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Of 61 patients examined by Doppler ultrasound, only 23 were found to have superficial venous thrombosis. The remaining 38 patients were considered to have lymphangitis or cellulitis. An algorithm of diagnostic and therapeutic pathways has been developed for the management of the patient who has suspected superficial thrombophlebitis.
Ten randomly selected patients with recurrent non-traumatic thrombophlebitis of unknown etiology were studied using a comprehensive environmental control method. All cleared their phlebitis without medications. Using withdrawal and challenge of incitants, eight of 10 patients had their phlebitis reproduced. The numerous single triggering agents were common-place inhaled and ingested foods and chemicals.
Ascending thrombophlebitis of the superficial leg veins is known to pass into the deep veins, causing an embolism to develop. Duplex ultrasonography has been shown to be a reliable technique for the evaluation of superficial venous thrombosis. If progression is noted, crossectomy proved to be effective in preventing passage of thrombi into the deep veins.
The results of treatment of 1225 patients with an acute subcutaneous foot veins thrombophlebitis were analysed. Morphological changes of the vein wall were studied up, bacteriological investigation of the thrombosed veins was conducted.
Continuous polymicrobial anaerobic septicemia was the main manifestation of a lateral sinus thrombophlebitis (LST) in a patient who had a history of chronic otitis media. Five different anaerobic microorganisms were isolated in blood cultures. Three of them were also present in ear cultures. The diagnosis was confirmed at surgery and the patient was successfully treated with moxalactam disodium therapy. This case emphasizes that LST should be considered before polymicrobial anaerobic septicemia, especially if there is a history of chronic otitis media.
A case of septic thrombophlebitis of the internal jugular vein after pharyngitis is reported. Because of the common use and effectiveness of antibiotics against throat infections, this complication is now rarely seen. This condition has characteristic signs and symptoms, and a diagnosis can be obtained when the physician is aware of these characteristics. Radionuclide scan and Doppler effect flow studies of the internal jugular vein are useful diagnostic adjuncts. If recognized early and treated promptly with antibiotics, resolution is the rule. The literature has been reviewed.
A 28-year-old man suffered from recurrent facial exanthema, arthritis and stomatitis for ten years and died six months after a catatonic episode with terminal cerebral convulsions. Three years before his death high KBR-Antititers to Herpes simplex- and cytomegalic virus were observed, while Lupus-Erythematosus-Tests (LE-Tests) only became positive in the last months. At autopsy, changes compatible with Systemic Lupus Erythematosus (SLE) were found in the mitral valves, the spleen, and the kidneys. The brain displayed hemorrhagic infarction of the striate bodies and thrombophlebitis of the internal cerebral veins, the wall of which exhibited circumscribed infiltrations with numerous hematoxilin bodies and LE cells. This seems to be the first observation of LE-specific changes in the brain. The importance of cerebral vein affection in SLE involving the nervous system is stressed and a hypothesis submitted proposing the viral etiology of SLE.
We report herein the case of a 70-year-old woman with enteropathy accompanied by protein loss, the cause of which was found to be thrombophlebitis of the mesenteric vein. The patient was admitted to our hospital for investigations to determine the cause of hypoproteinemia. She had suffered an episode of left abdominal pain with high fever and vomiting lasting 10 days, 8 months prior to her admission. She also had a 6-year history of uncontrolled diabetes. The alpha1-antitrypsin clearance was 85.7 ml/day, suggesting protein-losing enteropathy. A scintigraphy with 99m-technetium-human serum albumin disclosed protein leakage into the intestine. X-Rays and computed tomography showed a stenotic and thickened area of small intestine 50 cm in length. Thus, a laparotomy was performed to resect this part of the intestine which was found to have undergone past thrombophlebitic changes. Following the operation, the alpha1-antitrypsin clearance decreased to within the normal range and the patient gained 5 kg in weight.
Puerperal ovarian vein thrombophlebitis (POVT) is a rare postpartal complication. Its incidence is about 0.05%. POVT can follow a term pregnancy, a premature delivery, an abortion or an ectopic pregnancy. POVT usually presents as a syndrome consisting in lower abdominal pain and fever which does not respond to adequate antibiotics. We present a case report, in which the diagnosis was based upon computed tomography.
We describe a 12-year-old boy in whom primary Staphylococcus aureus thrombophlebitis of the femoral and iliac veins developed without history of trauma and with no association with acute osteomyelitis. The patient responded to therapy with intravenously administered antibiotics for 6 weeks, although oxacillin-associated hepatitis developed during the course of treatment.
PURPOSE: A prospective, nonrandomized study was conducted to evaluate the efficacy of a nonoperative approach of anticoagulation therapy to manage saphenofemoral junction thrombophlebitis (SFJT). METHODS: Over a 2-year period between January 1993 and January 1995, 20 consecutive patients with SFJT were entered into the study. They were hospitalized and given a full course of heparin. Duplex ultrasonography was performed before admission, both to establish the diagnosis and to evaluate the deep venous system. Two to 4 days after admission a follow-up scan was obtained to assess resolution of SFJT and to reexamine the deep venous system. Patients with SFJT alone and resolution of SFJT by duplex scanning were maintained on warfarin (Coumadin) for 6 weeks. Those with SFJT and deep venous thrombosis (DVT) were maintained on Coumadin for 6 months. Incidence of concurrent DVT and its location were noted. The efficacy of anticoagulation therapy was evaluated by measuring SFJT resolution, recurrent episodes of SFJT, and occurrence of pulmonary embolism (PE). RESULTS: There was a 40% incidence (eight of 20 patients) of concurrent DVT with SFJT. Of the eight patients, four had unilateral DVT, two had bilateral DVT, and two had development of DVT with anticoagulation. DVT was contiguous with SFJT in five patients and noncontiguous in three patients. Of 13 duplex scans obtained at 2 to 8 months follow-up, seven demonstrated partial resolution of SFJT, five had complete resolution, and one did not demonstrate resolution. There were no episodes of PE, no recurrences, and no complications of anticoagulation at maximum follow-up of 14 months. CONCLUSIONS: Anticoagulation therapy to manage SFJT was effective in achieving resolution, preventing recurrence and preventing PE within our follow-up period. There is a high incidence of DVT associated with SFJT that merits careful evaluation of the deep venous system during the course of management.
Eight Thai patients less than 15 years of age who were diagnosed with cavernous sinus thrombophlebitis at Ramathibodi Hospital, Bangkok, Thailand over the past 30 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children and adults. Despite severe neurologic dysfunction during admission, including blindness, there was neither death nor severe permanent deficit found in the majority of the patients. Only one patient experienced mild hemiparesis caused by cerebral infarction, which was secondary to this condition. Early recognition of this condition, the appropriate selection of empirical antibiotic therapy, and the awareness of associated complication were the key factors leading to excellent outcome.
The aim of the study was to present rarely reported neurologic complications in Nijmegen breakage syndrome. A 13-year-old female was referred because of chronic progressive headaches. There were dysmorphic features on physical examination, which suggested a diagnosis of chromosomal instability syndrome. The results of genetic and immunologic examinations confirmed the diagnosis. Cerebral magnetic resonance imaging revealed an 8 mm thickening of the meninges over the left hemisphere, corresponding with a chronic inflammatory condition, and symptoms of left cavernous thrombophlebitis were detected. Cerebrospinal fluid examination and an infusion test demonstrated disorders in its absorption. Antibiotic, anticoagulant and cerebral edema treatment was given and after 1 week improvement was observed. Regression of symptoms occurred after 14 days.
The diagnosis of postpartum ovarian vein thrombophlebitis has in the past been based purely on either clinical findings or surgical findings. There is almost no mention of this entity in the diagnostic imaging literature, a reflection of the lack of a means to demonstrate the vein that has existed to this time. We present a case in which the thrombosed vein and the surrounding inflammatory mass were demonstrated preoperatively by computed tomography (CT). We believe that CT may greatly facilitate the diagnosis of this potentially serious disorder.
OBJECTIVE AND IMPORTANCE: Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal conditions. The occurrence of all three in a single patient has not previously been described. We present such a case occurring in a young, otherwise healthy man. CLINICAL PRESENTATION: A 26-year-old man with a remote history of sinusitis developed rapidly progressive headache, fever, right eye pain, swelling, proptosis, and visual impairment. Magnetic resonance imaging demonstrated diffuse pansinusitis, including sphenoid sinusitis, and extension of inflammation and infection into the adjacent cavernous sinuses, pituitary gland, and posterior fossa. INTERVENTION: Urgent drainage of the ethmoid and maxillary sinuses was performed; pus was not identified. The patient continued to deteriorate clinically with worsening of visual acuity. Computed tomography of the head performed the next day revealed worsening hydrocephalus and an enlarging posterior fossa subdural empyema. Urgent ventricular drainage and evacuation of the empyema was performed, and subsequently, the patient's clinical course improved. The microbiology results revealed alpha hemolytic streptococcus and coagulase-negative staphylococcus species. The patient survived but during the follow-up period had a blind right eye and pituitary insufficiency. CONCLUSION: Paranasal sinusitis can have devastating intracranial sequelae. Involvement of the adjacent pituitary gland and cavernous sinuses can result in serious neurological morbidity or mortality, and retrograde spread of infection through the basal venous system can result in subdural or parenchymal brain involvement. A high index of suspicion and aggressive medical and surgical treatment are crucial for patient survival, but the morbidity rate remains high. Our patient survived but lost anterior pituitary function and vision in his right eye.
Puerperal pelvic thrombophlebitis is most commonly found in the ovarian veins. It may be diagnosed by laparotomy, but it should be suspected clinically when symptoms develop two to five days after delivery. If medical treatment with antibiotics, anticoagulants, and bed rest is unsuccessful, surgical intervention with ligation or removal of ovarian veins may be necessary.
Internal jugular thrombophlebitis usually results from contiguous infection or central catheterization. Ultrasonography and CT allow rapid, noninvasive methods of confirming the diagnosis of this condition. Although the choice of modality has not been systematically examined, where local expertise exists for both, ultrasonography is less expensive and should provide adequate images.
Septic pelvic thrombophlebitis is an uncommon but serious postpartum complication occurring in about 1 in 2,000 pregnancies, characterized by pain, antibiotic resistant fever and tachycardia. In about 50% of cases a pelvic mass is present which is usually right-sided (especially when the ovarian vein is involved). It is estimated to cause 18 maternal deaths per million pregnancies in the United States. Use of contrast enhanced CT scanning and a trial of heparin therapy increases the diagnostic certainty. It is particularly important because surgical management which may otherwise be suggested because of a spiking fever and a mass seems to be associated with a poorer prognosis than does conservative management.