Point of care ultrasound (POCUS) in diagnosis of proximal deep vein thrombosis among COVID-19 hospitalized patients with a high rate of low molecular weight heparin prophylaxis.

BACKGROUND: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are both complications linked with COVID-19. Lower limb point-of-care clinical ultrasound (POCUS) could detect occult clots, helping decide whom to treat with anticoagulation. OBJECTIVES: To determine proximal DVT prevalence with POCUS screening among hospitalized COVID-19 patients. PATIENTS/METHODS: Lower limb POCUS was performed in all patients admitted either to the ward or intensive care unit (ICU) between April 22nd and 30th 2020. Clinical and laboratory features, prescriptions, thrombotic complications and outcomes were assessed. RESULTS: 87 patients were screened, of which 26 (29.8%) either had been discharged from ICU (19.5%) or were still in critical condition (10.3%). DVT was found in 4 patients (3 femoral, 1 popliteal), of which 1 had not received low molecular weight heparin (LMWH) prophylaxis. 21 CT pulmonary angiograms were performed, being positive for PE in 5 cases (23.8%); only 2 of these patients suffered DVT. CONCLUSIONS: Screening lower extremities with POCUS did not find a high rate of DVT among patients receiving LMWH-prophylaxis. However, there was a noteworthy amount of PE without DVT.

ANTECEDENTES: La trombosis venosa profunda (TVP) y la embolia pulmonar (EP) son complicaciones relacionadas con la COVID-19. La ecografía clínica en el punto de atención (POCUS) de las extremidades inferiores podría detectar coágulos ocultos, ayudando a decidir a quién tratar con anticoagulación. OBJETIVOS: Determinar la prevalencia de la TVP proximal con el cribado mediante POCUS entre los pacientes hospitalizados por COVID-19. PACIENTES/MÉTODOS: Se realizó una POCUS de miembros inferiores a todos los pacientes ingresados en planta o en la Unidad de Cuidados Intensivos (UCI) entre el 22 y el 30 de abril de 2020. Se evaluaron las características clínicas y de laboratorio, las prescripciones, las complicaciones trombóticas y los resultados. RESULTADOS: Se examinaron 87 pacientes, de los cuales 26 (29,8%) habían sido dados de alta de la UCI (19,5%) o seguían en estado crítico (10,3%). Se detectó una TVP en cuatro pacientes (tres femoral, uno poplítea), de los cuales uno no había recibido profilaxis con heparina de bajo peso molecular (HBPM). Se realizaron 21 angiografías pulmonares por TC, siendo positivas para EP en cinco casos (23,8%); solo dos de estos pacientes sufrieron TVP. CONCLUSIONES: El cribado de las extremidades inferiores con POCUS no encontró una tasa elevada de TVP entre los pacientes que recibían profilaxis con HBPM. Sin embargo, hubo una cantidad notable de EP sin TVP.

Point of care ultrasound (POCUS) in diagnosis of proximal deep vein thrombosis among COVID-19 hospitalized patients with a high rate of low molecular weight heparin prophylaxis

Antecedentes: La trombosis venosa profunda (TVP) y la embolia pulmonar (EP) son complicaciones relacionadas con la COVID-19. La ecografía clínica en el punto de atención (POCUS) de las extremidades inferiores podría detectar coágulos ocultos, ayudando a decidir a quién tratar con anticoagulación.ObjetivosDeterminar la prevalencia de la TVP proximal con el cribado mediante POCUS entre los pacientes hospitalizados por COVID-19.Pacientes/métodosSe realizó una POCUS de miembros inferiores a todos los pacientes ingresados en planta o en la Unidad de Cuidados Intensivos (UCI) entre el 22 y el 30 de abril de 2020. Se evaluaron las características clínicas y de laboratorio, las prescripciones, las complicaciones trombóticas y los resultados.ResultadosSe examinaron 87 pacientes, de los cuales 26 (29,8%) habían sido dados de alta de la UCI (19,5%) o seguían en estado crítico (10,3%). Se detectó una TVP en cuatro pacientes (tres femoral, uno poplítea), de los cuales uno no había recibido profilaxis con heparina de bajo peso molecular (HBPM). Se realizaron 21 angiografías pulmonares por TC, siendo positivas para EP en cinco casos (23,8%); solo dos de estos pacientes sufrieron TVP. (AU)

Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are both complications linked with COVID-19. Lower limb point-of-care clinical ultrasound (POCUS) could detect occult clots, helping decide whom to treat with anticoagulation.ObjectivesTo determine proximal DVT prevalence with POCUS screening among hospitalized COVID-19 patients.Patients/MethodsLower limb POCUS was performed in all patients admitted either to the ward or intensive care unit (ICU) between April 22nd and 30th 2020. Clinical and laboratory features, prescriptions, thrombotic complications and outcomes were assessed.Results87 patients were screened, of which 26 (29.8%) either had been discharged from ICU (19.5%) or were still in critical condition (10.3%). DVT was found in 4 patients (3 femoral, 1 popliteal), of which 1 had not received low molecular weight heparin (LMWH) prophylaxis. 21 CT pulmonary angiograms were performed, being positive for PE in 5 cases (23.8%); only 2 of these patients suffered DVT. (AU)

Point of care ultrasound (POCUS) in diagnosis of proximal deep vein thrombosis among COVID-19 hospitalized patients with a high rate of low molecular weight heparin prophylaxis.

BACKGROUND: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are both complications linked with COVID-19. Lower limb point-of-care clinical ultrasound (POCUS) could detect occult clots, helping decide whom to treat with anticoagulation. OBJECTIVES: To determine proximal DVT prevalence with POCUS screening among hospitalized COVID-19 patients. PATIENTS/METHODS: Lower limb POCUS was performed in all patients admitted either to the ward or intensive care unit (ICU) between April 22nd and 30th 2020. Clinical and laboratory features, prescriptions, thrombotic complications and outcomes were assessed. RESULTS: 87 patients were screened, of which 26 (29.8%) either had been discharged from ICU (19.5%) or were still in critical condition (10.3%). DVT was found in 4 patients (3 femoral, 1 popliteal), of which 1 had not received low molecular weight heparin (LMWH) prophylaxis. 21 CT pulmonary angiograms were performed, being positive for PE in 5 cases (23.8%); only 2 of these patients suffered DVT. CONCLUSIONS: Screening lower extremities with POCUS did not find a high rate of DVT among patients receiving LMWH-prophylaxis. However, there was a noteworthy amount of PE without DVT.

Paraganglioma timpánico con extensión a trompa de Eustaquio y nasofaringe: a propósito de un caso / Tympanic paraganglioma with extension into the Eustachian tube and nasopharynx: a case report

Los paragangliomas timpánicos suelen presentarse como una masa hipervascular en oído medio, siendo los síntomas de presentación más frecuentes acúfeno pulsátil e hipoacusia. Presentamos un caso infrecuente de recidiva de paraganglioma timpánico con extensión a trompa de Eustaquio y nasofaringe, que se manifestó con epistaxis recurrente(AU)

Tympanic paragangliomas usually present as a vascular middle ear mass, with the most common presenting symptoms being pulsatile tinnitus and hearing loss. We report an unusual case of a recurrent tympanic paraganglioma extending along the Eustachian tube and nasopharynx, presenting with recurrent epistaxis(AU)

Early phase detection of bile leak after hepatobiliary surgery: value of Gd-EOB-DTPA-enhanced MR cholangiography.

PURPOSE: To assess the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR cholangiography for the detection of bile leaks after hepatobiliary surgery. METHODS: Twenty-three patients with symptoms suggestive of bile leak underwent conventional fat-suppressed T1- and T2-weighted MR cholangiography followed by Gd-EOB-DTPA-enhanced MR cholangiography using gradient-echo (GRE) T2-weighted sequences and fat-suppressed T1-weighted 3D gradient-echo sequences 20 min after an intravenous bolus of Gd-EOB-DTPA. The results of Gd-EOB-DTPA-enhanced MR cholangiography correlated with clinical findings, surgical repair, and the results of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography. RESULTS: The results of Gd-EOB-DTPA-enhanced MR cholangiography were negative in 13 patients (cholecystectomy 5, liver transplantation 2, liver resection for focal lesions 2, cholangiocarcinoma 1, and partial hepatectomy after liver injury 1). In 10 patients in whom bile leaks were detected, this complication occurred after liver resection for focal lesions in 3, cholecystectomy in 4, liver transplantation in 2, and liver resection for intrahepatic cholangiocarcinoma in 1. The diagnostic accuracy of Gd-EOB-DTPA-enhanced MR for the detection or exclusion of bile leaks was 100%. CONCLUSIONS: Gd-EOB-DTPA-enhanced MR cholangiography is a highly reliable technique for the detection of bile leaks after hepatobiliary surgery and may avoid the use of other, potentially risky invasive diagnostic techniques.

Tympanic paraganglioma with extension into the Eustachian tube and nasopharynx: a case report.

Tympanic paragangliomas usually present as a vascular middle ear mass, with the most common presenting symptoms being pulsatile tinnitus and hearing loss. We report an unusual case of a recurrent tympanic paraganglioma extending along the Eustachian tube and nasopharynx, presenting with recurrent epistaxis.