RESUMO
A forma mamária da síndrome de Mondor é uma afecção rara e autolimitada que se caracteriza pela tromboflebite de veias superficiais da mama. Entender tal síndrome é de suma importância para o diagnóstico correto e o tratamento preciso e não iatrogênico, tendo em vista apresentar considerável relação com o carcinoma mamário. Esse relato de caso retrata o surgimento da síndrome de Mondor em uma paciente jovem de 22 anos, após uma mamoplastia de aumento. O sinal característico da afecção, o cordão fibroso, manifestou-se na mama direita a partir do vigésimo terceiro dia de pós-operatório, desaparecendo por completo após 10 semanas. O diagnóstico foi dado pelo cirurgião plástico que acompanhou a paciente mediante anamnese e exame físico, sem a urgência de um exame complementar, como a mamografia. Vale ressaltar que tal afecção rara pode acometer o sexo masculino - em menor frequência - e afetar outras regiões, como o pênis e o escroto. Ademais, é salutar reconhecer e diagnosticar a síndrome de Mondor, visto que as cirurgias com o fitoestético estão em constante crescimento na atualidade, com o escopo de conduzir os pacientes da melhor forma para um tratamento eficaz e menos invasivo (exceto na presença concomitante de câncer de mama, por exemplo), além de tranquilizá-los a respeito da afecção.
The breast form of Mondor syndrome is a rare and self-limited condition characterized by thrombophlebitis of the superficial veins of the breast. Understanding this syndrome is extremely important for correct diagnosis and precise, non-iatrogenic treatment, given that it has a considerable relationship with breast carcinoma. This case report portrays the emergence of Mondor syndrome in a young 22-year-old patient, after breast augmentation. The characteristic sign of the condition, the fibrous cord, appeared in the right breast from the twenty-third day after surgery, disappearing completely after 10 weeks. The diagnosis was given by the plastic surgeon who followed the patient through anamnesis and physical examination, without the urgency of a complementary exam, such as a mammography. It is worth mentioning that this rare condition can affect males - less frequently - and affect other regions, such as the penis and scrotum. Furthermore, it is beneficial to recognize and diagnose Mondor syndrome, as surgeries using phytoaesthetics are constantly growing today, intending to guide patients in the best way possible for an effective and less invasive treatment (except in the concomitant presence of cancer). breast, for example), in addition to reassuring them about the condition.
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Plantar vein thrombosis (PVT) is an underdiagnosed condition affecting the deep plantar veins, with challenging clinical diagnosis, often presenting with non-specific symptoms that mimic other foot pathologies. This study assessed the magnetic resonance imaging (MRI) features of patients diagnosed with PVT to contribute to the understanding of this condition. We performed the comprehensive analysis of a substantial dataset, including 112 patients, with a total of 130 positive MRI scans (86 of the forefoot and 44 of the ankle) presenting with PVT. Upon evaluating all the veins of the feet, we observed a higher frequency of involvement of the lateral plantar veins (53.1%) when compared to the medial veins (3.8%). The most affected vascular segments in the forefeet were the plantar metatarsal veins (45.4%), the plantar venous arch (38.5%), and the plantar communicating veins (25.4%). The characteristic findings on MRI were perivascular edema (100%), muscular edema (86.2%), venous ectasia (100%), perivascular enhancement (100%), and intravenous filling defects (97.7%). Our study provides valuable insights into the imaging evaluation of PVT and shows that MRI is a reliable resource for such diagnosis.
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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.
Assuntos
Humanos , Criança , Apendicite/diagnóstico , Tromboflebite/diagnóstico , Tromboflebite/etiologia , Tromboflebite/tratamento farmacológico , Sepse/etiologia , Hepatopatias , Veia Porta , Antibacterianos/uso terapêuticoRESUMO
Plantar vein thrombosis is a venous disorder affecting deep plantar veins that can manifest with non-specific localized pain, plantar foot pain, swelling, and sensation of fullness. Plantar veins are not routinely assessed during sonographic scans for deep venous thrombosis, which makes plantar venous thrombosis a commonly missed diagnosis. This paper provides a comprehensive review of the venous anatomy of the foot and imaging findings of plantar venous thrombosis as well as discusses the current literature on the topic and its differential diagnoses.
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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.
Assuntos
Apendicite , Hepatopatias , Sepse , Tromboflebite , Humanos , Criança , Tromboflebite/diagnóstico , Tromboflebite/tratamento farmacológico , Tromboflebite/etiologia , Apendicite/diagnóstico , Antibacterianos/uso terapêutico , Sepse/etiologia , Veia PortaRESUMO
Abstract Lemierre's syndrome is marked by presence of septic thrombophlebitis in the internal jugular vein. This case report describes a 57-year-old woman who presented with a progressively swelling neck with onset 1 day prior to admission. She had a history of untreated dental infection. Physical examination revealed slightly increased blood pressure, at 140/80 mmHg, and a painful, erythematous, warm swelling in the mid area of the neck. Ultrasound of the neck revealed occlusive intraluminal thrombus in the right internal jugular vein, a computed tomography (CT) scan with contrast showed that there was a blockage in the right jugular vein. The mainstay treatment for Lemierre's syndrome is antibiotics, while administration of anticoagulants remains controversial. The patient was treated conservatively, with administration of antibiotics and anticoagulant. Several days later the patient's condition had improved significantly, with less pain and reduced swelling.
Resumo A síndrome de Lemierre é caracterizada pela presença de tromboflebite séptica da veia jugular interna. Este relato de caso descreve uma mulher de 57 anos que apresentou edema progressivo no pescoço 1 dia antes da internação. Ela tinha histórico de infecção dentária não tratada. O exame físico revelou pressão arterial levemente aumentada (140/80 mmHg), além de protuberância dolorosa, eritematosa e com aumento da temperatura na região média do pescoço. A ultrassonografia do pescoço revelou trombo intraluminal na veia jugular interna direita, e a tomografia computadorizada com contraste mostrou que havia trombose na veia jugular direita. O tratamento principal da síndrome de Lemierre é a antibioticoterapia, enquanto a administração de anticoagulantes permanece controversa. A paciente foi tratada de forma conservadora com administração de antibióticos e anticoagulantes. Vários dias depois, a condição da paciente melhorou significativamente, com diminuição do nível de dor e do tamanho da protuberância.
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Resumen El síndrome de Lemierre, también denominado trom boflebitis séptica de la vena yugular interna, necrobaci losis o sepsis postanginal es una infección que inicia en el espacio orofaríngeo, se complica con tromboflebitis séptica de la vena yugular interna y metástasis infeccio sas. La rápida progresión a cuadros clínicos graves que comprometen la vida del paciente y su baja frecuencia justifican la divulgación de casos clínicos. Se presenta el caso de una mujer de 27 años de edad, que a las 48 horas de completar el tratamiento con fenoximetilpenicilina por una infección odontógena evolucionó con edema facial y trismus. En la angio-TC de macizo craneofacial se evidenció extenso trombo en la vena yugular interna y en la tomografía computarizada de tórax, embolias sépticas pulmonares. El tratamiento consistió en antibió ticos endovenosos de amplio espectro y anticoagulación de manera precoz.
Abstract Lemierre's syndrome, also called septic thrombo phlebitis of the internal jugular vein, necrobacillosis or postanginal sepsis, is an infection that begins in the oropharyngeal space, is complicated by septic throm bophlebitis of the internal jugular vein and infectious metastases. The rapid progression to serious clinical conditions that compromise the patient's life and its low frequency justify the disclosure of clinical cases. We present the case of a 27-year-old woman who de veloped facial edema and trismus 48 hours after com pleting treatment with phenoxymethylpenicillin for an odontogenic infection. An angio-CT of the craniofacial massif revealed an extensive thrombus in the internal jugular vein and a computed tomography of the chest showed septic pulmonary emboli. Treatment consisted of broad-spectrum intravenous antibiotics and early anticoagulation.
RESUMO
Lemierre's syndrome, also called septic thrombophlebitis of the internal jugular vein, necrobacillosis or postanginal sepsis, is an infection that begins in the oropharyngeal space, is complicated by septic thrombophlebitis of the internal jugular vein and infectious metastases. The rapid progression to serious clinical conditions that compromise the patient's life and its low frequency justify the disclosure of clinical cases. We present the case of a 27-year-old woman who developed facial edema and trismus 48 hours after completing treatment with phenoxymethylpenicillin for an odontogenic infection. An angio-CT of the craniofacial massif revealed an extensive thrombus in the internal jugular vein and a computed tomography of the chest showed septic pulmonary emboli. Treatment consisted of broad-spectrum intravenous antibiotics and early anticoagulation.
El síndrome de Lemierre, también denominado tromboflebitis séptica de la vena yugular interna, necrobacilosis o sepsis postanginal es una infección que inicia en el espacio orofaríngeo, se complica con tromboflebitis séptica de la vena yugular interna y metástasis infecciosas. La rápida progresión a cuadros clínicos graves que comprometen la vida del paciente y su baja frecuencia justifican la divulgación de casos clínicos. Se presenta el caso de una mujer de 27 años de edad, que a las 48 horas de completar el tratamiento con fenoximetilpenicilina por una infección odontógena evolucionó con edema facial y trismus. En la angio-TC de macizo craneofacial se evidenció extenso trombo en la vena yugular interna y en la tomografía computarizada de tórax, embolias sépticas pulmonares. El tratamiento consistió en antibióticos endovenosos de amplio espectro y anticoagulación de manera precoz.
Assuntos
Síndrome de Lemierre , Embolia Pulmonar , Sepse , Tromboflebite , Feminino , Humanos , Adulto , Síndrome de Lemierre/complicações , Síndrome de Lemierre/tratamento farmacológico , Tromboflebite/complicações , Tromboflebite/tratamento farmacológico , Embolia Pulmonar/complicações , Anticoagulantes/uso terapêuticoRESUMO
Clinical signs and symptoms of venous thrombosis and musculoskeletal pathologies frequently overlap. Sometimes, patients with venous thrombosis undergo MR examinations under an equivocal suspicion of muscle, tendon or articular injury. A low pretest clinical suspicion and lack of familiarity with the conventional MR imaging signs of venous thrombosis may result in failure to diagnose venous thrombosis, delaying treatment and raising morbimortality. In MR imaging, thrombosis presents as venous ectasia with intraluminal heterogeneous content. Small vein thrombosis is often identified as having a branching aspect. Perivenous edema and inflammatory soft tissue changes may be the most prominent findings. The purpose of this paper is to illustrate MR findings of venous thrombosis in patients who underwent MR examinations due to suspected musculoskeletal pathologies. Cases of venous thrombosis in different sites of the body diagnosed through MR are presented.
Assuntos
Imageamento por Ressonância Magnética , Trombose Venosa , Humanos , Trombose Venosa/diagnóstico por imagemRESUMO
RESUMEN Introducción: La enfermedad de Mondor es una tromboflebitis superficial que afecta las venas subcutáneas toracoabdominales de forma unilateral, con un pico de incidencia en la quinta década de la vida, afecta de manera especial a las mujeres. Objetivo: Describir la presentación de una tromboflebitis superficial de la vena toracoepigástrica, también llamada enfermedad de Mondor en un varón adulto. Caso clínico: Paciente masculino de 43 años de edad, sin antecedentes relevantes quien acudió a consulta por presentar dolor constante de tres días de evolución localizado en región torácica antero lateral derecha de moderada intensidad no asociado a otra sintomatología. Los hallazgos clínicos destacados durante la exploración abarcaron cifras tensionales elevadas y la presencia de cordón subcutáneo, indurado, que se extiende desde el tercio inferior del cuadrante superior externo de la mama derecha hasta la región subcostal derecha. Se realizó ultrasonografía que reportó ausencia de colapso del vaso estudiado mediante compresión del transductor; se estableció diagnóstico de enfermedad de Mondor y se prescribieron antiinflamatorios no esteroideos durante una semana, con una mejoría gradual de los síntomas y resolución completa a las seis semanas de seguimiento. Conclusiones: Esta enfermedad, a pesar de ser poco frecuente en pacientes masculinos, debe tenerse en cuenta dentro de los diagnósticos diferenciales ante cuadros de dolor o induración longitudinal superficial en pared anterolateral del tórax, aun en ausencia de factores de riesgo para su aparición, el uso de la ultrasonografía corresponde a una buena herramienta diagnóstica complementaria para llegar al diagnóstico.
ABSTRACT Introduction: Mondor's disease is a superficial thrombophlebitis that affects the thoracoabdominal subcutaneous veins mainly unilaterally, with a peak incidence in the fifth decade of life affecting mainly women. Objective: To describe the presentation of a superficial thrombophlebitis of the thoracoepigastric vein, also called Mondor's disease, in a male adult. Case report: A 43-year-old male patient with no relevant history who consulted for presenting constant pain of three days of evolution located in the right anterolateral thoracic region of moderate intensity not associated with other symptoms. The clinical findings highlighted during the examination include elevated blood pressure levels and the presence of an indurated subcutaneous cord that extends from the lower third of the upper outer quadrant of the right breast to the right subcostal region. Ultrasonography is performed, which reports the absence of collapse of the vessel studied by compression of the transducer. A diagnosis of Mondor's disease is established and non-steroidal anti-inflammatory drugs are prescribed for one week, with gradual improvement in symptoms and complete resolution at six weeks of follow-up. Conclusions: This disease, despite being a rare entity, especially in male patients, should be taken into account within the differential diagnoses of pain or superficial longitudinal induration in the anterolateral chest wall, even in the absence of risk factors for its appearance, the use of ultrasonography corresponds to a good complementary diagnostic tool to reach the diagnosis.
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Se presenta el caso clínico de un paciente de 21 años de edad, con antecedente de herniorrafia inguinal derecha, quien asistió a consulta de control y refirió presentar una induración y dolor en la región dorsal del pene con 4 días de evolución, que había comenzado después de una relación sexual en la cual consumió marihuana. En el examen físico se encontró la vena dorsal del pene engrosada, dura y dolorosa a la palpación. Se le diagnosticó una enfermedad de Mondor del pene. La ecografía Doppler confirmó la tromboflebitis de esta vena. El paciente recibió tratamiento médico y evolucionó satisfactoriamente.
The case report of a 21 years patient with history of right inguinal herniorrhaphy is presented, who attended control visit and he made reference to an induration and pain in the dorsal region of the penis with 4 days of evolution that had begun after a sexual relationship in which he consumed marihuana. In the physical exam the penis dorsal vein was found thicken, hard and painful to the palpation. He was diagnosed a Mondor disease of the penis. The Doppler scanning confirmed the thrombophlebitis of this vein. The patient received medical treatment and had a favorable clinical course.
Assuntos
Pênis/lesões , Tromboflebite/diagnóstico por imagem , Ultrassonografia Doppler , HerniorrafiaRESUMO
RESUMEN Introducción: el síndrome de Lemierre, describe a la flebotrombosis séptica de la vena yugular interna posterior a una infección orofaríngea. Esta enfermedad representa un verdadero reto diagnóstico para el médico practicante. Las complicaciones más temidas son las relacionadas con la embolización a distancia. Objetivo: describir la evolución clínica de una paciente con síndrome de Lemierre atendida en el Hospital Militar Central "Dr. Carlos J. Finlay". Caso Clínico: paciente femenina de 24 años de edad, con antecedentes de salud; 12 días antes del ingreso comenzó con fiebre de 39-40˚C, asociada a odinofagia y secreciones blanquecinas localizadas sobre ambas amígdalas. Tras recibir antibioticoterapia por vía oral percibe discreta mejoría. Luego de la cual recrudece la fiebre, aparece tos, disnea y dolor en punta de costado en el hemitórax derecho. Conclusiones: la evolución de la paciente fue satisfactoria luego del drenaje quirúrgico de la colección pleural, el uso de antibióticos específicos y la anticoagulación. La atención de pacientes con síndrome de Lemierre requiere asistencia especializada.
ABSTRACT Introduction: Lemierre's Syndrome (LS) describes septic phlebothrombosis of the internal jugular vein following oropharyngeal infection. This entity represents a real diagnostic challenge for the practicing physician. The most alarming complications are those related to distant embolization. Objective: to describe the clinical evolution of a patient with Lemierre's Syndrome treated at Dr. Carlos J. Finlay Central Military Hospital. Case Report: a 24-year-old female patient with a medical history; who 12 days before admission started with fever of 39-40˚C, associated with odynophagia and whitish secretions located over both tonsils. After receiving oral antibiotic therapy, she perceived a slight improvement. Subsequently fever intensified, cough, dyspnea and flank pain in the right hemithorax appear. Conclusions: the evolution of the patient was satisfactory after surgical drainage of the pleural collection, the use of specific antibiotics and anticoagulation. The care of patients with Lemierre's syndrome requires specialized assistance.
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Resumen Objetivo: Revisar la incidencia de esta enfermedad en pacientes sometidos a mamoplastías en una clínicaprivada en el período de 11 años, con el fin de describir sus síntomas y signos, diagnóstico, tratamiento y evolución. Materiales y Método: Se estudiaron 355 mujeres que se sometieron a mamoplastías estéticas. Se excluyó aquellas cirugías reconstructivas secundarias a cáncer de mama y aquellas con otros antecedentes oncológicos previos. La información fue recolectada de las fichas clínicas. Resultado: Se analizan 710 mamas operadas en el período 2008-2018, de las cuales seis mamas (6/710) evolucionaron con enfermedad de Mondor (0,8%). El diagnóstico se realizó clínicamente. Todos los casos recibieron terapia antiinflamatoria oral y local, respondiendo favorablemente. Discusión: Existe poca literatura publicada al respecto. Casos bilaterales son menos reportados. Pareciera asociarse con cirugías del surco submamario y no está claro que requiera curación terapéutica. Conclusiones: La enfermedad de Mondor es infrecuente, puede presentarse secundario a mamoplastías, es de diagnóstico clínico y sólo tratamiento sintomático con evolución satisfactoria sin secuelas.
Aim: Review the disease incidence in patients who had mammoplasties in a private clinic on a 11 year-period. The purpose is to describe their symptoms and signs, diagnosis, treatment and evolution. Materials and Method: 355 women who underwent cosmetic mammoplasties were studied. Those reconstructive surgeries secondary to breast cancer and those with other previous oncological history were excluded. The information was collected from clinical files. Results: 710 breasts operated between 2008-2018 are analyzed, six of them (6/710) evolved Mondor disease (0.8%). The diagnosis was made clinically. All cases received oral and local antiinflammatory therapy, responding favorably. Discussion: There is a few published literature about it. Bilateral cases are less reported. It appears to be associated with surgeries of the submammary sulcus and it is not clear that it requires therapeutic cure. Conclusions: Mondor's disease is infrequent, can occur secondary to mammoplasty, diagnosis is clinical, treatment is symptomatic, all cases had satisfactory evolution without sequelae.
Assuntos
Humanos , Feminino , Tromboflebite/diagnóstico , Tromboflebite/terapia , Veias/patologia , Mama/cirurgia , Complicações Pós-Operatórias , Período Pós-Operatório , Parede Abdominal/patologia , Tratamento ConservadorRESUMO
Tromboses e tromboflebites superficiais de membros superiores são doenças frequentes e muitas vezes pouco valorizadas. Relatamos três pacientes no pós-operatório de cirurgias plásticas mamárias estéticas que apresentaram tromboflebite em membros superiores e que evoluíram com tromboembolismo pulmonar. Todas as pacientes apresentaram quadro clínico típico, com comprovação pelo Doppler ultrassonografia de trombose/flebite superficial de membros superiores e ausência de lesões em membros inferiores, bem como aumento de dímero-D e comprovação da embolia pulmonar por tomografia computadorizada ou cintilografia pulmonar. Os três casos evoluíram com melhora após anticoagulação e sem sequelas.
Superficial thrombosis and thrombophlebitis of the upper limbs are frequent and often underestimated diseases. We report three patients in the postoperative cosmetic breast plastic surgery period who presented thrombophlebitis in the upper limbs and who evolved with pulmonary thromboembolism. All patients had a typical clinical picture, with Doppler ultrasound evidence of thrombosis/superficial phlebitis of the upper limbs and absence of lesions in the lower limbs and an increase in D-dimer and evidence of pulmonary embolism by computed tomography or pulmonary scintigraphy. The three cases evolved with improvement after anticoagulation and without sequelae.
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La enfermedad de Mondor es una entidad clínica caracterizada por la aparición de una induración palpable similar a un cordón en la superficie del cuerpo. En general es considerada como una tromboflebitis benigna autolimitada que se resuelve en cuatro u ocho semanas sin ningún tratamiento específico. Se presenta un caso de aparición súbita y evolución favorable, espontánea. Se realiza una revisión de la literatura a propósito del mismo.
Mondor's disease is a clinical entity characterized by the appearance of a palpable cord-like lesion on the surface of the body. It is generally considered self-limiting benign thrombophlebitis that resolves in four to eight weeks without any specific treatment. It presents in the case of sudden appearance and favorable, spontaneous evolution. A literature review on the subject is carried out.
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RESUMEN Presentamos caso clínico de puérpera de cesárea de noveno día con cuadro febril en espigas, asintomática, en que se plantea desde su ingreso el diagnóstico de tromboflebitis séptica pelviana y se inicia tratamiento con antibióticos parenterales de amplio espectro y heparina de bajo peso molecular en dosis terapéuticas. La respuesta es a la mejoría al tercer día de tratamiento. Se discuten los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.
ABSTRACT A case of a woman on her 9th post-operative day after childbirth by cesarean section (CS) consulting with febrile spikes, otherwise asymptomatic, is presented. The diagnosis of a septic pelvic thrombophlebitis is proposed from the admission and treated with parenteral broad-spectrum antibiotics and low-molecular-weight heparin at therapeutic doses. Patient significantly improved on her third day of treatment. The diagnostic procedures, differential diagnosis and treatment are discussed.
Assuntos
Humanos , Feminino , Adulto , Ovário/irrigação sanguínea , Tromboflebite/etiologia , Cesárea/efeitos adversos , Sepse/etiologia , Pelve/irrigação sanguínea , Tromboflebite/tratamento farmacológico , Tromboflebite/diagnóstico por imagem , Heparina/uso terapêutico , Tomografia Computadorizada por Raios X , Sepse/tratamento farmacológico , Sepse/diagnóstico por imagem , Diagnóstico Diferencial , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêuticoRESUMO
Resumen La flegmasia cerulea dolens (FCD, flebitis, cianosis, dolor) es una complicación rara de la trombosis venosa profunda, se debe a obstrucción del retorno venoso, generalmente del miembro inferior, con cianosis severa y compromiso circulatorio que compromete vasos colaterales, a diferencia de la flegmasía alba dolens que no compromete las colaterales. El cuadro clínico se caracteriza por dolor de inicio súbito, debido al aumento significativo de la presión venosa, que lleva a ausencia de pulsos periféricos y gangrena. Pocas veces se presenta en la práctica médica diaria, por lo que el diagnóstico es importante para evitar la gangrena. Se presentan tres casos de pacientes atendidos. Se confirmó el diagnóstico clínico y por imágenes, se muestra la evolución y el tratamiento médico realizado.
Summary Phlegmasia cerulea dolens (phlebitis, cyanosis, pain) is a rare severe form of deep venous thrombosis, caused by obstruction of the vein flow of the lower limb (usually) with severe cyanosis and circulatory compromise which affects collateral vessels, unlike Phlegmasia alba dolens not compromise collateral vessels. It is characterized by sudden onset of pain, because an increase of the venous pressure, that can lead to pulselessness and gangrene. Is unfrequently in daily medical practice, so the diagnosis is important to avoid gangrene. We present three cases of patients attended with this disease. Diagnosis was confirmed by clinic and imaging; we present the evolution and medical treatment that was performed.
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Resumen: El síndrome de Lemierre constituye una entidad poco frecuente y potencialmente grave que puede complicar una infección orofaríngea. Incluye una tromboflebitis de la vena yugular interna y embolias sépticas a distancia. Presentamos el caso clínico de un hombre joven que se presentó, luego de una infección respiratoria alta, con una trombosis de vena yugular interna, seno sigmoideo y transverso izquierdos, asociando además tromboembolismo pulmonar séptico y empiema pleural. Mostró buena evolución con antibioticoterapia empírica, drenaje pleural y anticoagulación. Realizamos una revisión de la literatura sobre este tema enfatizando los aspectos clínicos, epidemiológicos y microbiológicos.
Summary: Lemierre's syndrome constitutes a rare and potentially serious entity, that may complicate oropharyngeal infections. This condition includes thrombophlebitis of the internal jugular vein and distant septic embolisms. The study presents the clinical case of a young man who consulted after an upper respiratory infection, with internal jugular vein thrombosis, left sigmoid and transverse seins, also associating septic pulmonary embolism and pleural empyema. The patient had a positive evolution after empirical antibiotic, pleural drainage and anticoagulants. We conducted literature review on this condition, focusing on clinical, epidemiological and microbiological aspects.
Resumo: A síndrome de Lemierre é uma doença rara e potencialmente grave que pode complicar uma infecção orofaríngea. Inclui uma tromboflebite da veia jugular interna e embolias sépticas a distância. Descrevemos o caso clínico de um homem jovem que depois de uma infecção respiratória alta apresentou trombose de veia jugular interna, seio sigmoide e transverso esquerdos, associado com tromboembolismo pulmonar séptico e empiema pleural. Teve boa evolução com antibioticoterapia empírica, drenagem pleural e anticoagulação. Realizamos uma revisão da literatura sobre este tema enfatizando os aspectos clínicos, epidemiológicos e microbiológicos.
Assuntos
Adulto , Síndrome de Lemierre , Embolia Pulmonar , Trombose VenosaRESUMO
A síndrome de Lemierre caracteriza-se por uma rara entidade que gera tromboflebite da veia jugular interna e embolismo séptico em história da infecção recente da orofaringe, além de sinais radiológicos e isolamento de patógenos anaeróbicos, principalmente Fusobacterium necrophorum. Relatamos o caso de uma paciente do sexo feminino, 13 anos de idade, com histórico de carcinoma de nasofaringe associado ao vírus Epstein-Barr (estadiamento T4N2M0), submetida a procedimentos cirúrgicos e quimiorradioterapia. Iniciou com queixa de mialgia intensa, diplopia, lesões infectadas em membros e choque séptico. Por meio de exames de ultrassonografia cervical com Doppler colorido e tomografia computadorizada de pescoço com contraste endovenoso, foram identificados trombos intraluminais na veia jugular interna, além de trombos sépticos pulmonares, por meio da tomografia computadorizada de tórax. Posteriormente, ainda evoluiu com artrite piogênica coxofemoral esquerda. Foi isolada, por hemocultura, a bactéria Klebsiella pneumoniae Carpemenase, e o tratamento se deu pela associação entre vancomicina, amicacina, meropenem, metronidazol e anfotericina B. Conclui-se que, após o diagnóstico de SL e, embora com múltiplas complicações e diagnóstico tardio, a paciente encontra-se bem e assintomática, além do relato comprovar a dificuldade diagnóstica e de seu tratamento
Lemierre's syndrome is a rare condition that leads to thrombophlebitis of the internal jugular vein and septic embolism following recent oropharyngeal infection, being characterized by radiological signs and isolation of anaerobic pathogens, especially Fusobacterium necrophorum. We report the case of a 13-year-old female patient with history of nasopharyngeal carcinoma associated with Epstein-Barr virus (T4N2M0 staging), who underwent surgical procedures and chemoradiotherapy. Her initial complaint was severe myalgia, diplopia, infected limb injuries, and septic shock. Cervical color Doppler ultrasound and computed tomography scan of the neck with intravenous contrast showed intraluminal thrombi in the internal jugular vein, and chest computed tomography showed pulmonary septic thrombi. Subsequently, she progressed with left coxofemoral pyogenic arthritis. The bacterium Klebsiella pneumoniae Carpemenase was isolated in blood culture, and the patient was treated with the association of vancomycin, amikacin, meropenem, metronidazole, and amphotericin B. It is concluded that, despite the multiple complications and late diagnosis, the patient is well and asymptomatic after the diagnosis of Lemierre's syndrome; in addition, the report proves the difficulty of diagnosis and treatme
Assuntos
Humanos , Feminino , Adolescente , Embolia Pulmonar/etiologia , Artrite Infecciosa/etiologia , Síndrome de Lemierre/complicações , Articulação do Quadril/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Antivirais/uso terapêutico , Derrame Pleural/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Esvaziamento Cervical , Sinovite/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias Nasofaríngeas/virologia , Herpesvirus Humano 4/isolamento & purificação , Ultrassonografia Doppler em Cores , Doenças Raras/complicações , Diagnóstico Diferencial , Diagnóstico Tardio , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/microbiologia , Síndrome de Lemierre/sangue , Síndrome de Lemierre/virologia , Hemocultura , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêuticoRESUMO
Superficial venous thrombosis (SVT) or superficial thrombophlebitis is characterized by thrombi within superficial veins, with partial involvement or occlusion of the lumen and inflammatory reaction along the course of the vein. Clinical diagnosis tends to be straightforward, but supplementary tests and examinations are needed to confirm thrombosis extension and possible thromboembolic complications. SVT can be associated with deep venous thrombosis in 6 to 40% of cases, with asymptomatic pulmonary embolism (PE) in 20 to 33%, and with symptomatic PE in 2 to 13%. Despite the morbidity and complications, there are currently no Brazilian guidelines for SVT. These guidelines cover the most important issues related to SVT definition, terminology, and etiology, and set out recommendations for diagnosis and treatment.