Thrombosis, leiomyoma and GnRH-a therapy. A case report.

BACKGROUND: Diverse complications have been reported in association with the growth and medical treatment of uterine leiomyomata. Infarction and necrosis may be common and incite complications from parasitic vascular attachment, pain and thrombosis. The rarity of severe complications in this situation warrants presentation of the following unique association. CASE: A 33-year-old female, gravida 1, para 1, was treated with gonadotropin-releasing hormone agonist (GnRH-a) for three months prior to laparotomy and removal of a solitary, 5,190-g, pedunculated myoma. The mass had secured an additional vascular supply from the transverse colon and omentum. Although the immediate postoperative course was uncomplicated, delayed onset of abdominal pain and fever lead to the diagnosis of superior mesenteric and portal vein thrombosis. Portal vein thrombosis responded to thrombolytic infusion into the superior mesenteric artery. Superior mesenteric vein thrombosis persisted, with evidence of early vascular recanalization. After six weeks of additional anticoagulation, assessment by computed tomographic scan showed complete resolution of all thrombi. CONCLUSION: While thrombosis has been reported with GnRH-a therapy in men with prostate cancer, its association with treatment in this benign case may have been a consequence of the massive tumor size. Steroid hormone deprivation potentially contributed to neovascularization and bowel involvement.

Improved detection of healed myocardial infarction by Fourier amplitude and phase imaging in two projections: validation with MRI.

Biplane Fourier amplitude and phase images from radionuclide ventriculograms were analyzed for the presence of regional wall motion abnormalities in 25 patients who had a total of 33 healed myocardial infarctions (nonviable scar tissue) documented by contrast ventriculography and ECG. This indirect evidence was validated by MRI, which permits direct visualization of healed myocardial infarction. The use of amplitude and phase images in both projections resulted in the detection of more healed myocardial infarctions (91%) than did the use of conventional radionuclide ventriculography with left anterior oblique images alone (67%), because inferior wall infarcts are more readily visualized in the left posterior oblique projection.