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Twelve patients suffering from subcutaneous dorsal induration of the penis were investigated. The diagnosis of a lymphangitis or thrombophlebitis depends on clinical features. It is of nonvenereal origin, and the treatment, if necessary, consists in local or systemic antiinflammatory or antibiotic therapy.
Four cases of cerebral thrombophlebitis, 3 of which occurred during post-partum and 1 during the first trimester of pregnancy, are reported. The symptoms were misleading, being predominantly psychiatric, with secondary appearance of an epileptic attack or motor deficit. The value of cerebral angiography is stressed in the literature.
The causalgic form of the postphlebitic syndrome or reflex sympathetic dystrophy resulting from acute deep thrombophlebitis is a relatively uncommon and, unfortunately, frequently unrecognized form of the postphlebitic syndrome. The usual signs of venous insufficiency are minimal, but severe burning pain is characteristic, usually increased by dependency. The diagnosis is confirmed by phlebography and the response to a lumbar sympathetic block. A lumbar sympathectomy produces permanent pain relief.
In reference to one new case of post-partum cerebral thrombophlebitis, the authors stress the difficulty of the clinical diagnosis. Because of its great reliability, conventional arteriography occupies a place of choice among the medical imaging techniques. Heparin therapy at isocoagulating doses has permitted to improve the very poor prognosis of this disease.
We report two cases of post partum right ovarian vein thrombophlebitis: The aspect of the C.T. is presented, specifying the anatomic relations of the right ovarian vein. The C.T. progression under treatment is illustrated in one case by the appearance of a vena cava thrombosis and in another by a return to normal. The possibility of other examinations is discussed. Correct knowledge of these C.T. findings should allow a diagnosis and a treatment without invasive procedures.
A 42-year-old woman had a puerperal aseptic cerebral thrombophlebitis with repeated episodes of subarachnoid hemorrhage. Cerebrospinal fluid studies revealed a delayed, severe and lasting low sugar and high protein levels. The possible mechanisms of low sugar levels are discussed.
In 125 cases surgically treated for thrombophlebitis of the lower limbs, thrombectomy was done in 96, while caval clipping alone was done in 31. Beginning in 1965, technical improvements and systematic control of the 3 major cross points of the lower limb venous system resulted in gradually improved results as regards patency rate and clinical status. When the return flow was increased by arteriovenous fistula, the patency rate and the clinical results were significantly improved. Comparison of a first group of 23 patients submitted to venous thrombectomy alone with 102 patients protected by filters or serrated clips shows a drastic decrease in lethal pulmonary embolism postoperatively. Mortality in the unprotected group was 8.7% while in the protected series it fell to .98%: the latter death was in fact due to forced selection of an operation of second choice. In the protected series, 69 preoperative pulmonary embolisms were recorded in 55 patients. Only one minor postoperative embolism occurred, this originating from an axillary phlebitis. We find caval clipping to be formally indicated whether or not a venous disobstruction procedure is feasible.
A case of cerebral thrombophlebitis that arose during pregnancy is presented. The aetiology of this form is discussed and its relation to placental pathology and disseminated intravasal coagulopathy.
A boy 14 years is described who had partial agenesis of the right lateral sinus. Following thrombophlebitis of the left lateral sinus secondary to mastoiditis he developed progressive visual impairment due to papilledema. This was cured by vein graft between the right lateral sinus and the right external jugular vein.
Three cases of thrombophlebitis of the ovarian vein occurred early after delivery. The thrombus extended into the inferior vena cava in all three cases and led to pulmonary emboli in one patient. The clinical presentation was suggestive of the diagnosis which was confirmed by echography and computed tomography. Heparin and antibiotics were given at diagnosis and thrombectomy of the inferior vena cava was performed in 2 cases with a vibrating thrombus. Ligature was required in these cases. The clinical case was favourable in all three cases.
Because of the low incidence and the lack of clinical symptomatology, puerperal ovarian vein thrombophlebitis has constituted a diagnostic problem now as ever, and diagnostic errors are frequent. With the help of US and CT, however, the chances of early detection have improved. On the 26-year old patient P. C. a section had to be performed in the 34th week of pregnancy because of premature rupture of the bag of waters. On the 7th postoperative day, the patient developed pyrexia inspite of antibiotic therapy. Sonographical examinated lead us to suspect a floating thrombus in the vena cava inferior. It was in the CT that the diagnosis of ovarian vein thrombosis was made for the first time. On the 13th day post partum a laparotomy and exstirpation of the v.ovarica dextra with removal of the thrombus plug from the v.cava inferior infrarenally was performed. Primarily, conservative treatment is given preference if the development is uncomplicated; operative sanitation is undertaken in case of difficulties only.
The authors report the complications of a case of cellulitis from dental origin. A cavernous sinus thrombophlebitis and a temporo-mandibular ankylosis succeed, pointing on the importance of a precocious treatment of dental phlegmons, in order to prevent occurrence of local or regional complications.
While before antibiotics cases of septic thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection were frequent and had a poor prognosis, today they are exceptional and often have a favourable course under antibiotic therapy. The clinical features are often limited to fever and a painful tumefaction of the anterior border of the sterno-cleido-mastoidian muscle, symptoms may be more pronounced in the Lemierre syndrome in which the anaerobic septicaemia is associated with secondary, especially pleuro-pulmonary, localizations. The diagnosis can be confirmed with a cervical CT-scan showing an enlarged, thrombosed vein which does not opacify and has a hyperdense periphery. Treatment is based on parenteral antibiotics adapted to anaerobic germs.
Lateral sinus thrombophlebitis (LST) is an intracranial complication of otitis media. Its incidence has markedly decreased in the era of antibiotic therapy but mortality is still high. A 13-year-old girl presented with fever, ear discharge and torticollis. On the day of admission LST was diagnosed from the clinical presentation and CT-scan. She was operated immediately and intravenous antibiotics were administered. Despite the rapid intervention, the course was protracted, with recurrent events of septic pulmonary embolism. Despite internal jugular vein ligation, fever continued and anticoagulant therapy was begun. The possibility of LST should be considered in patients with ear discharge and fever. CT-scan enables early diagnosis of LST and MRI has a role in detecting additional intracranial septal foci. Surgical intervention should be early and aggressive. The efficacy of jugular vein ligation is unclear; anticoagulant therapy should be considered.
The authors report two recent observations of thrombophlebitis of the right ovarian vein. The first occurred after a cesarotomy, due to a bigeminal pregnancy, and the second, after a breech delivery. The diagnosis was given when faced to a febrile syndrome and pains of the right flank and confirmed in both cases by an abdominal tomodensimetric examination. In both cases, an enlargement of the lower vena cava thrombosis was observed with a floating clot that reached the renal veins. Both patients underwent a surgery. The latter consisted in both cases in a thrombectomy of the lower vena cava as well as a ligature of the right ovarian vein. In both cases, the evolution was positive, thanks to a remote-control of the lower vena cava via tomodensimetry. This therapeutic procedure and other potential therapies were discussed.
The authors report two cases of puerperal right ovarian vein thrombophlebitis (POVT) with floating thrombus in the inferior vena cava (IVC). The originality of this report lies in the first line surgical treatment approach. POVT is recognized as presenting usually within the first week post-partum after about 0.05% of deliveries. The syndrome consists of lower abdominal or flank pain, unexplained fever and a tender abdominal mass. Abdominal or pelvic findings are often scanty. In some cases, the thrombus may extend to the inferior vena cava, leading to the risk of pulmonary embolism or low grade renal insufficiency. Diagnosis has been difficult in the past. Since acute appendicitis is the commonest differential diagnosis, laparotomy is frequent. CT scan provides a readily available, accurate, non invasive technique for the diagnosis of POVT. Criteria are: enlargement of the vein, a low density lumen within the vessel wall and a sharply defined vessel wall enhanced by contrast media. The treatment of POVT is initially medical. Antibiotics should be given to cover the commonest infecting organisms. Heparin should also be prescribed at therapeutic IV doses to be followed by oral anticoagulants for at least six weeks. Surgery is usually only recommended when the patient remains symptomatic despite proper medical management, develops clinical, scan or arteriographic evidence of pulmonary embolism, or cannot be anticoagulated. The recommended surgical technique is to clamp the anastomosis of the ovarian vein with the vena cava.(ABSTRACT TRUNCATED AT 250 WORDS)
Puerperal ovarian vein thrombophlebitis is a relatively rare postpartum complication that may result in serious complications. The syndrome may be diagnosed through exploratory surgery or diagnostic imaging, although the best method remains unclear. In one case, open laparoscopy yielded a swift diagnosis and ensured prompt treatment without necessitating further diagnostic studies.
Thrombophlebitis of the ovarian vein is a well recognized but uncommon complication during the postpartum period. We report a small series and emphasize the contribution of color Doppler and the basic therapeutic measures.