Abstract No. 624 Venous thrombolysis and recanalization in pediatric patients: a single-center experience
Venous thrombosis in a pediatric population can be multifactorial such as secondary to extrinsic compression syndromes: Paget-Schroetter syndrome, May-Thurner syndrome (iliac vein thrombosis), hypercoagulable state, PICC or other central venous catheters and can also occur in patients with arteriovenous fistulae or grafts in patients requiring long-term hemodialysis. DVT affects 0.07-0.14 in 10,000 children annually;58 per 10,000 in hospitalized children. Catheter-directed thrombolysis (CDT), venous angioplasty, stent placement, and mechanical thrombectomy are used to treat both acute and chronic venous thrombosis.
Authors: Davis R, Reed E, Kraus C Abstract A 20-year-old male swimmer presented to the emergency department with right arm pain and swelling several days after a weight training session following swim team practice. The initial diagnosis was muscle strain, and the patient was discharged. The next day, he was evaluated by his swim team physician, who ordered right upper extremity duplex ultrasonographic imaging, which revealed no flow and thrombosis in the subclavian and axillary veins, and Paget-Schroetter syndrome was diagnosed. He subsequently had a mechanical thrombectomy and catheter-directed thrombolysis was i...
Authors: El-Attrache A, Kephart E Abstract Paget-Schroetter Syndrome is a rare condition in the spectrum of deep vein thromboses involving spontaneous upper extremity venous thrombosis in the axillary-subclavian vein. The syndrome usually occurs in young, healthy individuals and is a progressive, anatomic manifestation of venous thoracic outlet syndrome. Thrombosis is secondary to repetitive overuse of the arm, leading to compression, microtrauma, and local inflammation of the particularly vulnerable subclavian vein in the thoracic outlet at the junction of the first rib and clavicle. The condition is often misdiag...
ConclusionsDuplex ultrasound has significant limitations in the initial evaluation of patients with suspected SCV thrombosis, with false-negative results in 21% of patients with proven VTOS. This is rarely acknowledged in ultrasound reports, but false-negative ultrasound studies have the potential to delay definitive imaging, thrombolysis, and further treatment for VTOS. Initial false-negative ultrasound results are associated with progressive thrombus extension and a more frequent need for SCV bypass reconstruction at the time of surgical treatment.Graphical Abstract
Upper extremity deep vein thrombosis (DVT) results from pathologic compression of the subclavian vein at the costoclavicular junction.1-3 Also known as Paget-Schroetter syndrome, this pathology is associated with high morbidity and severe symptoms.2-5 The military population is particularly susceptible given the prevalence of young, healthy service members performing rigorous physical activity and training. Our group has previously reported significant functional recovery following supraclavicular decompression for neurogenic thoracic outlet syndrome (NTOS) in the high-performance military population.
Conclusion: As a kind of systemic disease, MT is mainly characterized by painful or painless muscle masses and swelling at a single site or at multiple sites. Patients with a history of tuberculosis and immune system disease are susceptible to MT. A diagnosis is mainly made on the basis of the results of pathological biopsy and bacteriological culture. Early diagnosis and timely standardized anti-tuberculosis treatment can improve the prognosis.
The objective of this study was to assess the use and consequences of upper extremity duplex ultrasound (U/S) in the initial diagnostic evaluation of patients with suspected subclavian vein (SCV) thrombosis and venous thoracic outlet syndrome (VTOS).
We report the case of a previously healthy 15-year-old boy who presented with a painful and swollen right arm after throwing firecrackers. Doppler ultrasound showed extensive right subclavian and axillary vein thrombosis. Anticoagulation therapy was started and had favorable evolution. We emphasize that PSS must be included in the differential diagnosis of a swollen arm.
ConclusionsKey conditions including upper extremity and lower extremity venous thrombosis, venous aneurysms, Paget-Schroetter syndrome (effort thrombosis), and popliteal vein entrapment syndrome are discussed. Further studies evaluating long-term outcomes on morbidity for current treatment regimens in upper extremity DVT, effort thrombosis, venous thoracic outlet syndrome, and popliteal venous entrapment syndrome are required.
ConclusionsIn our experience, venous bypass combined with thoracic outlet decompression achieves symptomatic relief in approximately 90% of patients with symptomatic upper extremity central venous occlusion, with morbidity limited to the perioperative period.
A 35 year old man presents with a swollen and uncomfortable right arm. He states his arm feels heavy and weak. You perform a vascular ultrasound The post Ultrasound Case 085 appeared first on Life in the Fast Lane • LITFL • Medical Blog.