ABSTRACT
BACKGROUND: Imaging methods for diagnosis of pulmonary embolism (PE) are not available at small medical or rural centres as well as during night time. Herein, we evaluated the diagnostic value of brachial venous pressure measurement in the diagnosis of PE in patients with deep vein thrombosis. MATERIALS AND METHODS: One-hundred and fifty consecutive patients with deep vein thrombosis and suspected PE were prospectively evaluated by measuring brachial vein pressure by CW Doppler. Diagnosis of PE was made by computed tomography angiography and pulmonary angiography. RESULTS: Seventy-one patients (47.3%) had PE. A significant correlation was observed between brachial venous pressure and systolic pulmonary artery pressure (sPAP) estimated at echocardiography (rho 0.922, p<0.0001) as well as with invasively measured sPAP (rho 0.965, p<0.0001). Brachial venous pressure was significantly higher in the PE group (38.5 vs. 13.9 mmHg, p<0.0001) and was associated with increased extent of PE (p<0.0001). A cut-off of brachial venous pressure >15 mmHg had a sensitivity of 100%, a specificity of 77% and a negative likelihood ratio of 0.0%. A cut-off of brachial venous pressure > 19 mmHg had a sensitivity of 100% and specificity of 100% as no patient with PE had a brachial venous pressure below 20 mmHg, and no patients without PE had a venous pressure above this value. CONCLUSIONS: Brachial venous pressure may assist in the diagnosis of PE at bed-side in patients with deep vein thrombosis. Further studies are needed to confirm the validity and reliability of this method.
Subject(s)
Blood Pressure Determination/methods , Pulmonary Embolism/diagnosis , Arm , Female , Humans , Male , Middle Aged , Prospective Studies , Pulmonary Embolism/etiology , Venous Thrombosis/complicationsABSTRACT
Among 34 patients under observation, two young women, aged 23 and 24, developed Takayasu's disease (Takayasu's arteritis) associated with Crohn's disease. The typical vascular symptoms of Takayasu's arteritis developed late during a quiescent phase of Crohn's disease. We discuss the usefulness of diagnostic methods, particularly the contribution of duplex Doppler. Currently, this method appears to provide effective diagnosis of Takayasu's arteritis although clinical data, including hyposphygmy of the radial arteries and carotidynia (pain appearing along the carotid course) are still fundamental. The possible etiopathogenic relations between these two diseases and correlation of results with those in the literature are discussed (J Mal Vasc 1999; 24: 373-376).
Subject(s)
Crohn Disease/complications , Takayasu Arteritis/complications , Adult , Carotid Arteries/diagnostic imaging , Crohn Disease/immunology , Female , Genetic Predisposition to Disease , HLA Antigens/genetics , Humans , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/complications , Laser-Doppler Flowmetry , Physical Examination , Takayasu Arteritis/diagnosis , Takayasu Arteritis/drug therapy , Takayasu Arteritis/immunology , UltrasonographySubject(s)
Arteriosclerosis Obliterans/pathology , Peripheral Vascular Diseases/pathology , Female , Humans , MaleABSTRACT
Deep venous thrombosis with pulmonary embolism is considered rare in pediatric population, but a literature review points out this disease more frequent than would be expected in children. The low incidence and the poor consideration of this occurrence in pediatric age group, cause the thromboembolic disease with pulmonary involvement an often missed diagnosis. The illness is usually related to intravenous catheters, surgery, trauma, sepsis, prolonged immobilization, neoplasia, drugs, some congenital or acquired diseases. The Authors report their experience with two pediatric cases of inferior vena cava thrombosis and pulmonary embolism treated with anticoagulant therapy, temporary vena cava filters and locoregional fibrinolysis.
Subject(s)
Postoperative Complications/therapy , Pulmonary Embolism/prevention & control , Thrombosis/therapy , Vena Cava Filters , Vena Cava, Inferior , Adolescent , Anticoagulants/therapeutic use , Child , Combined Modality Therapy , Humans , Male , Postoperative Complications/diagnosis , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Thrombolytic Therapy , Thrombosis/complications , Thrombosis/diagnosis , Urokinase-Type Plasminogen Activator/administration & dosageABSTRACT
The authors examined 47 subjects affected by acute phlebothrombosis of the lower limbs by means of light-reflection-rheography (LRR). The diagnosis was based on the results of clinical, Doppler, and duplex scanner evaluations. The results were compared with those obtained in 30 healthy subjects (control group). The LRR examinations were performed by two methods: the one consisting of a passive execution of postural movements of the limb, the other using the technique of plethysmographic venous occlusion. The pathological LRR curves were characteristic for each type of disease and for the site of thrombosis and were different from the normal ones. The results obtained show the usefulness of the method and it potential in studying the collateral circulation and the effects of different therapies.
