe consenso en su tratamiento, pero éste debe ser rápido, multidisciplinario y agresivo. La anticoagulación con heparina, la fibrinólisis sistémica, la trombectomía percutánea con fibrinólisis local, la trombectomía quirúrgica, la fasciotomía, la colocación de filtro de vena cava inferior y la amputación son algunos de los tratamientos propuestos.

Abstract Phlegmasia cerulea dolens (FCD) is a rare complication of deep vein thrombosis. Its cause is unknown. The main predisposing factors for the disease are neoformative processes, hypercoagulable states, congestive heart failure, pregnancy, prolonged immobilization, and surgeries on the affected limb. FCD is characterized by massive edema, severe pain, and cyanosis. The diagnosis is clinical. It is associated in most cases with pulmonary embolism and can lead to loss of the compromised limb if not treated in time. So far there is no consensus on its treatment. In clinical practice the use of anticoagulation with heparin, local thrombolysis, systemic fibrinolysis, surgical thrombectomy, fasciotomy, and inferior vena cava filter are described. In irreversible cases amputation is required. We present the case of a patient with FCD, the treatment performed and the evolution.

Tromboflebitis séptica pelviana post cesárea / Septic pelvic thromboflebitis after cesarean section

RESUMEN Presentamos caso clínico de puérpera de cesárea de noveno día con cuadro febril en espigas, asintomática, en que se plantea desde su ingreso el diagnóstico de tromboflebitis séptica pelviana y se inicia tratamiento con antibióticos parenterales de amplio espectro y heparina de bajo peso molecular en dosis terapéuticas. La respuesta es a la mejoría al tercer día de tratamiento. Se discuten los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.

ABSTRACT A case of a woman on her 9th post-operative day after childbirth by cesarean section (CS) consulting with febrile spikes, otherwise asymptomatic, is presented. The diagnosis of a septic pelvic thrombophlebitis is proposed from the admission and treated with parenteral broad-spectrum antibiotics and low-molecular-weight heparin at therapeutic doses. Patient significantly improved on her third day of treatment. The diagnostic procedures, differential diagnosis and treatment are discussed.

Thrombophlebitis of the lateral chest wall (Mondor's disease).

Mondor's disease is a rare condition, which involves the thrombophlebitis of the superficial veins of the breast and anterior chest wall. A 37-year-old woman presented with sudden onset of local pain and edema on her right chest wall, accompanied by a longitudinal retraction of the skin during arm abduction in the area. Clinical, histological and ultrasonographic findings confirmed Mondor's disease and the treatment was symptomatic, using pain relievers and warm compresses. The symptomatology remitted within 2 weeks of therapy. Mondor's disease is a rare condition where ultrasound complements the clinical evaluation and allows the characterization of certain abnormalities, which correlated with functional biochemical data and other procedures may substitute the need of biopsy.

Mondor's disease of breast

A case of Mondor's disease of breast in a 32 years old lady is described. She presented with painful vertical subcutaneous cords under her left breast. On scintimammography a suspicious nodule in her breast was detected, which revealed to be benign epithelial lesion on FNAC. With reassurance and placebo, the disease resolved spontaneously within two months

Radionuclide venography in the diagnosis of deep vein thrombosis of the lower extremities: a comparison to contrast venography.

Radionuclide venography (RNV) and contrast venography (CV) were compared in 72 limbs of 59 patients being clinically suspected of deep vein thrombosis (DVT) of the lower extremities. The criteria of positive RNV for DVT regarding flow pattern abnormality included (1) nonfilling or nonvisualization of a deep vein, (2) interruption of the flow, (3) irregular or asymmetric filling of a deep vein, and (4) presence of abnormal collateral vessels. The overall accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio (LR+) were 90 per cent, 88 per cent, 96 per cent, 98 per cent, 79 per cent, and 20.8 respectively. These figures are even higher when we focused on the major veins of the thigh and pelvis. They were 97 per cent, 95 per cent, 98 per cent, 98 per cent, 95 per cent, and 61 respectively. The results indicate that radionuclide venography, while technically simple, is a reliable test for detection of DVT particularly of the major veins of the lower extremities. Combined radionuclide venography and perfusion lung scan can also be performed in the same setting if Tc99m-MAA is used. Contrast venography which is an invasive procedure, should be reserved for questionable cases of those with suspected isolated calf vein thrombosis.

Doppler and duplex assessment of the venous circulation of the lower limbs in hemiplegia

Clinically significant thromboembolic disease originating from the paralyzed legs of hemiplegic patients can occur unexpectedly and may affect morbidity and mortality of such patients. Doppler and Duplex sonography, are simple noninvasive techniques, that can accurately reveal deep venous thrombosis of the lower limbs. Doppler and Duplex examination were performed on the lower extremities of 40 hemiplegic patients suffering from cerebrovascular stroke. The study showed that 25% of patients [10 of 40 patients] had evidence of deep leg vein thrombosis. 9 cases were detected in the paralyzed limbs, forming an incidence of 22.5%. Six were acute [15%] abd 3 chronic [7.5%]. One case was detected in the non-paretic limb, with an incidence of 2.5%. Patients in the age group of 60-70 years showed the highest incidence of phlebothrombosis, and increased incidence was also shown in patients with poor or no muscle power of the affected limb. It was concluded that Doppler and Duplex imaging can be successfully used in the early detection of DVT in high risk hemiplegic patient, thus leading to prompt medical management, and may reduce morbidity and mortality

value of ultrasonography in DVT during pregnancy

32 pregnant patients with symptoms suggestive of D.V.T. were studied. Diagnosis was confirmed in 15 of these patients by the use of B-mode compression ultrasonography. Follow up revealed additional 2 patients with D.V.T. B-mode compression ultrasonography assisted by Doppler ultrasonography were used in this work. Venography was excluded because its known hazards to pregnant subjects. Involvement of the left limb was more common than the right [9/5], both sides were affected in 3 patients. Iliofemoral thrombosis was found in 10 patients while calf thrombosis existed in 7. Two patients were recurrent and pulmonary embolism complicated one case. The sensitivity and specificity of this B-mode compression ultrasonography in diagnosis of both iliofemoral and calf thrombosis were 15/17 [88.2%], 15/15 [100%] respectively