RESUMEN
Background: Renal angiomyolipoma (AML) without local invasion is generally considered benign. However, it may extend to the renal sinus, even the renal vein, or the inferior vena cava (IVC). In patients with non-tuberous sclerosis complex, coexistence of renal cell carcinoma (RCC) and renal AML is uncommon. Case presentation: A 72-year-old woman was incidentally found to have a solitary right renal mass with an IVC thrombus extending into the right atrium during a routine health checkup. Robot-assisted laparoscopic radical nephrectomy and thrombectomy were successfully performed through adequate preoperative examination and preparation. Two tumor lesions were found and pathologically confirmed as renal AML and RCC, and the tumor thrombus was derived from the renal AML. During the one-year follow-up period, no signs of recurrence or metastatic disease were observed. Conclusions: Renal AML with a tumor thrombus in the IVC and right atrium accompanied by RCC may occur, although rarely. In clinical practice, if preoperative manifestations differ from those of common diseases, rare diseases must be considered to avoid missed diagnoses. In addition, adequate examination and multidisciplinary discussions before making a diagnosis are necessary. For a level 4 tumor thrombus with no infringement of the venous wall, adoption of robot-assisted minimally invasive surgery, without extracorporeal circulation technology, is feasible.
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Angiomiolipoma , Carcinoma de Células Renales , Atrios Cardíacos , Neoplasias Renales , Vena Cava Inferior , Humanos , Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/cirugía , Femenino , Anciano , Vena Cava Inferior/diagnóstico por imagen , Neoplasias Renales/complicaciones , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Angiomiolipoma/complicaciones , Angiomiolipoma/cirugía , Atrios Cardíacos/diagnóstico por imagen , Nefrectomía/métodos , Trombectomía/métodos , Trombosis/cirugía , Trombosis/complicaciones , Procedimientos Quirúrgicos Robotizados/métodosRESUMEN
A rare transthoracic echocardiographic image of left sinus of Valsalva aneurysm complicated by thrombus formation.
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Aneurisma de la Aorta , Ecocardiografía , Seno Aórtico , Trombosis , Humanos , Seno Aórtico/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/complicaciones , Ecocardiografía/métodos , Masculino , Diagnóstico DiferencialAsunto(s)
Apéndice Atrial , Estenosis de la Válvula Mitral , Índice de Severidad de la Enfermedad , Trombosis , Humanos , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/complicaciones , Apéndice Atrial/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/complicaciones , Cardiopatías/diagnóstico por imagen , Cardiopatías/complicaciones , Masculino , FemeninoAsunto(s)
Aneurisma de la Aorta Torácica , Polimialgia Reumática , Trombosis , Humanos , Polimialgia Reumática/complicaciones , Polimialgia Reumática/diagnóstico , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/diagnóstico , Femenino , Anciano , Masculino , Anciano de 80 o más Años , Tomografía Computarizada por Rayos XRESUMEN
Testicular malignancies commonly affect adolescent and young adult males. Although they tend to respond well to cisplatin-based chemotherapy with excellent overall survival, complications such as inferior vena cava tumor thrombus are rare and can be associated with high morbidity and mortality. We present a case of tumor thrombus in a 21-year-old active duty male with a newly diagnosed stage IIIB non-seminomatous germ cell tumor presenting with extensive left lower extremity swelling. Ultrasound with Doppler was notable for significant thrombus of the left common femoral, femoral, and popliteal vein. Computed tomography imaging revealed extensive thrombus of the inferior vena cava, left iliac veins, and left gonadal vein with sparing of the left renal vein. Endovascular thrombectomy was performed with pathologic analysis confirming the presence of malignant cells consistent with tumor thrombus. The patient continued subsequent non-seminomatous germ cell tumor treatment without complications.
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Personal Militar , Neoplasias de Células Germinales y Embrionarias , Neoplasias Testiculares , Humanos , Masculino , Neoplasias de Células Germinales y Embrionarias/complicaciones , Neoplasias Testiculares/complicaciones , Adulto Joven , Trombosis/etiología , Trombosis/complicaciones , Vena Cava Inferior , Tomografía Computarizada por Rayos X/métodos , Trombectomía/métodosRESUMEN
Hepatic abscesses are divided into bacterial and amoebic types. Although the prognosis of bacterial liver abscesses has improved owing to progress in drainage techniques and antimicrobial agents, poor outcomes remain common. While there have been some reports of amoebic liver abscesses complicated by thrombosis, bacterial liver abscesses and subsequent thrombus in the right atrium are very rare. We herein report the case of an 82-year-old man. He had suffered acute obstructive suppurative cholangitis 10 months previously, and bile culture yielded Enterococcus faecalis. In the present case, a right atrial thrombus caused by a bacterial liver abscess was observed and the causative organism was thought to be Enterococcus faecalis, for which was detected in a blood culture was positive. The patient was successfully treated with hepatic abscess drainage and surgical right atrial thrombectomy under cardiopulmonary bypass with a beating heart.
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Atrios Cardíacos , Cardiopatías , Absceso Piógeno Hepático , Trombosis , Humanos , Masculino , Absceso Piógeno Hepático/diagnóstico por imagen , Absceso Piógeno Hepático/complicaciones , Absceso Piógeno Hepático/cirugía , Anciano de 80 o más Años , Atrios Cardíacos/cirugía , Trombosis/cirugía , Trombosis/diagnóstico por imagen , Trombosis/complicaciones , Cardiopatías/complicaciones , Cardiopatías/cirugía , Cardiopatías/diagnóstico por imagen , Enterococcus faecalis , Infecciones por Bacterias Grampositivas/complicacionesRESUMEN
AIMS: Blood stasis is crucial in developing left atrial (LA) thrombi. LA appendage peak flow velocity (LAAFV) is a quantitative parameter for estimating thromboembolic risk. However, its impact on LA thrombus resolution and clinical outcomes remains unclear. METHODS AND RESULTS: The LAT study was a multicentre observational study investigating patients with atrial fibrillation (AF) and silent LA thrombi detected by transoesophageal echocardiography (TEE). Among 17 436 TEE procedures for patients with AF, 297 patients (1.7%) had silent LA thrombi. Excluding patients without follow-up examinations, we enrolled 169 whose baseline LAAFV was available. Oral anticoagulation use increased from 85.7% at baseline to 97.0% at the final follow-up (P < 0.001). During 1 year, LA thrombus resolution was confirmed in 130 (76.9%) patients within 76 (34-138) days. Conversely, 26 had residual LA thrombi, 8 had thromboembolisms, and 5 required surgical removal. These patients with failed thrombus resolution had lower baseline LAAFV than those with successful resolution (18.0 [15.8-22.0] vs. 22.2 [17.0-35.0], P = 0.003). Despite limited predictive power (area under the curve, 0.659; P = 0.001), LAAFV ≤ 20.0â cm/s (best cut-off) significantly predicted failed LA thrombus resolution, even after adjusting for potential confounders (odds ratio, 2.72; 95% confidence interval, 1.22-6.09; P = 0.015). The incidence of adverse outcomes including ischaemic stroke/systemic embolism, major bleeding, or all-cause death was significantly higher in patients with reduced LAAFV than in those with preserved LAAFV (28.4% vs. 11.6%, log-rank P = 0.005). CONCLUSION: Failed LA thrombus resolution was not rare in patients with AF and silent LA thrombi. Reduced LAAFV was associated with failed LA thrombus resolution and adverse clinical outcomes.
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Anticoagulantes , Apéndice Atrial , Fibrilación Atrial , Ecocardiografía Transesofágica , Trombosis , Humanos , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/complicaciones , Masculino , Femenino , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Anciano , Trombosis/fisiopatología , Trombosis/diagnóstico por imagen , Trombosis/complicaciones , Persona de Mediana Edad , Velocidad del Flujo Sanguíneo , Anticoagulantes/uso terapéutico , Factores de Riesgo , Resultado del Tratamiento , Enfermedades Asintomáticas , Factores de Tiempo , Cardiopatías/fisiopatología , Cardiopatías/complicaciones , Cardiopatías/diagnóstico por imagen , Tromboembolia/etiología , Tromboembolia/fisiopatología , Anciano de 80 o más Años , Función del Atrio IzquierdoRESUMEN
BACKGROUND: Thrombosis with thrombocytopenia syndrome (TTS) is a very rare prothrombotic disorder that is a safety concern for some COVID-19 vaccines. We aimed to devise a case definition to estimate the incidence of thrombosis with thrombocytopenia as a proxy for TTS in a national insurance claims database. METHODS: We conducted a retrospective observational study using the National Health Insurance Research Database (NHIRD) in Taiwan over the three-year period prior to the SARS-COV-2 pandemic (2017-2019). Our case definition was all patients with newly diagnosed thrombosis co-occurring with a diagnosis of thrombocytopenia within seven days before or after the thrombosis diagnosis. Cases were identified using International Classification of Disease-10 codes. FINDINGS: We identified 2010 patients with newly diagnosed thrombosis co-occurring with thrombocytopenia during the study period. The mean age was 64.71 years; female:male ratio 1:1.45. The most frequent thrombotic events were coronary artery disease (18.81%), cerebral infarction (16.87%), and disseminated intravascular coagulation (13.13%). Cerebral venous sinus thrombosis was rare (<0.1%). The average annual incidence rate of co-occurring new diagnoses of thrombosis and thrombocytopenia was 2.84 per 100 000 population. Incidence rates were higher in men than women, except in 20-39 year-olds (higher in females). 20.6% of patients died within the first month after diagnosis. INTERPRETATION: We observed that the demographic and clinical characteristics of thrombosis with co-occurring thrombocytopenia using our case definition is different from that of TTS. Further research is needed to refine the case definition of TTS in the post-COVID-19 vaccination period.
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COVID-19 , Trombocitopenia , Trombosis , Humanos , Femenino , Masculino , Persona de Mediana Edad , COVID-19/complicaciones , COVID-19/epidemiología , Trombocitopenia/epidemiología , Trombocitopenia/complicaciones , Incidencia , Trombosis/epidemiología , Trombosis/etiología , Trombosis/complicaciones , Anciano , Estudios Retrospectivos , Taiwán/epidemiología , Adulto , SARS-CoV-2/aislamiento & purificación , Adulto Joven , Anciano de 80 o más Años , Bases de Datos Factuales , Adolescente , PandemiasAsunto(s)
Empiema , Insuficiencia Cardíaca , Ventrículos Cardíacos , Arteritis de Takayasu , Trombosis , Humanos , Femenino , Arteritis de Takayasu/complicaciones , Arteritis de Takayasu/diagnóstico por imagen , Adulto , Insuficiencia Cardíaca/etiología , Trombosis/diagnóstico por imagen , Trombosis/complicaciones , Trombosis/patología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Empiema/diagnóstico por imagen , Enfermedad AgudaRESUMEN
BACKGROUND: A coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction. CASE PRESENTATION: We describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a "giant" CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up. CONCLUSIONS: Management of rare entities such as "giant" CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.
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Fístula Arteriovenosa , Aneurisma Coronario , Enfermedad de la Arteria Coronaria , Infarto del Miocardio , Trombosis , Femenino , Humanos , Persona de Mediana Edad , Volumen Sistólico , Función Ventricular Izquierda , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/etiología , Infarto del Miocardio/terapia , Aneurisma Coronario/complicaciones , Aneurisma Coronario/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico por imagen , Trombosis/complicaciones , Angiografía Coronaria/métodosRESUMEN
CASE: A 47-year-old orthopaedic surgeon presented with acute volar left wrist pain. He performed over 250 robot-assisted knee arthroplasties each year. Color Doppler evaluation revealed bilateral persistent median arteries and bifid median nerves, with focal occlusive thrombosis of the left median artery. He was advised rest and oral aspirin. He could return to his professional activities after 1 month. He had no recurrence of symptoms at 1 year of follow-up. CONCLUSION: Orthopaedic surgeons use vibrating hand tools on a daily basis. The possibility of hand-arm vibration syndrome must be considered in the differential diagnosis of wrist pain among orthopaedic surgeons.
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Artroplastia de Reemplazo de Rodilla , Síndrome del Túnel Carpiano , Procedimientos Quirúrgicos Robotizados , Robótica , Cirujanos , Trombosis , Humanos , Masculino , Persona de Mediana Edad , Arterias , Artralgia/cirugía , Síndrome del Túnel Carpiano/cirugía , Nervio Mediano/cirugía , Trombosis/etiología , Trombosis/complicacionesAsunto(s)
Trombosis de las Arterias Carótidas , Estenosis Carotídea , Trombosis , Humanos , Arterias Carótidas , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Arteria Carótida Interna , Trombosis de las Arterias Carótidas/complicaciones , Trombosis de las Arterias Carótidas/diagnóstico por imagenRESUMEN
Continuously holding its position as the sixth most common cause of cancer and the third leading cause of cancer death, globally, Hepatocellular Carcinoma (HCC) remains as a healthcare priority. Production of various substances may result into systemic or metabolic complications, often known as paraneoplastic phenomena of HCC. A 56-year-old male with history of untreated chronic hepatitis B arrived with generalized weakness and intermittent headache in the last two days prior to admission. Laboratory findings demonstrated elevated hemoglobin (20.5 g/dl), alpha-fetoprotein (29,845 ng/dl), and d-Dimer (2,120 ng/ml) levels. Hypoglycemia (44 mg/dl) was documented with normal basal insulin level, confirming non-islet cell tumor hypoglycemia. Abdominal multiphasic CT-scan demonstrated a large solid lesion involving the whole right liver lobe, hyper-enhanced at arterial phase and wash-out pattern at venous and delayed phases, with portal vein thrombosis; thus, confirming HCC BCLC C. Further examinations revealed hypercellularity from bone marrow biopsy with the absence of JAK2 mutation. He underwent serial phlebotomy and received 80 mg acetylsalicylic acid orally, as well as cytoreductive agent to reduce the risk of thrombosis. Despite applications of different interventions, control of hypoglycemia could not be achieved without parenteral administration of high dextrose load. He was planned to receive oral multikinase inhibitor, however, he passed away due to severe hospital-acquired pneumonia. Paraneoplastic phenomena are common in HCC. Increased risk of blood hyper-viscosity and thrombosis attributed to polycythemia, as well as medical emergency resulting from hypoglycemia showed that both conditions should not be overlooked since they may worsen the patient's prognosis.
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Carcinoma Hepatocelular , Hipoglucemia , Neoplasias Hepáticas , Policitemia , Trombosis , Masculino , Humanos , Persona de Mediana Edad , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/patología , Policitemia/complicaciones , Trombosis/complicaciones , Hipoglucemia/etiologíaRESUMEN
Congenital protein C (PC) deficiency is one type of hereditary thrombosis. Patients with hereditary thrombosis are at high risk for thrombosis in the perioperative period, but a standard management strategy has not been established. Here we report a case of perioperative management of a fracture in a child with homozygous congenital PC deficiency. The patient was a 3-year-old boy who was diagnosed with congenital PC deficiency at birth. He sustained a traumatic supracondylar fracture of the right humerus and underwent emergency surgery. To prepare for open surgery for fixation of the fracture, warfarin was discontinued, and an activated PC (APC) concentrate was used in combination with vitamin K antagonism. However, warfarin was administered during the scheduled nail extraction because the operation was minimally invasive. No thrombotic or bleeding complications occurred in either operation. In emergency surgery in patients with congenital PC deficiency, the combination of vitamin K and APC concentrate is considered a maintenance option for PC deficiency. Postoperative PT-INR control was difficult in our patient due to the administration of vitamin K and withdrawal of warfarin, and this issue must be addressed in the future. Further case experience is desirable to standardize perioperative management.
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Fracturas Óseas , Deficiencia de Proteína C , Trombosis , Preescolar , Humanos , Recién Nacido , Masculino , Anticoagulantes , Fracturas Óseas/complicaciones , Deficiencia de Proteína C/complicaciones , Trombosis/complicaciones , Vitamina K , Warfarina/uso terapéuticoAsunto(s)
Estenosis de la Válvula Aórtica , Atrios Cardíacos , Estenosis de la Válvula Mitral , Derrame Pleural , Cardiopatía Reumática , Trombosis , Humanos , Estenosis de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/cirugía , Trombosis/complicaciones , Atrios Cardíacos/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/cirugía , Derrame Pleural/etiología , Derrame Pleural/diagnóstico por imagen , Femenino , Cardiopatías/etiología , Cardiopatías/complicaciones , Cardiopatías/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The importance of thromboembolism in the pathogenesis of lacunar stroke (LS), resulting from cerebral small vessel disease (cSVD), is debated, and although antiplatelets are widely used in secondary prevention after LS, there is limited trial evidence from well-subtyped patients to support this approach. We sought to evaluate whether altered anticoagulation plays a causal role in LS and cSVD using 2-sample Mendelian randomization. METHODS: From a recent genome-wide association study (n=81â 190), we used 119 genetic variants associated with venous thrombosis at genome-wide significance (P<5*10-8) and with a linkage disequilibrium r2<0.001 as instrumental variables. We also used genetic associations with stroke from the GIGASTROKE consortium (62â 100 ischemic stroke cases: 10â 804 cardioembolic stroke, 6399 large-artery stroke, and 6811 LS). In view of the lower specificity for LS with the CT-based phenotyping mainly used in GIGASTROKE, we also used data from patients with magnetic resonance imaging-confirmed LS (n=3199). We also investigated associations with more chronic magnetic resonance imaging features of cSVD, namely, white matter hyperintensities (n=37â 355) and diffusion tensor imaging metrics (n=36â 533). RESULTS: Mendelian randomization analyses showed that genetic predisposition to venous thrombosis was associated with an increased odds of any ischemic stroke (odds ratio [OR], 1.19 [95% CI, 1.13-1.26]), cardioembolic stroke (OR, 1.32 [95% CI, 1.21-1.45]), and large-artery stroke (OR, 1.41 [95% CI, 1.26-1.57]) but not with LS (OR, 1.07 [95% CI, 0.99-1.17]) in GIGASTROKE. Similar results were found for magnetic resonance imaging-confirmed LS (OR, 0.94 [95% CI, 0.81-1.09]). Genetically predicted risk of venous thrombosis was not associated with imaging markers of cSVD. CONCLUSIONS: These findings suggest that altered thrombosis plays a role in the risk of cardioembolic and large-artery stroke but is not a causal risk factor for LS or imaging markers of cSVD. This raises the possibility that antithrombotic medication may be less effective in cSVD and underscores the necessity for further trials in well-subtyped cohorts with LS to evaluate the efficacy of different antithrombotic regimens in LS.
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Enfermedades de los Pequeños Vasos Cerebrales , Accidente Cerebrovascular Embólico , Accidente Vascular Cerebral Lacunar , Accidente Cerebrovascular , Trombosis , Trombosis de la Vena , Humanos , Enfermedades de los Pequeños Vasos Cerebrales/diagnóstico por imagen , Enfermedades de los Pequeños Vasos Cerebrales/genética , Enfermedades de los Pequeños Vasos Cerebrales/complicaciones , Imagen de Difusión Tensora , Accidente Cerebrovascular Embólico/complicaciones , Fibrinolíticos , Estudio de Asociación del Genoma Completo , Análisis de la Aleatorización Mendeliana , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/genética , Accidente Cerebrovascular/complicaciones , Accidente Vascular Cerebral Lacunar/diagnóstico por imagen , Accidente Vascular Cerebral Lacunar/genética , Accidente Vascular Cerebral Lacunar/complicaciones , Trombosis/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/epidemiología , Trombosis de la Vena/genéticaRESUMEN
OBJECTIVES: (I) To identify and measure the clinical consequences of a delayed diagnosis in patients with primary obstetric antiphospholipid syndrome (POAPS), in terms of time and events associated to antiphospholipid syndrome (APS), and (II) to evaluate the impact of their treatment status on perinatal outcomes, before and after diagnosis. METHODS: This retrospective multicentre study included 99 POAPS women who were separated in two groups of timelines based on their diagnostic status: group 1: women who met the clinical criteria for POAPS; group 2: included the same patients from group 1 since they meet the laboratory criteria for APS. In group 1, we assessed the following variables: obstetric events, thrombotic events and time (years) to diagnosis of APS. We also compared perinatal outcomes between patients in group 1 vs. group 2. Women in group 2 were treated with standard of care for POAPS. Simple and multivariable logistic regression analyses were performed. RESULTS: Regarding the impact of the delay on diagnosis, a total of 87 APS-related events were recorded: 46 miscarriages, 32 foetal losses and 9 premature deliveries before the 34th week due to preeclampsia, and one thrombosis. The estimated rate of preventable events was 20.58 per year/100 patients. The mean diagnostic delay time was 4.27 years. When we compared both groups during pregnancy, we found that patients in group 1 (no treatment) had a higher association with pregnancy losses [OR = 6.71 (95% CI: 3.59-12.55), p < 0.0001]. CONCLUSION: Our findings emphasize the negative impact of POAPS underdiagnosis on patient health and the critical importance of a timely intervention to improve pregnancy outcomes. Key Points â¢Our study shows the relevance of underdiagnosis on primary obstetric antiphospholipid syndrome (POAPS). â¢These patients presented a high risk of APS-related events with each passing year. â¢Shorter diagnostic delay time was observed in the reference centres.