Plantar vein thrombosis: an uncommon cause of plantar foot pain / Trombose venosa plantar: uma causa incomum de dor em região plantar

INTRODUCTION: Plantar vein thrombosis is a rare condition that can lead to pain, edema, and walking difficulties. It presents a series of predisposing factors, such as recent surgeries, the use of oral contraceptives, and local trauma, among others. Imaging tests are essential for the right diagnosis, and ultrasonography is the modality of choice. As for treatment, there is no consensus in the literature. REPORT: Case of a 30-year-old patient who sought emergency medical care complaining of sudden severe pain in the plantar region of her right foot with walking difficulties. On physical examination, hyperalgesia was observed in the plantar region, irradiating to the calf, associated with swelling. Color Doppler imaging identified an acute thrombus in the medial plantar vein. Rivaroxaban was initially prescribed and replaced by acetylsalicylic acid after three months. The treatment was effective, and the patient was discharged after 11 months. CONCLUSION: Plantar vein thrombosis is a rare condition and has a wide range of differential diagnoses so physicians must maintain a high level of clinical suspicion. To improve diagnosis and treatment, it would be necessary to include plantar veins in the investigation protocols of patients suspected of having Deep Venous Thrombosis, besides additional clinical research for improving treatment.

INTRODUÇÃO: A trombose de veias plantares é uma condição rara que pode cursar com dor, edema e dificuldade na deambulação. Apresenta uma série de fatores predisponentes, como cirurgias recentes, uso de anticoncepcional oral, trauma local, entre outros. A realização de exame de imagem é essencial para o diagnóstico, sendo a ultrassonografia a modalidade de escolha. Quanto ao tratamento, não há consenso na literatura. RELATO: Relatamos o caso de uma paciente de 30 anos que procurou atendimento médico de urgência com queixa de dor de forte intensidade, súbita, em região plantar do pé direito com dificuldade de deambulação. Ao exame físico, observou-se hiperalgesia em região plantar com irradiação para panturrilha, associada a empastamento da mesma. O ecodoppler colorido identificou trombo agudo em veia plantar medial. Optou-se pela prescrição de rivaroxabana, a qual foi substituída por ácido acetilsalicílico após três meses. A paciente evoluiu bem e recebeu alta do tratamento após 11 meses. CONCLUSÃO: A trombose de veias plantares é rara e tem uma alta gama de diagnósticos diferenciais, de forma que o profissional médico deve manter um alto nível de suspeição clínica. Para aperfeiçoar seu diagnóstico e tratamento, seria necessária a inclusão das veias plantares aos protocolos de investigação de pacientes com suspeita de Trombose Venosa Profunda, e pesquisas clínicas que elucidassem os melhores métodos terapêuticos.

Thrombectomy in a severe case of iliofemoral venous thrombosis involving the deep femoral vein via a single percutaneous access from the jugular vein: case report and description of the technique / Trombectomia em caso grave de trombose venosa iliofemoral afetando a veia femoral profunda pela técnica de punção e sessão única realizada pela veia jugular: relato de caso e descrição da técnica

ABSTRACT: Iliac vein thrombectomy is usually performed via access through veins located in the lower limbs, which makes it impossible to treat the deep femoral vein, which in turn is an important inflow route to the iliac vein stent. We describe a clinical case and the previously unpublished technique of percutaneous thrombectomy, angioplasty, and stent implantation performed in a single session and with a single access, obtained via the internal jugular vein.

RESUMO: A trombectomia mecânica venosa ilíaca geralmente é realizada por acesso em veias localizadas nos membros inferiores, o que impossibilita o tratamento da veia femoral profunda, que, por sua vez, é uma importante via de influxo ao stent venoso ilíaco. Descrevemos um caso clínico em que foi aplicada a técnica inédita de trombectomia percutânea, angioplastia e implante de stent, realizada por sessão e acesso único, obtido na veia jugular interna.

Tumor renal con extensión al atrio derecho a través de la vena cava inferior: reporte de caso / Renal tumor with extension to the right atrium through the inferior vena cava: case report

Resumen El presente articulo describe un caso clínico de una paciente con un ''trombo tumoral''. Estos son tumores que se extienden desde el órgano afectado hasta el atrio derecho, por la vena cava inferior. Hasta el 10 % de los tumores descritos pueden alcanzar la vena cava inferior y el 1 % de estos llegan a atrio derecho. El carcinoma de células renales es el más frecuente en producir este cuadro. El objetivo del articulo es mostrar que es fundamental realizar un adecuado diagnóstico diferencial, ya que existen diferentes procesos tumorales que pueden causar un ''trombo tumoral'' y diferentes causas de masas en el atrio derecho. La clínica de los pacientes con este cuadro será por obstrucción de la vena cava. El diagnóstico se realiza con estudios de imágenes, ultrasonido (US), ecocardiograma, tomografía axial computarizada (TAC) y resonancia magnética. El manejo debe de ser quirúrgico, sin embargo, presenta pronóstico desfavorable, en algunos casos se puede resecar el tumor primario y extraer la masa que ha invadido la vena cava inferior.

Abstract: This article describes a clinical case of a patient with a 'tumoral thrombus''. These are tumors that extend from the affected organ to the right atrium, through the inferior vena cava. Up to 10% of the tumors described can reach the inferior vena cava and 1% of these reach the right atrium. Renal cell carcinoma is the most common to produce this condition. The objective of the article is to show that it is essential to carry out an adequate differential diagnosis since there are different tumor processes that can cause a ''tumoral thrombus'' and different causes of masses in the right atrium. The symptoms of patients with this condition will be caused by the obstruction of the vena cava. The diagnosis is made with imaging studies, ultrasound (US), echocardiography, computerized axial tomography (CT) and magnetic resonance imaging. The management must be surgical, however it has an unfavorable prognosis, in some cases the primary tumor can be resected and the mass that has invaded the inferior vena cava removed.

Deep Vein Thrombosis in the Setting of Neurofibromatosis Type 1: Case Report

Neurofibromatosis type 1 (NF1) is a genetic syndrome which typically presents with neurological manifestations. Some of the patients may also present with vasculopathies, among which arterial aneurysms and stenosis are the most common. Deep vein thrombosis (DVT) has rarely been described, and, to the best of our knowledge, the present is the first report of DVT due to venous compression by a neurofibroma in the setting of NF1. This is the case of a 23-year-old male with NF1 who experienced DVT due to compression of the left posterior tibial veins by a large tumor arising from the tibial nerve. The DVT was acutely treated with enoxaparin and then with rivaroxaban. Two months after the diagnosis, Doppler ultrasonography showed partial recanalization and persistence of the DVT. The patient was then referred to neurosurgery for surgical resection of the tumor. There were no complications during the procedure, and the patient did not present postoperative neurological deficits. The final histopathological diagnosis was of a benign neurofibroma. After one year of follow-up with vascular surgery, the patient presented no more episodes of DVT. In case there is a tumor compressing the deep vessels of the leg and promoting DVT, surgical resection with microsurgical techniques may be curative.

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.

Agenesia de segmento infra-hepático de veia cava inferior associada a trombose venosa profunda de repetição: relato de caso / Agenesis of the infra-hepatic segment of the inferior vena cava associated with recurrent deep venous thrombosis: case report

Resumo A agenesia de veia cava inferior é descrita em menos de 1% da população, de ocorrência rara e devido a alterações embrionárias. Sua correlação com a trombose venosa profunda certamente é subestimada, visto que tal alteração é de difícil detecção pela ultrassonografia. O objetivo deste artigo foi relatar o caso de uma paciente de 41 anos com dor e edema até a raiz de coxa direita após cirurgia plástica. Foi realizado dúplex venoso de membros inferiores e evidenciada trombose venosa profunda ilíaco-femoro-poplíteo e distal bilateralmente. Solicitado angiotomografia venosa devido a não visualização de veia cava inferior no ultrassom, evidenciando trombose de plexo lombar direito e segmento ilíaco-femoral bilateral, além de agenesia de segmento infra-hepático de veia cava inferior, com ectasia e tortuosidade compensatória de veias paravertebrais, sistema ázigos e hemiázigos, com varizes pélvicas bilateralmente. Foi realizada anticoagulação sistêmica e oral, com boa evolução clínica.

Abstract Agenesis of the inferior vena cava (IVC) has been described in less than 1% of the population; a rare occurrence caused by embryonic abnormalities. Its correlation with deep vein thrombosis (DVT) is certainly underestimated, since this change is hard to detect using ultrasound. The aim of the article is to report the case of a 41-year-old female patient with pain and edema up to the top of the right thigh after plastic surgery. Bilateral venous duplex ultrasound revealed bilateral DVT involving iliac-femoral-popliteal and distal segments. Venous angiotomography was requested because the IVC was not visible on ultrasound, revealing thrombosis of the right lumbar plexus and iliofemoral segment bilaterally and agenesis of the infrahepatic segment of the inferior vena cava, with ectasia and compensatory tortuosity of paravertebral veins and the azygos-hemiazygos system, and bilateral pelvic varices. Systemic and oral anticoagulation were administered, with a satisfactory clinical response.

Trombosis venosa profunda y agenesia de vena cava inferior: presentación típica en una anomalía poco frecuente. Caso clínico

Abnormalities of the inferior vena cava are rare. Its embryological development occurs between the sixth and eighth week of gestation and depends on the persistence or regression of three pairs of veins: the posterior cardinal veins, the subcardinal veins and the supracardinal veins. The type of congenital alteration depends on the moment that embryogenesis is altered. The most frequent clinical presentation is deep vein thrombosis, which occurs mainly in young men. We report a 16-year-old male presenting with edema of the left leg. No risk factor for thrombosis was recorded. A Doppler ultrasound confirmed the presence of a deep femoro-popliteal vein thrombosis. An abdominal CAT scan showed an agenesis of the supra and infra-adrenal inferior vena cava, with multiple collaterals. The study for thrombophilia was negative. The patient was treated with vitamin K antagonists with a good clinical response.

Trombosis de la vena ovárica derecha tras histerectomía subtotal y colposacropexia vía laparoscópica: a propósito de un caso / Right ovarian vein thrombosis after subtotal laparoscopic hysterectomy and colposacropexy: report of clinical case

La trombosis de la vena ovárica es una complicación infrecuente que suele ocurrir durante el postparto, comúnmente tras una cesárea. Sin embargo, existen otras causas como son: la cirugía abdominal, las infecciones, las neoplasias malignas o los estados procoagulantes. La sintomatología es variada e inespecífica. En el estudio de esta entidad, tanto la Resonancia Magnética como el TAC con contraste intravenoso juegan un papel importante. Puesto que las complicaciones pueden ser mortales, es fundamental el tratamiento inmediato con anticoagulación y antibioterapia. El caso presentado a continuación supone uno de los posibles diagnósticos a considerar en una paciente intervenida de histerectomía subtotal laparoscópica con colposacropexia, que presenta dolor abdominal persistente tras la cirugía y riesgo de trombosis moderado por sus factores de riesgo.

Ovarian vein thrombosis is a rare complication that might happen in the postpartum period, most commonly after a cesarean section. However, there are many other causes such as abdominal surgery, infection, malignant neoplasms and procoagulant statuses. Symptoms are varied and unspecific. The computed tomography with intravenous contrast and the magnetic resonance play an important role in the diagnosis. As complications can be fatal, treatment with anticoagulants and antibiotics is necessary. We present a case in which ovarian vein thrombosis needs to be considered in the differential diagnosis in a woman after a subtotal laparoscopic hysterectomy with colposacropexy with moderate risk factors of thrombosis.

Trombose venosa portomesentérica após cirurgia bariátrica: série de casos / Portomesenteric vein thrombosis after bariatric surgery: a case series

RESUMO A trombose portomesentérica (TPM) é uma complicação potencialmente grave que pode ocorrer após a cirurgia bariátrica. A TPM ganhou importância devido ao crescente número de cirurgias bariátricas sendo realizadas. Objetivo: Relatar complicação rara após cirurgia bariátrica, porém grave e de difícil manejo. Tentar identificar algumas características comuns aos pacientes e discutir possíveis causas, comparando a pouca literatura disponível. Métodos: Descrevemos seis casos de TPM em mulheres jovens com diferentes apresentações. Resultados: Todos os seis casos ocorreram em mulheres jovens de 29 a 41 anos sem obesidade grave - índice de massa corporal - IMC: 36 a 39 e com peso que variou de 105 a 121 kg. As pacientes apresentavam poucas comorbidades (todas relacionadas à síndrome metabólica) e esteatose hepática moderada, sem sinais de cirrose. Cinco pacientes usavam contraceptivos orais até dias antes da cirurgia. Uma paciente apresentou resultado positivo para trombofilia. Cinco pacientes foram submetidas a gastrectomia vertical e apenas uma submetida ao bypass gástrico sem complicações durante a cirurgia (tempo médio de operação: 61,3 min, variando de 52 a 91 min). A duração média do seguimento após a hospitalização foi de 12,3 meses (variação: 7 a 18 meses) e até o momento apenas uma paciente não teve recanalização. Conclusão: A frequência da TPM parece ser maior em mulheres e após gastrectomia vertical. Nossos achados indicam que pacientes com dor abdominal semanas após a cirurgia bariátrica devem ser investigados.

ABSTRACT Portomesenteric vein thrombosis (PMVT) is a potentially severe complication that can occur after bariatric surgery. PMVT has gained importance because of the increasing number of bariatric surgeries being performed. Objective: to report a rare and severe complication after bariatric surgery, which is difficult to manage. To try to identify common characteristics among the cases and discuss potential causes comparing our data to the available literature. Methods: We describe six cases of PMVT in young women with different presentations. Results: All six cases occurred in young women 29-41 years old with obesity - body mass index - BMI: 36-39) and weighing 105-121 kg. The patients had few comorbidities (all of which were related to metabolic syndrome) and moderate hepatic steatosis with no sign of cirrhosis. Five patients used oral contraceptives until a few days before the operation. One patient tested positive for thrombophilia. Five patients underwent a laparoscopic sleeve gastrectomy and one underwent a gastric bypass with no complications during the operation (median operating time: 61.3 min, range 52-91 min). The mean duration of follow-up after hospitalization was 12.3 months (range: 7-18 months) and to-date only one patient has had no recanalization. Conclusion: The frequency of PMVT appears to be increased in woman and after sleeve gastrectomy. Our findings indicate that patients with abdominal pain weeks after bariatric surgery must be investigated.

Trombosis venosa profunda de los miembros inferiores: utilidad de la ecografía doppler / Doppler ecography: a safe method for diagnosis of Deep venous thrombosis

In this review, the different diagnostic methods of deep vein thrombosis will be treated, to which the first symptoms of the pathology appear once, and as it has varied until currently using Doppler Ultrasound, which provides a safe non-invasive method able to provide an anatomical and hemodynamic topography.

En esta revisión, se tratarán los diferentes métodos de diagnóstico de la trombosis venosa profunda, a los que se recurren una vez los primeros síntomas de la patología aparece, y como ha variado hasta usar actualmente la ecografía doppler, que proporciona un método seguro no invasivo capaz de suministrar una topografía anatómica y hemodinámica.

Trombosis vascular en injerto renal visualizado en renograma con 99mtc - mag3, un evento infrecuente / Vascular thrombosis in renal graft visualized in 99mtc- mag3 renogram, in unfortunate event / Trombose vascular do enxerto em renal renogram exibido em 99m - mag3, um evento pouco freqüente

El trasplante renal es el tratamiento de elección para la enfermedad renal terminal. Pueden presentarse diversas complicaciones médicas y quirúrgicas posteriores, entre ellas las vasculares (trombosis/estenosis de la vena y/o arteria renal) que son poco frecuentes y resultan en la pérdida del injerto. Presentamos el caso de un paciente masculino que al tercer día posterior al trasplante persisten con anuria y elevación de azoados, realizándose renograma con 99m - Tc MAG3 con hallazgos compatibles de trombosis vascular.

Kidney transplantation is the treatment of choice for end-stage renal disease. Various medical and surgical complications can occur later, among them the vascular ones (thrombosis/stenosis of the vein and/or renal artery) that are infrequent and result in the loss of the graft. We present the case of a male patient who persisted with anuria and azoate elevation on the third day after transplantation, performing a renogram with 99m - Tc MAG3 with compatible findings of vascular thrombosis.

Pulmonary hypertension could be a risk for deep vein thrombosis in lower extremities after joint replacement surgery

SUMMARY A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. METHODS A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. RESULTS Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. CONCLUSION PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.

RESUMO OBJETIVO A hipertensão pulmonar (HP) indica elevação progressiva da resistência vascular pulmonar, levando ao excesso de enchimento, elevação da pressão venosa, congestão em vários órgãos e edema no sistema venoso. Este estudo teve como objetivo investigar se a HP é um fator de risco para trombose venosa profunda (TVP) das extremidades inferiores após cirurgia de prótese de quadril e joelho. MÉTODOS Um total de 238 pacientes que receberam a substituição da articulação das extremidades inferiores em nosso departamento de ortopedia de janeiro de 2009 a junho de 2012 foi examinado por ecocardiograma e fluxo de imagem Doppler colorido (CDFI) dos membros inferiores. De acordo com a pressão arterial pulmonar (PAP), os pacientes foram divididos em grupo PAP normal (n=214) e grupo PH (n=24). Todos os pacientes foram reexaminados por CDFI durante os cuidados pós-operatórios. RESULTADOS Entre os 238 pacientes, 18 pacientes tiveram TVP nas extremidades inferiores após a operação. A taxa de incidência total de TVP foi de 7,56% (18/238). No grupo PH, 11 pacientes tiveram TVP (45,83%, 11/24), mas no grupo PAP normal, apenas sete pacientes tiveram TVP (3,27%, 7/214). A incidência de TVP foi significativamente menor no grupo PAP normal do que no grupo PH (P<0,01). Além disso, houve uma correlação positiva entre a PAP e a incidência de TVP. CONCLUSÃO A HP poderia ser um fator de alto risco para a ocorrência de TVP nas extremidades inferiores do paciente após cirurgias de substituição articular.

Trombosis venosa cerebral / Cerebral venous thrombosis

En la actualidad la trombosis venosa cerebral (TVC) se considera un reto diagnóstico y terapéutico, debido a la alta variabilidad de presentación y a la falta de un consenso terapéutico claro. Representa 0,5 por ciento de los ictus y afecta con mayor frecuencia a sujetos jóvenes con factores de riesgo congénitos o adquiridos. Tiene manifestaciones clínicas variables que unidas a un estudio de neuroimagen adecuado, permiten realizar el diagnóstico. Se presenta un caso con el objetivo de describir la evolución clínico-radiológica de una paciente puérpera adolescente, con trombosis venosa cerebral que además tuvo un angioma venoso cerebral interauricular, que a los 21 días del puerperio presenta cefalea de moderada intensidad en región occipital y posteriormente hemiparesia derecha, con recuperación del defecto en 42 h. Se diagnóstica por Angio-TAC trombosis de seno recto, venas de galeno y venas cerebrales internas con evolución favorable luego de tratamiento anticoagulante(AU)

Cerebral venous thrombosis (CVT) is currently considered a diagnostic and therapeutic challenge, due to the high variability of presentation and the lack of a clear therapeutic consensus. It represents 0.5 percent of strokes and most frequently affects young subjects with congenital or acquired risk factors. The variable clinical manifestations, together with an adequate neuroimaging study, allow diagnosis. We report this case aiming to describe the clinical-radiological evolution of a postpartum adolescent patient with cerebral venous thrombosis who also had an interatrial cerebral venous angioma. She had moderate headache in the occipital region and, later, in right hemiparesis, 21 days after the puerperium. the defect was solved in 42 h. Thrombosis of the right sinus, veins of galen and internal cerebral veins was diagnosed by CT angiography. Favorable evolution was achieved after anticoagulant treatment(AU)

Mesocaval Shunt Creation for Jejunal Variceal Bleeding with Chronic Portal Vein Thrombosis

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.

Thrombosed aneurysm of saphenous vein coronary artery bypass grafting / Aneurisma trombosado de bypass aortocoronariano de veia safena

Summary We describe the case of a male patient, aged 76 years, referred for cardiac investigation due to retrosternal chest pain and dyspnea. He had a history of acute myocardial infarction and angioplasties in the last 30 years, including a saphenous vein coronary artery bypass grafting (SVCABG). Echocardiogram showed hypoechoic oval formation near the right ventricle, suggesting a pericardial cyst. Computed angiotomography revealed a predominantly fusiform and thrombosed aneurysmal dilation of the SVCABG to the right coronary artery. SVCABG aneurysms are very rare and potentially fatal. They usually appear in the late postoperative period, and patients are often asymptomatic. On radiography, it is frequently presented as enlargement of the mediastinum, with echocardiography, computed tomography and magnetic resonance imaging being very useful for diagnosis. Coronary angiography is the gold standard to detect these cases. Our report illustrates a rare situation arising late from a relatively common surgery. Due to its severity, proper recognition in the routine assessment of patients with a similar history is essential.

Resumo Descrevemos o caso de paciente do sexo masculino, 76 anos, em avaliação cardiológica em razão de dor torácica retroesternal e dispneia. Antecedente de infartos agudos do miocárdio e angioplastias nos últimos 30 anos, incluindo um bypass aortocoronário de veia safena (BACVS) ou "ponte de safena". Em ecocardiograma, observou-se formação ovalada alongada hipoecoica junto ao ventrículo direito, podendo sugerir um cisto pericárdico. Angiotomografia computadorizada do tórax evidenciou uma dilatação aneurismática predominantemente fusiforme e trombosada de "ponte de safena" para artéria coronária direita. Aneurismas de BACVS são raríssimos e potencialmente fatais. Geralmente, surgem em um período tardio pós-cirúrgico, sendo seus portadores muitas vezes assintomáticos. Na radiografia, frequentemente se apresentam como alargamento do mediastino, sendo a ecocardiografia, a tomografia computadorizada e a ressonância magnética muito úteis no diagnóstico. A angiografia coronariana é o padrão-ouro na detecção. Este relato ilustra uma situação rara decorrente tardiamente de uma cirurgia relativamente comum, e por causa de sua gravidade torna-se essencial o seu reconhecimento na rotina de avaliação de pacientes com antecedentes semelhantes.

Clinical Impact of Portal Vein Thrombosis Prior to Liver Transplantation: A Retrospective Cohort Study

ABSTRACT Introduction. To identify the impact of portal vein thrombosis (PVT) and associated medical and surgical factors on outcomes post liver transplant (LT). Material and methods. Two analyses were performed. Analysis One: cohort study of 505 consecutive patients who underwent LT (Alberta) between 01/2002-12/2012. PVT was identified in 61 (14%) patients. Analysis Two: cohort study of 144 consecutive PVT patients from two sites (Alberta and London) during the same period. Cox multivariable survival analysis was used to identify independent associations with post-LT mortality. Results. In Analysis One (Alberta), PVT was not associated with post-LT mortality (log rank p = 0.99). On adjusted analysis, complete/occlusive PVT was associated with increased mortality (Hazard Ratio (HR) 8.4, p < 0.001). In Analysis Two (Alberta and London), complete/occlusive PVT was associated with increased mortality only on unadjusted analysis (HR 3.7, p = 0.02). On adjusted analysis, Hepatitis C (HR 2.1, p = 0.03) and post-LT portal vein re-occlusion (HR 3.2, p = 0.01) were independently associated with increased mortality. Conclusion: Well-selected LT patients who had PVT prior to LT had similar post-LT outcomes to non-PVT LT recipients. Subgroups of PVT patients who did worse post-LT (complete/occlusive thrombosis pre-LT, Hepatitis C or post-LT portal vein re-occlusion) warrant closer evaluation in listing and management post-LT.

Accuracy of ultrasound to detect thrombosis in pregnancy: A systematic review / Acurácia da ultrassonografia para detectar trombose na gravidez: uma revisão sistemática

Summary Objective: To determine the diagnostic accuracy of ultrasound to detect deep--vein thrombosis in pregnant patients. Method: We searched Pubmed, LILACS, Scopus, Google Scholar and System for Information on Grey Literature from inception to April 2016. The reference lists of the included studies were analyzed. Original articles from accuracy studies that analyzed ultrasonography to diagnose deep-vein thrombosis in pregnant women were included. Reference standard was the follow-up time. The QUADAS-2 score was used for quality assessment. Results: Titles and summaries from 2,129 articles were identified. Four studies that evaluated deep-vein thrombosis in pregnant women were included. In all, 486 participants were enrolled. High risk of bias was seen in three out of four studies included regarding flow and timing domain of QUADAS-2. Negative predictive value was 99.39%. Conclusion: Accuracy of ultrasonography to diagnose deep-vein thrombosis in pregnant women was not determined due to the absence of data yielding positive results. Further studies of low risk of bias are needed to determine the diagnostic accuracy of ultrasonography in this clinical scenario.

Resumo Objetivo: Determinar a acurácia diagnóstica da ultrassonografia para detectar trombose venosa profunda (TVP) em pacientes grávidas. Método: Pubmed, Lilacs, Scopus, Google Acadêmico e System for Information on Grey Literature foram pesquisados do início até abril de 2016. As referências dos estudos incluídos foram avaliadas. Artigos originais de estudos de acurácia que analisaram ultrassonografia para diagnosticar trombose venosa profunda em mulheres grávidas foram incluídos. O teste de referência foi o tempo de seguimento. O escore de QUADAS-2 foi usado para avaliar a qualidade. Resultados: Títulos e resumos de 2.129 artigos foram identificados. Quatro estudos que avaliaram trombose venosa profunda em grávidas foram incluídos. No total, 486 participantes foram selecionadas. Alto risco de viés foi visto em três dos quatro estudos incluídos considerando o domínio fluxo e tempo do QUADAS-2. O valor preditivo negativo foi 99,39%. Conclusão: A acurácia da ultrassonografia para diagnosticar trombose venosa profunda em mulheres grávidas não pôde ser determinada em razão da ausência de dados de resultados positivos. Estudos com baixo risco de viés são necessários para determinar a acurácia diagnóstica da ultrassonografia nesse cenário clínico.

The clinical importance of air plethysmography in the assessment of chronic venous disease / Importância clínica da pletismografia a ar na avaliação da doença venosa crônica

Abstract Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.

Resumo A pletismografia a ar é um método não invasivo que pode quantificar refluxo e obstrução venosa medindo alterações no volume das pernas. Seus achados se correlacionam com parâmetros clínicos e hemodinâmicos. Ela pode fornecer informações quantitativas dos diferentes componentes da hemodinâmica venosa: refluxo valvular, função de bomba muscular da panturrilha e obstrução venosa. Apesar de ter seu uso clínico validado, a pletismografia a ar é usada quase que exclusivamente para pesquisa. Ela pode ser usada para avaliar a doença venosa crônica, mensurar o ganho hemodinâmico após cirurgia venosa, diagnosticar trombose venosa profunda atual ou prévia, avaliar os efeitos da elastocompressão, estudar as implicações fisiológicas do uso de salto alto em mulheres e também avaliar a probabilidade de cura de uma úlcera venosa.