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May-Thurner syndrome/Cockets syndrome/ileocaval syndrome is a rarely diagnosed, anatomical and pathologically variable condition, causing venous flow obstruction in iliocaval territory. We report a case of 64 year old male patient who presented with unprovoked proximal deep venous thrombosis (DVT) of left lower limb. Evaluated for hypercoagulable s...
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Background
D-dimer is a biomarker of fibrin production and degradation, and changes in D-dimer concentration suggest fibrin clot formation, which is associated with thromboembolism and hypercoagulable states. Thus, an elevated D-dimer concentration could be a useful prognostic predictor for patients with venous thromboembolism (VTE).
Methods and r...
Citations
... TKA total knee arthroplasty, DVT deep vein thrombosis, RCIA right common iliac artery, IVC inferior vena cava, LCIV left common iliac vein, CTV CT venography the LCIV, followed by the RCIV and this frequency was consistent with our results. The reason for more frequent LCIV compression was due to the larger angle between the inferior vena cava (IVC) and LCIV and the more likely transverse course predisposing to compression [4,37]. Since the IVC was likely compressed simultaneously with LCIV opening compression [37], it was thought that LCIV compression was associated with both limb distal DVT after TKA. ...
... The reason for more frequent LCIV compression was due to the larger angle between the inferior vena cava (IVC) and LCIV and the more likely transverse course predisposing to compression [4,37]. Since the IVC was likely compressed simultaneously with LCIV opening compression [37], it was thought that LCIV compression was associated with both limb distal DVT after TKA. On the other hand, the branching angle of RCIV from IVC was small with a vertical course [4,37], so RCIV compression was not frequent and seemed to be associated with only right limb DVT. ...
... Since the IVC was likely compressed simultaneously with LCIV opening compression [37], it was thought that LCIV compression was associated with both limb distal DVT after TKA. On the other hand, the branching angle of RCIV from IVC was small with a vertical course [4,37], so RCIV compression was not frequent and seemed to be associated with only right limb DVT. Collectively, we found that the presence of IVCS, regardless of the LCIV or RCIV compression, might be associated with DVT occurrence after TKA. ...
Introduction
This study aimed to identify whether iliac vein compression syndrome(IVCS) is associated with deep vein thrombosis(DVT) after total knee arthroplasty(TKA) and whether lower lumbar degenerative changes were risk factors for IVCS.
Materials and methods
A total of 259 consecutive patients who underwent TKA from January 2019 to March 2022 was retrospectively reviewed. Preoperative plain radiographs of lumbar spines and CT venography (CTV) for DVT diagnosis at postoperative 7 days were performed in all patients. Imaging findings of lower lumbar degenerative changes were analyzed on plain radiograph including lateral osteophytes, scoliosis, lateralolisthesis, retrolisthesis, anterolisthesis, and lower lumbar lordosis angle (LLLA). Percent compression at the left common iliac vein (LCIV) and right common iliac vein (RCIV) as well as DVT were evaluated on CTV. Moreover, IVCS was defined as greater than 50% of compression of the iliac vein on CTV.
Results
DVT occurred in 79 patients (30.5%) after TKA. The overall occurrence of DVT was significantly higher in patients with IVCS of LCIV (52.8%) than those without (18.8%, P < 0.001). When DVT was further subdivided, compared to non-IVCS, IVCS of LCIV was significantly associated with bilateral DVT (P < 0.001, both), especially distal DVT (P < 0.001, both), and IVCS of RCIV was significantly associated with right-side DVT (P = 0.031), especially popliteal (P = 0.008) and distal DVT(P = 0.011). Female patients (OR: 3.945, P = 0.039), presence of left osteophyte (OR: 2.348, P = 0.006), and higher LLLA (OR: 1.082, P < 0.001) were significantly associated with IVCS of LCIV, and presence of right osteophyte (OR: 3.494, P = 0.017) was significantly associated with IVCS of RCIV.
Conclusion
IVCS was significantly associated with DVT after TKA and lumbar degenerative changes with lateral osteophytes and hyperlordosis were significant risk factors for IVCS.
... Some suggest that the proportion of patients with this anatomy is underestimated, because some patients do not have any lower extremity symptoms or have delayed occurrence of symptoms. For example, the age at which symptoms first occurred was >60 years in some patients [4,5]. The fact that some patients do not have symptoms or have delayed onset of symptoms has previously been explained from an anatomical perspective, including differences in the severity of iliac vein compression or the development of intimal hyperplasia. ...
Background and Objectives: Compression of the common iliac veins (CIV) is not always associated with lower extremity symptoms. This study analyzed this issue from the perspective of patient venous blood flow changes using quantitative flow magnetic resonance imaging. Materials and Methods: After we excluded patients with active deep vein thrombosis, the mean flux (MF) and mean velocity (MV) of the popliteal vein, femoral vein, and external iliac vein (EIV) were compared between the left and right sides. Results: Overall, 26 of the patients had unilateral CIV compression, of which 16 patients had symptoms. No significant differences were noted in the MF or MV of the veins between the two sides. However, for the 10 patients without symptoms, the EIV MF of the compression side was significantly lower than the EIV MF of the non-compression side (p = 0.04). The receiver operating characteristic curve and chi-squared analyses showed that when the percentage difference of EIV MF between the compression and non-compression sides was ≤−18.5%, the relative risk of associated lower extremity symptoms was 0.44 (p = 0.016). Conclusions: If a person has compression of the CIV, a decrease in EIV blood flow rate on the compression side reduces the rate of symptom occurrence.
... This cytokine storm can be associated with the severity of the disease and its negative consequences [23,24]. Blood clots formed in DVT may also have a variety of causes, including vascular damage, surgery, special medications, and limited mobility [25], but the exact cause of COVID-19-induced DVT is still unknown [26]. ...
In December 2019, the World Health Organization (WHO) announced a series of pneumonia cases caused by an unknown origin, discovered in Wuhan, China. A dangerous virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a disease named acute respiratory syndrome, which was later popularly called coronavirus infection (COVID-19). Patients with acute COVID-19 are at high risk of thrombosis in various blood vessels due to hypercoagulability, blood stasis, and endothelial damage. In this study, we present a case report of a patient with COVID-19, who was hospitalized in one of the hospitals in Sanandaj, Iran. There were symptoms of fever, chills, muscle aches, cough, and tachycardia. Laboratory tests showed high levels of CRP, ESR, Ferritin CLIA, LDH and D-Dimer in this patient. Doppler ultrasound of the patient also revealed an abnormal finding, thrombosis in the right greater saphenous vein. This suggests that COVID-19 may lead to other negative effects through damage to blood vessels.
... This cytokine storm can be related to the severity of the disease and its negative consequences [21,32]. Blood clots formed in deep vein thrombosis may have a variety of causes, including vascular damage, surgery, special medications, and limited mobility, [33] but the exact cause of COVID-19-induced deep vein thrombosis is still a mystery [34]. ...
In December 2019, the World Health Organization (WHO) announced a series of pneumonia cases caused by an unknown origin, discovered in Wuhan, China. A dangerous virus called SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2) caused a disease named acute respiratory syndrome, which was later popularly called coronavirus infection (COVID-19). Patients with acute COVID-19 are at high risk for thrombosis in various blood vessels due to over-coagulation, blood stasis, and endothelial damage. To date, very little research has been done on the number and side effects of thromboembolic disorders in patients with COVID-19. In this study, we report a case with COVID-19, who was hospitalized in one of the hospitals in Sanandaj, Iran. There were symptoms of fever, chills, muscle aches, cough, and tachycardia. Laboratory tests such as CRP, ESR, Ferritin CLIA, LDH and D-Dimer were observed in this patient at a high level. Doppler ultrasound of this patient revealed an abnormal finding, thrombosis in the right greater saphenous vein. This suggests that COVID-19 may lead to other side effects through damage to blood vessels.
May-Thurner syndrome is rarely considered in the differential diagnosis of deep vein thrombosis (DVT). Patients present with a clinical picture suggestive of DVT, and the true diagnosis is not confirmed until CT venography. We present a case of a 71-year-old woman, with risk factors of hypercoagulability, such as an anatomical variant and a 50-pack-year history, who presented with sudden onset swelling and redness of her left leg. Further investigation led to a diagnosis of May-Thurner syndrome. Our case discusses this extrinsic cause of venous stasis and how early diagnosis, and treatment can prevent the progression into Phlegmasia Cerulea Dolens.
May-Thurner Syndrome commonly presents with left leg swelling. Right sided venous compression syndromes are rare. We report a 49- year- old gentleman who presented with right lower extremity swelling following leg trauma. He was found to have right distal common iliac vein compression by the overlying right internal iliac artery. He was treated with an endovascular approach with balloon venoplasty and stenting. This is a unique presentation of May-Thurner syndrome variation affecting the right lower extremity with limited description in the literature.
Background
Deep vein thrombosis (DVT) is commonly identified and diagnosed in the emergency department. Factors including sedentary life (immobility), pregnancy in women, cancer, postoperation, admission to ICU, smoking, and obesity are identified risks for thrombosis development. We report a case of a 35-year-old man who presented to the emergency department developing left lower leg swelling and pain, low-grade fever, and headache after he was treated and discharged, cured of severe COVID-19. Then venous and arterial Doppler ultrasound of the lower leg revealed dilated, absent flow and luminal thrombus in the distal popliteal, anterior and posterior tibial veins and perforator vessels were diagnosed as leg DVT.
Conclusion
DVT is a hematological emergency that needs serious consideration in prevention as well early diagnosis in patients with possible risk factors. This case report aims to arouse the clinician’s awareness of the occurrence of deep vein thrombosis during and after COVID-19.
On December 31, 2019, the World Health Organization was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. The pneumonia was caused by a virus called SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2), which was later named coronavirus infectious disease 2019 (COVID-19). The symptoms most commonly reported by patients affected by COVID-19 include fever, dry cough, and shortness of breath. In this report, we present a case of a 57-year-old woman who presented to the clinic’s infectious department with swelling, pain, warmth, and redness in the left leg who was treated with therapeutic heparin. There were no typical and distinguished symptoms of COVID-19, and she had no risk factor for deep vein thrombosis. Then chest X-ray revealed bilateral patchy ground-glass opacity, and computed tomography angiography was performed to rule out pulmonary thromboembolism, which showed no evidence of thrombosis. Left lower limb venous color Doppler ultrasound revealed dilatation and thrombosis in the external iliac and left iliac veins up to the level of the bifurcation of the common iliac veins, as well as thrombosis to the superficial and small saphenous veins. Because of ground-glass opacity and lymphopenia, nasal swabs were used for sampling, and SARS-CoV-2 nucleic acid was detected by reverse transcription polymerase chain reaction (RT-PCR). This case aims to arouse the medical staff’s awareness of deep vein thrombosis as a clinical symptom of COVID-19 even if the patient has no typical symptoms of COVID-19.
Background
On 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. The pneumonia was caused by a virus called SARS-Cov-2, which was later named COVID-19. In this report, we present a patient with COVID-19 who developed deep vein thrombosis.
Case presentation
A 57-year-old woman presented to the clinic's infectious department with no underlying illness due to pain, redness, and leg swelling. According to a patient report, she had a mild dry cough for the past 3 days and had no other symptoms. The patient had no history of prone thrombosis conditions. Initially, CT angiography was performed to rule out pulmonary thromboembolism, which showed no evidence of thrombosis. Dilatation and thrombosis were seen in the examinations of the paired veins of the leg, popliteal, superficial and left femoral joints, and no evidence of vascular flow suggesting acute DVT. Because of fever and lymphopenia, nasal swabs were used for sampling and SARS-CoV-2 nucleic acid was detected by RT-PCR. Chest X-ray also revealed bilateral patchy ground-glass opacity. Other tests including ANA, Anti-dsDNA, RF test and ACA test was normal. Heparin at a dose of 80 units/kg IV bolus, chloroquine 400 mg single dose and lopinavir/ritonavir (Kaletra) 400 mg twice daily were prescribed to treat illness and relieve symptoms. On illness day 3, fever stopped and nasal swab sample turned undetectable for SARS-CoV-2 by RT-PCR as well as swelling and tenderness on her leg had been disappeared gradually. She is under regular follow-up with no new symptoms to date.
Conclusion
The mechanism of DVT formation due to COVID-19 is unknown despite thrombocytopenia, and has not been investigated but it resolved as COVID-19 symptoms, tenderness, and leg pain improved. Although COVID-19 presented with Deep Vein Thrombosis is a rare condition, in middle-aged people with sudden onset of manifestations, we should recognize it from other diseases as an important and treatable differential diagnosis. Rapid diagnostic assays, efficient treatment, and prudent use of CT-scan are important to control future COVID-19 spread.
