RESUMEN
BACKGROUND: External Jugular Thrombophlebitis (EJT) is a rare clinical phenomenon with few reports in the literature, especially in the pediatric population. This is a report of an unusual case of right-sided EJT in a pediatric patient secondary to acute pharyngitis with sinusitis most prominent on the left side. CASE PRESENTATION: A 13-year-old presented to the emergency department with worsening upper respiratory infectious (URI) symptoms and facial swelling, cough, throat pain, and emesis. The patient had traveled to Switzerland and received amoxicillin for strep throat 6 weeks before this hospitalization. Physical examination revealed nasal purulence, allodynia over the right side of the face without overlying erythema, and oropharyngeal exudate. CT scan revealed left-sided predominate sinusitis and right external jugular vein thrombosis. Blood cultures confirmed the presence of group A streptococcus infection. Treatment included IV antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), IV steroids, and anticoagulation. Follow-up imaging demonstrated improvement in thrombosis, cellulitis, and sinus disease. The patient was discharged on antibiotics for 6 weeks and anticoagulation for 10 weeks. Follow-up imaging at 6 months revealed no EJT, and medications were discontinued. CONCLUSIONS: EJT is a rare condition, and to our knowledge, no reports of EJT with sinusitis most pronounced on the contralateral side have been published. Physicians will benefit from noting clinical signs of EJT such as facial edema, headache, erythema, and palpable neck mass, especially if these symptoms occur with URI symptoms refractory to treatment. The use of anticoagulation is controversial for internal jugular vein thrombosis, and while no guidelines for EJT exist, anticoagulation is likely not necessary save for severe complications.
Asunto(s)
Venas Yugulares , Faringitis , Tromboflebitis , Humanos , Faringitis/complicaciones , Adolescente , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/etiología , Tromboflebitis/diagnóstico , Masculino , Venas Yugulares/diagnóstico por imagen , Enfermedad Aguda , Antibacterianos/uso terapéutico , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Anticoagulantes/uso terapéuticoAsunto(s)
Tromboflebitis , Humanos , Tromboflebitis/etiología , Tromboflebitis/patología , Tromboflebitis/diagnóstico , Eritema/patología , Eritema/etiología , Arteritis/patología , Síndrome de Churg-Strauss/complicaciones , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/patología , Femenino , Masculino , Granulomatosis con Poliangitis/patología , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/diagnóstico , Livedo Reticularis/patología , Livedo Reticularis/etiología , Persona de Mediana EdadRESUMEN
This article reports a case of a female patient admitted with swelling and subcutaneous mass in the right forearm, initially suspected to be multiple nerve fibroma. However, through preoperative imaging and surgery, the final diagnosis confirmed superficial thrombophlebitis. This condition resulted in entrapment of the radial nerve branch, leading to noticeable nerve entrapment and radiating pain. The surgery involved the excision of inflammatory tissue and thrombus, ligation of the cephalic vein, and complete release of the radial nerve branch. Postoperative pathology confirmed the presence of Superficial Thrombophlebitis. Through this case, we emphasize the importance of comprehensive utilization of clinical, imaging, and surgical interventions for more accurate diagnosis and treatment. This is the first clinical report of radial nerve branch entrapment due to superficial thrombophlebitis.
Asunto(s)
Antebrazo , Síndromes de Compresión Nerviosa , Nervio Radial , Tromboflebitis , Humanos , Femenino , Tromboflebitis/cirugía , Tromboflebitis/etiología , Tromboflebitis/diagnóstico , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugía , Antebrazo/inervación , Antebrazo/irrigación sanguínea , Antebrazo/cirugía , Nervio Radial/cirugía , Neuropatía Radial/etiología , Neuropatía Radial/cirugía , Persona de Mediana EdadAsunto(s)
Neoplasias Ováricas , Tromboflebitis , Humanos , Femenino , Neoplasias Ováricas/patología , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/cirugía , Neoplasias Ováricas/diagnóstico por imagen , Tromboflebitis/etiología , Tromboflebitis/diagnóstico , Tromboflebitis/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
Pylephlebitis, which is a type of septic thrombophlebitis of the portal vein, is a rare and life-threatening complication that commonly occurs following appendicitis. However, nonspecific abdominal complaints and fever can impede the diagnosis of pylephlebitis. Timely use of appropriate antibiotics and anticoagulants is paramount for treating this condition. We present a case of pylephlebitis and septic shock caused by acute nonperforated appendicitis. A 32-year-old man presented with migratory right lower abdominal pain. Blood cultures showed the presence of Escherichia coli. Blood test results showed increased bilirubin concentrations and coagulation factor abnormalities. A computed tomographic abdominal scan showed that the portal vein had a widened intrinsic diameter. After intensive care treatment with antibiotics, antishock therapy, anticoagulants, and other supportive treatments, the infection was monitored, the abdominal pain disappeared, and the jaundice subsided. Laparoscopic appendectomy was performed. Histopathology showed acute suppurative appendicitis, and no abnormalities were observed during the follow-up period after discharge. A multidisciplinary approach is mandatory for the decision-making process in the presence of pylephlebitis caused by appendicitis to obtain a correct diagnosis and prompt treatment. Similarly, the timing of appendectomy is important for minimizing intra- and postoperative complications.
Asunto(s)
Apendicitis , Vena Porta , Choque Séptico , Tromboflebitis , Humanos , Apendicitis/complicaciones , Apendicitis/cirugía , Apendicitis/diagnóstico , Masculino , Adulto , Tromboflebitis/diagnóstico , Tromboflebitis/etiología , Tromboflebitis/microbiología , Choque Séptico/etiología , Choque Séptico/microbiología , Vena Porta/patología , Antibacterianos/uso terapéutico , Apendicectomía , Tomografía Computarizada por Rayos X , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Enfermedad Aguda , Dolor Abdominal/etiologíaRESUMEN
Phlegmasia cerulea dolens is a devastating sequelae of propagating deep vein thrombosis causing total venous outflow obstruction of an extremity. It is characterized by significant pain, edema, cyanosis, and critical limb ischemia and may progress toward venous gangrene. Morbidity and mortality rates associated with this phenomenon are high. Treatment options are limited and consist of early and aggressive therapeutic anticoagulation and fluid resuscitation, followed by thrombectomy or thrombolysis if the patient fails to respond clinically in 6-12 hours.
Asunto(s)
Vena Ilíaca , Recuperación del Miembro , Stents , Trombectomía , Humanos , Trombectomía/métodos , Femenino , Vena Ilíaca/cirugía , Recuperación del Miembro/métodos , Tromboflebitis/etiología , Tromboflebitis/terapia , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Persona de Mediana EdadRESUMEN
Thrombosis and thrombophlebitis of the facial vein represent exceptionally rare diagnoses, particularly when occurring as complications of acute sialadenitis of the submandibular gland. This case report details the experience of a middle-aged man initially presenting at a tertiary care ear, nose and throat department with right submandibular gland sialadenitis. Despite initiating outpatient treatment involving oral antibiotics and sialagogues, the patient returned after a week with persistent and worsening pain, accompanied by swelling of the right submandibular gland and cheek. Using ultrasound, the accurate diagnosis was promptly identified, revealing thrombosis in the facial vein.The patient underwent a comprehensive treatment regimen involving anticoagulation and intravenous antibiotics. With a subsequent reduction in pain and swelling, the patient was discharged, continuing oral anticoagulation and antibiotics. Outpatient follow-up revealed a complete recovery 3 weeks later. This case underscores the importance of timely and precise diagnostic measures in managing rare complications associated with sialadenitis.
Asunto(s)
Sialadenitis , Tromboflebitis , Trombosis de la Vena , Masculino , Persona de Mediana Edad , Humanos , Trombosis de la Vena/complicaciones , Tromboflebitis/diagnóstico , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/etiología , Glándula Submandibular/diagnóstico por imagen , Sialadenitis/diagnóstico , Sialadenitis/etiología , Dolor/complicaciones , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéuticoRESUMEN
BACKGROUND: Central catheter-related bloodstream infections (CRBIs) can lead to severe complications, including suppurative thrombophlebitis, endocarditis, and metastatic infections. While complications due to CRBIs caused by Staphylococcus aureus (SA) are well-known, there are limited data regarding CRBIs caused by other bacteria. METHODS: This 2-year retrospective single-center study of patients with CRBIs from a tertiary care hospital examined the hematogenous complications associated with CRBIs according to patient characteristics, central venous catheter (CVC) types, and causative bacteria. RESULTS: All in all, 254 patients with confirmed CRBIs were included; 285 bacteria types were isolated, mainly Enterobacteriaceae (n = 94), coagulase-negative Staphylococci (CNS, n = 82), SA (n = 45), and non-fermenting Gram-negative bacteria (NGB, n = 45). Among the patients, 35 developed at least one hematogenous complication (14 %), including suppurative thrombophlebitis (n = 15), endocarditis (n = 7) and metastatic infections (n = 16). In multivariate analysis, hemodialysis, persistent bacteremia for at least 3 days, and CRBIs caused by SA were associated with increased risk for hematogenous complications, while previous curative anticoagulant treatment was associated with reduced risk. Diabetes, CVC maintenance, and hematogenous complications were associated with increased 3-month mortality. CONCLUSION: A thorough investigation of hematogenous complications should be envisioned in patients with persistent bacteremia, particularly those with SA infections and those on hemodialysis.
Asunto(s)
Bacteriemia , Catéteres Venosos Centrales , Endocarditis , Infecciones Estafilocócicas , Tromboflebitis , Humanos , Catéteres Venosos Centrales/efectos adversos , Estudios Retrospectivos , Staphylococcus aureus , Factores de Riesgo , Tromboflebitis/etiología , Tromboflebitis/complicaciones , Bacteriemia/epidemiología , Bacteriemia/microbiología , Endocarditis/complicacionesRESUMEN
RATIONALE: Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial. PATIENT CONCERNS: A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture. DIAGNOSIS: The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization. INTERVENTIONS: During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained. OUTCOMES: The patient was discharged with optimal evolution. LESSONS: LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
Asunto(s)
Síndrome de Lemierre , Staphylococcus aureus Resistente a Meticilina , Infecciones de los Tejidos Blandos , Tromboflebitis , Femenino , Humanos , Adulto , Síndrome de Lemierre/diagnóstico , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/terapia , Infecciones de los Tejidos Blandos/complicaciones , Tromboflebitis/etiología , Tromboflebitis/tratamiento farmacológico , Staphylococcus aureus , Antibacterianos/uso terapéuticoRESUMEN
La pileflebitis es definida como la trombosis supurativa de la vena porta como complicación de infecciones abdominales. En pediatría, la etiología más frecuente es la apendicitis, generalmente de diagnóstico tardío, que se presenta como sepsis, con una elevada mortalidad. Para el diagnóstico son necesarios métodos de diagnóstico por imágenes; los más utilizados son la ecografía Doppler y la angiotomografía. El tratamiento se basa en la intervención quirúrgica, la antibioticoterapia y la anticoagulación. Esta última tiene indicación controvertida, pero podría mejorar el pronóstico y disminuir la morbimortalidad. Se presenta un caso clínico de pileflebitis secundaria a sepsis por Escherichia coli con punto de partida en una apendicitis aguda, en un paciente pediátrico que evoluciona a la transformación cavernomatosa de la vena porta. Es de importancia conocer el manejo de esta entidad, ya que, una vez superado el cuadro inicial, requerirá un minucioso seguimiento por la posibilidad de evolucionar a la insuficiencia hepática.
Pylephlebitis is defined as suppurative thrombosis of the portal vein as a complication of abdominal infections. In pediatrics, the most frequent etiology is appendicitis, generally of late diagnosis, presenting as sepsis, with a high mortality rate. Imaging methods are necessary for diagnosis; the most common are the Doppler ultrasound and computed tomography angiography. Treatment is based on surgery, antibiotic therapy, and anticoagulation. The indication for the latter is controversial, but it may improve prognosis and decrease morbidity and mortality. Here we describe a clinical case of pylephlebitis secondary to Escherichia coli sepsis, which started as acute appendicitis in a pediatric patient who progressed to cavernomatous transformation of the portal vein. It is important to know the management of this disease because, once the initial symptoms are overcome, it will require close follow-up due to a potential progression to liver failure.
Asunto(s)
Humanos , Niño , Apendicitis/diagnóstico , Tromboflebitis/diagnóstico , Tromboflebitis/etiología , Tromboflebitis/tratamiento farmacológico , Sepsis/etiología , Hepatopatías , Vena Porta , Antibacterianos/uso terapéuticoRESUMEN
Pylephlebitis is defined as suppurative thrombosis of the portal vein as a complication of abdominal infections. In pediatrics, the most frequent etiology is appendicitis, generally of late diagnosis, presenting as sepsis, with a high mortality rate. Imaging methods are necessary for diagnosis; the most common are the Doppler ultrasound and computed tomography angiography. Treatment is based on surgery, antibiotic therapy, and anticoagulation. The indication for the latter is controversial, but it may improve prognosis and decrease morbidity and mortality. Here we describe a clinical case of pylephlebitis secondary to Escherichia coli sepsis, which started as acute appendicitis in a pediatric patient who progressed to cavernomatous transformation of the portal vein. It is important to know the management of this disease because, once the initial symptoms are overcome, it will require close follow-up due to a potential progression to liver failure.
La pileflebitis es definida como la trombosis supurativa de la vena porta como complicación de infecciones abdominales. En pediatría, la etiología más frecuente es la apendicitis, generalmente de diagnóstico tardío, que se presenta como sepsis, con una elevada mortalidad. Para el diagnóstico son necesarios métodos de diagnóstico por imágenes; los más utilizados son la ecografía Doppler y la angiotomografía. El tratamiento se basa en la intervención quirúrgica, la antibioticoterapia y la anticoagulación. Esta última tiene indicación controvertida, pero podría mejorar el pronóstico y disminuir la morbimortalidad. Se presenta un caso clínico de pileflebitis secundaria a sepsis por Escherichia coli con punto de partida en una apendicitis aguda, en un paciente pediátrico que evoluciona a la transformación cavernomatosa de la vena porta. Es de importancia conocer el manejo de esta entidad, ya que, una vez superado el cuadro inicial, requerirá un minucioso seguimiento por la posibilidad de evolucionar a la insuficiencia hepática.
Asunto(s)
Apendicitis , Hepatopatías , Sepsis , Tromboflebitis , Humanos , Niño , Tromboflebitis/diagnóstico , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/etiología , Apendicitis/diagnóstico , Antibacterianos/uso terapéutico , Sepsis/etiología , Vena PortaRESUMEN
Objective:To analyze the clinical diagnosis, treatment ï¼and surgical timing of otogenic intracranial complications. Methods:The clinical data of 11 patients with intracranial complications with ear symptoms as the first manifestation in Department of Otorhinolaryngology Head and Neck Surgery, Qilu Hospital of Shandong Universityï¼Qingdaoï¼ from December 2014 to June 2022 were collected, including 8 males and 3 females, aged from 4 to 69 years. All patients had complete otoendoscopy, audiology, imaging and etiology examination, and the diagnosis and treatment plan was jointly developed through multidisciplinary consultation according to the critical degree of clinical symptoms and imaging changes. Among the 11 patients, 5 cases were treated with intracranial lesions first in neurosurgery department and middle ear lesions later in otolaryngology, 3 cases of meningitis, were treated with middle ear surgery after intracranial infection control, 1 case was treated with middle ear lesions and intracranial infection simultaneously, and 2 cases were treated with sigmoid sinus and transverse sinus thrombosis conservatively. They were followed up for 1-6 years. Descriptive statistical methods were used for analysis. Results:All the 11 patients had ear varying symptoms, including ear pain, pus discharge and hearing loss, etc, and then fever appeared, headache, disturbance of consciousness, facial paralysis and other intracranial complication. Otoendoscopy showed perforation of the relaxation of the tympanic membrane in 5 cases, major perforation of the tension in 3 cases, neoplasia in the ear canal in 1 case, bulging of the tympanic membrane in 1 case, and turbidity of the tympanic membrane in 1 case. There were 4 cases of conductive hearing loss, 4 cases of mixed hearing loss and 3 cases of total deafness. Imaging examination showed cholesteatoma of the middle ear complicated with temporal lobe brain abscess in 4 cases, cerebellar abscess in 2 cases, cholesteatoma of the middle ear complicated with intracranial infection in 3 cases, and sigmoid sinus thrombophlebitis in 2 cases. In the etiological examination, 2 cases of Streptococcus pneumoniae were cultured in the pus of brain abscess and cerebrospinal fluid, and 1 case was cultured in streptococcus vestibularis, Bacteroides uniformis and Proteus mirabilis respectively. During the follow-up, 1 patient died of cardiovascular disease 3 years after discharge, and the remaining 10 patients survived. There was no recurrence of intracranial and middle ear lesions. Sigmoid sinus and transverse sinus thrombosis were significantly improved. Conclusion:Brain abscess, intracranial infection and thrombophlebitis are the most common otogenic intracranial complications, and cholesteatoma of middle ear is the most common primary disease. Timely diagnosis, multidisciplinary collaboration, accurate grasp of the timing in the treatment of primary focal and complications have improved the cure rate of the disease.
Asunto(s)
Absceso Encefálico , Infecciones del Sistema Nervioso Central , Enfermedades del Oído , Trombosis de los Senos Intracraneales , Tromboflebitis , Femenino , Humanos , Masculino , Absceso Encefálico/etiología , Absceso Encefálico/terapia , Colesteatoma , Sordera/etiología , Pérdida Auditiva/etiología , Trombosis del Seno Lateral/etiología , Trombosis del Seno Lateral/terapia , Estudios Retrospectivos , Tromboflebitis/etiología , Tromboflebitis/terapia , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Colesteatoma del Oído Medio/complicaciones , Colesteatoma del Oído Medio/terapia , Infecciones del Sistema Nervioso Central/etiología , Infecciones del Sistema Nervioso Central/terapia , Trombosis de los Senos Intracraneales/etiología , Trombosis de los Senos Intracraneales/terapia , Enfermedades del Oído/complicaciones , Enfermedades del Oído/terapiaRESUMEN
RATIONALE: Septic thrombophlebitis of the internal jugular vein also known as Lemierre syndrome occurs secondary to an oropharyngeal infection often leading to septic embolisms to distant sites. Anaerobic gram-negative bacillus, Fusobacterium nucleatum and Fusobacterium necrophorum are commonly isolated organisms. Fusobacterium species has also been reported to complicate an intra-abdominal infection leading to septic thrombophlebitis of portal vein also known as pylephlebitis or abdominal variant of lemierre syndrome. PATIENT CONCERNS: The patient was a middle-aged female patient with chief complaints of abdominal discomfort, intermittent fever and vomiting for one month. DIAGNOSES: The final diagnosis was septic thrombophlebitis of portal and splenic vein secondary to Fusobacterium nucleatum. INTERVENTIONS: Patient was managed with broad spectrum intravenous antibiotics with coverage against gram-negative bacilli, anaerobes, and aerobic streptococcus species with therapeutic anticoagulation. OUTCOMES: Patient gradually improved and was discharged on oral apixaban. She was instructed to follow up with gastrointestinal specialist upon discharge in anticipation of the need for liver transplant in future. LESSONS: Due to its high mortality and associated long term disease morbidity, clinicians should always strive towards early diagnosis and treatment of the condition with involvement of multidisciplinary teams.
Asunto(s)
Síndrome de Lemierre , Infecciones de los Tejidos Blandos , Tromboflebitis , Persona de Mediana Edad , Humanos , Femenino , Síndrome de Lemierre/complicaciones , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/tratamiento farmacológico , Fusobacterium nucleatum , Vena Esplénica , Tromboflebitis/etiología , Abdomen , Venas YugularesAsunto(s)
Mastitis , Tromboflebitis , Femenino , Humanos , Tromboflebitis/diagnóstico , Tromboflebitis/etiología , Pie , Extremidad InferiorRESUMEN
Background: The pilephlebitis is the septic thrombophlebitis of the portal venous system ranging from asymptomatic to severe complications. Diagnosed based on imaging tests, and their treatment is based on antibiotics and anticoagulant therapy. Clinic case: 24 years male, appendectomy 12 days before. Readmission for 3 days with fever, jaundice and choluria; hyperbilirrubinemia. Intravenous contrast CT is performed, showed thrombus in portal, splenic and mesenteric vein system. Diagnosis of pylephlebitis is established, initiating managed with antibiotics and anticoagulant, with favorable clinical outcome. The pylephlebitis has an estimated incidence of 2.7 cases per year, with an unspecified clinical picture ranging from asymptomatic to severe cases with septic shock and hepatic failure. There may be accompanying fever and abdominal pain in more than 80% of the cases and presenting in some cases with leukocytosis and hyperbilirrubinemia. Intravenous contrast CT is the gold standard. The treatment is based on 4 points: Septic focus control, antibiotics, early anticoagulant and resolution of complications. Conclusions: The pylephlebitis should be taken into consideration as a possible secondary complication of intraabdominal infections. A timely diagnosis with a imaging tests and apply treatment reduce their morbidity and mortality.
Introducción: la pileflebitis es la tromboflebitis séptica del sistema venoso portal, que puede variar desde un cuadro asintomático hasta complicaciones severas. Su diagnóstico requiere estudios de imagen y su tratamiento se basa en la antibioticoterapia y anticoagulación. Caso clínico: paciente hombre de 24 años de edad, posoperado de apendicetomía 12 días previos. Reingresa por fiebre de tres días, ictericia y coluria, hiperbilirrubinemia. Se realiza tomografía con contraste intravenoso, evidenciando trombo en sistema portoesplemesaraico. Se establece diagnóstico de pileflebitis, iniciando manejo con antibióticos y anticoagulación, con evolución clínica favorable. La pileflebitis tiene una incidencia estimada de 2.7 casos por año, con un cuadro clínico inespecífico, que va desde un estado asintomático a casos graves con choque séptico y falla hepática. Puede haber dolor abdominal y fiebre en más del 80% de los casos, presentando en algunos casos leucocitosis e hiperbilirrubinemia. La tomografía con contraste intravenoso es el estudio de elección. El tratamiento se basa en cuatro puntos: control del foco séptico, antibióticos, anticoagulación precoz y resolución de las complicaciones. Conclusiones: se debe tener en cuenta a la pileflebitis como una posible complicación secundaria en casos de infecciones intraabdominales, estableciendo un diagnóstico oportuno con estudio de imagen y otorgar tratamiento temprano para reducir su morbimortalidad.
Asunto(s)
Apendicitis , Tromboflebitis , Humanos , Masculino , Apendicitis/complicaciones , Apendicitis/diagnóstico , Apendicitis/terapia , Vena Porta , Tromboflebitis/etiología , Tromboflebitis/complicaciones , Anticoagulantes/uso terapéutico , Antibacterianos/uso terapéuticoRESUMEN
The current report presents two cases with leg ulcers related to Behçet's disease (BD) resistant to conventional immunosuppressive therapy (CIST) but successfully treated with adalimumab (ADA). BD, which can affect vessels of any size and type, is a systemic vasculitis. In the vascular system, veins are the most predominantly affected blood vessels, with deep vein thrombosis and recurrent superficial vein thrombophlebitis being the most common vascular signs of the disease in the lower extremities. Leg ulcers, commonly associated with vasculitis or deep vein thrombosis, are rare in patients with BD. Conventional immunosuppressive therapy is very critical to prevent relapses and diminish the risk of post-thrombotic syndrome. In patients with BD-associated venous thrombosis (deep vein thrombosis or superficial vein thrombophlebitis) resistant to these treatments, tumour necrosis factor-α inhibitors can be used alone or in combination with traditional disease-modifying antirheumatic drugs. In view of such information, add-on adalimumab treatment was considered appropriate for both patients. Response to this intervention was highly satisfying for the patients at the end of the 6-month treatment. Nonetheless, it warrants further studies directly evaluating the efficacy of tumour necrosis factor-α inhibitors alone in leg ulcers in BD.
Asunto(s)
Síndrome de Behçet , Úlcera de la Pierna , Tromboflebitis , Trombosis de la Vena , Humanos , Adalimumab/uso terapéutico , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamiento farmacológico , Factor de Necrosis Tumoral alfa , Inmunosupresores/uso terapéutico , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/etiología , Tromboflebitis/diagnóstico , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/etiología , Terapia de Inmunosupresión , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/tratamiento farmacológico , Úlcera de la Pierna/etiologíaRESUMEN
To clarify the effect of catheter indwelling depth on the occurrence of thrombophlebitis, a total of 339 hospitalized patients were randomly enrolled and divided by the catheter indwelling depth into 2 groups. Then the effect of indwelling depth on thrombophlebitis was analyzed, and the independent influence factors on the occurrence of thrombophlebitis were clarified. There were 49 cases of thrombophlebitis, including 8 tumor-bearing patients and 41 patients with lung infection. Thirteen of the 135 patients with indwelling depth of 1 cm, and 36 of the 204 patients with indwelling depth of 1.9 cm suffered thrombophlebitis. The relationship between incidence rate of thrombophlebitis and clinicopathological parameters was analyzed. It was found the incidence of thrombophlebitis was significantly correlated with males (X2 = 5.77), lung infection (X2 = 7.79), and indwelling depth of 1.9 cm (X2 = 4.223). Multifactor analysis of variance showed the significant independent risk factors of thrombophlebitis were male [hazard ratio (HR) 3.12 (1.39-6.98)], and lung infection (HR 0.22 [0.06-0.69]), and the indwelling depth of 1.9 cm affected the occurrence of thrombophlebitis (HR 0.79 [0.42 -3.09]) but was not an independent risk factor. In our treatment center, while appropriate fixation was ensured, the catheter indwelling depth shall be as short as possible, so as to reduce the occurrence of thrombophlebitis. For patients with lung infection, nursing at the intubation site shall be strengthened, so as to decrease thrombophlebitis.
Asunto(s)
Cateterismo Periférico , Tromboflebitis , Humanos , Masculino , Femenino , Cateterismo Periférico/efectos adversos , Catéteres de Permanencia/efectos adversos , Tromboflebitis/epidemiología , Tromboflebitis/etiología , Factores de Riesgo , Vejiga UrinariaRESUMEN
BACKGROUND: Septic thrombophlebitis (STP) of the lower extremities caused by foreign bodies is rare in the clinic, and the symptoms are serious. If the correct treatment is not implemented as soon as possible, the patient may progress to sepsis. CASE PRESENTATION: We report the case of a 51-year-old normally healthy male who developed fever 3 days after field work. When he was weeding with a lawn mower in the field, a metal foreign body from the grass flew into his left lower abdomen, resulting in an eschar on his left lower abdomen. He was diagnosed with scrub typhus but did not respond well to anti-infective treatment. After a detailed inquiry of his medical history and an auxiliary examination, the diagnosis was confirmed as STP of the left lower limb caused by a foreign body. After surgery, anticoagulation and anti-infection treatment, the infection and thrombosis were controlled, and the patient was cured and discharged. CONCLUSIONS: STP caused by foreign bodies is rare. Early detection of the aetiology of sepsis and early adoption of the correct measures can effectively block the progression of the disease and reduce the patient's pain. Clinicians should identify the source of sepsis through a medical history and clinical examination.
Asunto(s)
Cuerpos Extraños , Tifus por Ácaros , Sepsis , Infecciones de los Tejidos Blandos , Tromboflebitis , Humanos , Masculino , Persona de Mediana Edad , Tifus por Ácaros/diagnóstico , Sepsis/diagnóstico , Sepsis/etiología , Tromboflebitis/diagnóstico , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/etiología , Extremidad Inferior , Cuerpos Extraños/complicaciones , Cuerpos Extraños/diagnósticoRESUMEN
Phlegmasia alba dolens is a rare sequela of acute extensive venothrombus of the iliofemoral segments. Rarely, phlegmasia alba dolens can also result from clotted inferior vena cava filter. A 39-year-old with protein S deficiency, and prior inferior vena cava filter placement after remote trauma presented to the emergency department with progressive bilateral lower extremity pain and swelling. Venous duplex revealed extensive bilateral deep vein thromboses from the external iliac veins to popliteal veins, as well as thrombophlebitis of the left great saphenous vein. Venography confirmed patency of the suprarenal vena cava with abrupt occlusion of the infrarenal segment at the level of the inferior vena cava filter. The filter was removed followed by endovascular thrombectomy and adjunctive venoplasty. The patient progressed well and discharged on therapeutic anticoagulation. This case illustrates that a staged endovascular approach may be utilized for acute on chronic caval thrombosis and filter removal.