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[Clinical thinking and decision-making in the practice. A patient with thrombophlebitis].

A 55-year-old man presented with deep venous thrombosis of his left leg. Laboratory evaluation disclosed macrocytic anaemia and leukocytosis. In the clinical decision process it was not verified whether all symptoms fitted in with the presumptive diagnosis of pernicious anaemia and stomach carcinoma. The ultimate diagnosis was acute lymphocytic leukaemia. A proper evaluation of a peripheral blood smear would have led to this diagnosis earlier.

Anemia, Macrocytic↗

[A rare case of acute scrotum. Thrombophlebitis from ectasia of the left pampiniforme plexus].

The acutely painful scrotum may be due to testicular torsion, twisted testicular appendages, twisted spermatic cord or epididymitis. Most rarely it occurs as a result of a testicular trauma, orchitis, idiopathic scrotal edema, idiopathic infarction of testis and vaginalis tunica or testicular neoplasm; a spontaneous thrombosis of the spermatic vein vessels is quite unusual. A rare case of thrombosis of a dilated pampiniform plexus which occurred in a 6 year-old child is reported and its clinical presentation, diagnosis and treatment is discussed. The difficulty in making such a diagnosis is stressed since thrombosis of the spermatic vein is quite a rare entity; a conservative approach is suggested as a treatment of choice whenever a definite diagnosis is made, otherwise surgical intervention (ligation of the spermatic vein, if necessary) is required in order to rule out any other urologic emergency.

Child↗

[Spontaneous rupture of the left external iliac vein. A complication of deep vein thrombophlebitis?].

A 52 years old woman was hospitalized on suspicion of left femoral venous thrombosis. Within 24 hours she went into shock, and laparotomy was performed on suspicion of a ruptured abdominal aortic aneurysm. The operative finding was a ruptured iliac vein, which was repaired and anticoagulant treatment was started. Unfortunately the patient never stabilized and died from cardiovascular collapse within 12 hours.

Anticoagulants↗

[Homonymous lateral hemianopsia revealing cerebral thrombophlebitis. Role of a deficiency of protein S induced by l-asparaginase].

BACKGROUND: Cerebral thrombosis associated with protein S deficiency is very rare and is mainly related to hereditary form of protein S deficiency. CASE REPORT: A 19-year-old girl with acute lymphoblastic leukemia presented hemianopsy within a few days after the first administration of L-asparaginase. Magnetic resonance of the brain showed a cortical infarct. A marked decrease of the level of protein S was documented. Few days later, the patient was free of symptoms and protein S level was restored to the normal suggesting that the cerebral thrombosis was caused by transient protein S deficiency induced by L-asparaginase administration. DISCUSSION: Patients with neurological complication caused by L-asparaginase should be tested for protein S and other anticoagulant deficiencies.

Adult↗