1/57. Thrombosis of mitral valve prosthesis presenting as abdominal pain.A 67-year-old woman presented with abdominal pain, anemia, and leukocytosis. Five years previously, the patient had undergone mitral valve replacement with a St. Jude bileaflet mechanical prosthesis. After her admission, echocardiography confirmed an immobile leaflet of the prosthetic valve. At urgent surgery, thrombosis and pannus, obstructing the disc, were found, and the mechanical valve was replaced with a bioprosthesis. The incidence of mitral valve thrombosis is low, ranging from 0.1% to 5.7% per patient per year. patients who receive inadequate anticoagulation, particularly with valve prostheses in the mitral position, have an increased risk for thrombus or pannus formation. Presentation varies, from symptoms of congestive heart failure or systemic embolization, to fever or no symptoms. New or worsening symptoms in a patient with a prosthetic heart valve should raise concerns about prosthetic dysfunction. Aggressive investigation and, if indicated, urgent or emergency surgery for treatment can be lifesaving.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
2/57. Extensive spontaneous retroperitoneal hemorrhage: an unusual complication of heparin anticoagulation during pregnancy.A 27-year-old patient at 13 weeks' gestation maintained on subcutaneous heparinization due to hemoglobin S and hemoglobin c (SC) sickle cell disease and previous splenic vein thrombosis presented with spontaneous acute onset of severe left lower abdominal and groin pain. The pain, which radiated to the anterior aspect of the thigh, was associated with nausea and vomiting and was exacerbated by extension of the left lower extremity. The patient was hemodynamically stable, yet during the first 24 h of hospitalization a marked decrease in hematocrit from 29% to 22% occurred. Contrast computed tomography (CT) revealed an extensive abdominal-pelvic, retroperitoneal hematoma extending approximately 15 cm in length from above L5 cephalad to below the greater trochanter of the left femur caudally. The retroperitoneal hemorrhage self-tamponaded and did not require surgical management. The dosage of heparin was decreased and maintained with appropriate activated partial prothrombin (aPTT) levels. To our knowledge, this is the first report of a spontaneous retroperitoneal hemorrhage complicating heparin anticoagulation in pregnancy. Unusual hemorrhagic complications of anticoagulation therapy are discussed.- - - - - - - - - - ranking = 0.5keywords = thrombosis (Clic here for more details about this article) |
3/57. Mesenteric venous thrombosis associated with protein c deficiency.An 83-year-old man had gradually worsening abdominal pain and vomiting. laparotomy revealed segmental intestinal infarction resulting from thrombosis in the superior mesenteric vein. Necrosed intestine was resected and anastomosis was performed successfully. The patient was anticoagulated with intravenous heparin and nafamostat mesilate followed by oral aspirin. He recovered rapidly. Blood chemistry revealed protein c deficiency, while protein S and antithrombin iii levels were normal. Laboratory evaluation of these proteins may help define the cause of mesenteric venous thrombosis.- - - - - - - - - - ranking = 3keywords = thrombosis (Clic here for more details about this article) |
4/57. Mesenteric vein thrombosis due to factor v Leiden gene mutation.BACKGROUND: Mesenteric venous thrombosis is a rare cause of acute abdominal pain that may be the result of coagulation abnormalities. methods: Four consecutive patients with mesenteric venous thrombosis underwent haematological evaluation. RESULTS: All four had activated protein c resistance resulting from a single mutation in the gene coding for coagulation factor v. Three had surgery; in one patient the diagnosis was made by ultrasonography. One of the patients who had surgery died but the other three survived and were treated with long-term anticoagulation. CONCLUSION: activated protein c resistance may be an important pathogenetic factor in primary mesen-teric vein thrombosis.- - - - - - - - - - ranking = 3.5keywords = thrombosis (Clic here for more details about this article) |
5/57. Mesenteric and portal vein thrombosis in a young patient with protein s deficiency treated with urokinase via the superior mesenteric artery.A 32-year-old man, who was previously healthy, had acute abdominal pain without peritonitis. Diffuse mesenteric and portal vein thrombosis were shown by means of a computed tomography scan. A protein s deficiency was found by means of an extensive workup for hypercoagulable state. Successful treatment was achieved with urokinase infusion via the superior mesenteric artery without an operation. This represents an attractive alternative approach to treating patients with this disease. The previous standard of operative intervention(1) can now be reserved for complications, such as bowel infarction with peritonitis, or for those patients with absolute contraindications to thrombolytic therapy.- - - - - - - - - - ranking = 2.5keywords = thrombosis (Clic here for more details about this article) |
6/57. Superior mesenteric and portal vein thrombosis following laparoscopic nissen fundoplication.This case report describes superior mesenteric and portal vein thrombosis after laparoscopic Nissen fundoplication. As a thromboembolic prophylaxis, 2,500 IU of dalteparin was given preoperatively. After postoperative day 19, the patient experienced gradually increasing abdominal pain, mostly related to meals. physical examination and laboratory tests were normal. CT scan revealed a portal and superior mesenteric vein thrombosis. dalteparin and warfarin treatment was started, and symptoms relieved rapidly. In a control Doppler ultrasound 1 month after the onset of the treatment, a good flow in the portal and superior mesenteric vein was seen. Possible mechanisms are discussed.- - - - - - - - - - ranking = 3keywords = thrombosis (Clic here for more details about this article) |
7/57. Isolated dissection of the celiac artery--a case report.Isolated arterial dissection, which occurs with the absence of aortic dissection, has been reported in carotid and renal arteries but rarely in visceral arteries. A case of isolated celiac artery dissection is reported here. A healthy 58-year-old man experienced sudden upper abdominal pain, which continued for several days. A body computed tomogram (CT) showed a multiple low-density wedge-shaped area in the spleen, which was diagnosed as splenic infarction, and an aneurysm with thrombus in the celiac artery. A selective angiogram showed dilatation of the celiac artery with wall irregularity, and proximal occlusion of the hepatic artery. The distal hepatic artery was fed by collateral arteries from the superior mesenteric artery. splenic infarction was probably due to the embolism from the thrombus in the dissected celiac artery. The absence of other vascular lesions and causes or risks for the arterial dissection would suggest the occurrence of spontaneous dissection. The dissection of visceral arteries should be considered in diagnosing acute abdominal pain.- - - - - - - - - - ranking = 0.01245746132223keywords = embolism (Clic here for more details about this article) |
8/57. Right atrial myxoma with extracardiac manifestations.Right atrial myxoma is a rare intracardiac tumor that is often difficult to diagnose. pulmonary embolism from tumor fragments originating from the tumor mass is a potentially fatal complication. early diagnosis of cardiac myxoma is important since surgical treatment leads to resolution with low rates of recurrence and good long-term survival. The presence of a cardiac myxoma can be heralded by nonspecific constitutional symptoms as well as by disturbances in the clotting mechanism.- - - - - - - - - - ranking = 0.01245746132223keywords = embolism (Clic here for more details about this article) |
9/57. enoxaparin associated with hugh abdominal wall hematomas: a report of two cases.enoxaparin is a low-molecular-weight heparin used for prophylaxis against deep venous thrombosis. Indications include hip and knee replacement surgery, risk of deep venous thrombosis during abdominal surgery, and prevention of ischemic complications of unstable angina and non-Q-wave myocardial infarction. Its efficacy in the prevention of the above complications has been previously studied; however, the liberal use of enoxaparin is not without incident. Complications of enoxaparin include hemorrhage, thrombocytopenia, and local reactions. Since 1993 there have been more than 40 reports of epidural or spinal hematoma formation with the concurrent use of enoxaparin and spinal/epidural anesthesia or spinal puncture. Herein reported are two cases of abdominal wall hematomas in patients receiving prophylaxis with enoxaparin. Both patients sustained an unexplained fall in the hematocrit and abdominal pain. A CT scan confirmed the diagnosis. One patient recovered uneventfully; however, the other patient, on chronic hemodialysis, became hemodynamically unstable and hyperkalemic and sustained a fatal cardiac arrhythmia. An extensive review of the literature revealed no similar cases of abdominal wall hematomas associated with enoxaparin although other complications, including spinal and epidural hematomas, psoas hematomas, and skin necrosis have been reported. The extended use of enoxaparin as an anticoagulant requires the physician to be vigilant of these rare complications. Bleeding can occur at any site during therapy with enoxaparin. An unexplained fall in the hematocrit or blood pressure should lead to a search for a bleeding site.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
10/57. Mesenteric venous thrombosis: a diagnosis not to be missed!Mesenteric venous thrombosis (MVT), an uncommon but important clinical entity, is one possible cause of ischemia or infarction of the small intestine. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptoms. The hallmark is pain that is out of proportion to the physical findings. We report two cases of MVT, where the patients initially presented with vague abdominal symptoms. Diagnosis was made on the basis of computed tomography of the abdomen showing thrombus within the superior mesenteric vein. A search for a precipitating condition revealed no evidence of a hypercoagulable state, myeloproliferative disorder, or malignancy. These cases illustrate well the nonspecific clinical presentation of MVT. A high index of suspicion, recognition of known risk factors, or a previous history of venous thrombosis coupled with a history of nonspecific abdominal symptoms should alert clinicians to the possibility of MVT. early diagnosis and prompt anticoagulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel.- - - - - - - - - - ranking = 3keywords = thrombosis (Clic here for more details about this article) |
| | Next -> |