1.The Interobserver Agreement between Residents and Experienced Radiologists for Detecting Pulmonary Embolism and DVT with Using CT Pulmonary Angiography and Indirect CT Venography.
Ulas Savas YAVAS ; Cuneyt CALISIR ; Ibrahim Ragip OZKAN
Korean Journal of Radiology 2008;9(6):498-502
OBJECTIVE: We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE). MATERIALS AND METHODS: We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64x0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist. RESULTS: Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96). CONCLUSION: It does not seem adequate to base the final long-term treatment of PE on only the resident's reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE.
Adult
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Aged
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Aged, 80 and over
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Female
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Humans
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Male
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Middle Aged
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Observer Variation
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*Phlebography
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Pulmonary Artery/*radiography
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Pulmonary Embolism/*radiography
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*Tomography, X-Ray Computed
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Venous Thrombosis/*radiography
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Young Adult
2.Venous Thromboembolism in Korean Patients Undergoing Major Orthopedic Surgery: A Prospective Observational Study using Computed Tomographic (CT) Pulmonary Angiography and Indirect CT Venography.
Seung Ick CHA ; Shin Yeop LEE ; Chang Ho KIM ; Jae Yong PARK ; Tae Hoon JUNG ; Jae Hyuck YI ; Jongmin LEE ; Seung HUH ; Hyun Joo LEE ; Shin Yoon KIM
Journal of Korean Medical Science 2010;25(1):28-34
In patients undergoing major orthopedic surgery, data of deep venous thrombosis (DVT) and pulmonary embolism (PE) are lacking as studied by computed tomographic (CT) pulmonary angiography and indirect CT venography (CTPA-CTV). A prospective observational study was performed for 363 Korean patients undergoing major orthopedic surgery to determine the incidence of venous thromboembolism (VTE), especially proximal DVT and PE. The incidence of VTE was 16.3% (n=59). Of them, 8 patients (2.2%) were symptomatic. The rate of VTE was the highest in patients who underwent total knee replacement (40.4%), followed by hip fracture surgery (16.4%), and total hip replacement (8.7%; P<0.001). The incidence of PE was 6.6% (n=24). Of them, 4 patients (1.1%) were symptomatic. Forty-one patients (11.3%) were in the proximal DVT or PE group. Based on multivariate analysis, total knee replacement and age > or =65 yr were significant risk factors for proximal DVT or PE in patients undergoing major orthopedic surgery (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1; P=0.025; and OR, 2.1; 95% CI, 1.0-4.4; P=0.046, respectively). Taken together, the overall incidence of PE was 6.6% and rate of symptomatic PE rate was 1.1%. Knee joint replacement and age > or =65 yr were significant risk factors for proximal DVT or PE.
Aged
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Arthroplasty, Replacement, Knee
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Female
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Humans
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Male
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Middle Aged
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Odds Ratio
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*Orthopedic Procedures
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Phlebography
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Prospective Studies
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Pulmonary Artery/radiography
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Pulmonary Embolism/radiography/surgery
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Republic of Korea
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Risk Factors
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Tomography, X-Ray Computed
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Venous Thromboembolism/*epidemiology/*radiography
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Venous Thrombosis/radiography/surgery
3.Spontaneous Dissolution of Isolated Superior Mesenteric Vein Thrombosis in Acute Pancreatitis.
Byung Soo NA ; Byung Min JOHN ; Ki Bum KIM ; Je Soo LEE ; Hyun Woo JO ; Chang Hyeon SEOCK ; Dong Hui KIM ; Ki Sung LEE
The Korean Journal of Gastroenterology 2011;57(1):38-41
Acute pancreatitis can result in many vascular complications in both artery and vein. Venous complication usually occurs as a form of splenic or portal vein thrombosis, and also can simultaneously occur in superior mesenteric vein as well. Rarely, isolated superior mesenteric vein thrombosis occurs as a venous complication. Although it is uncommon, mesenteric vein thrombosis is an important clinical entity because of the possibility of mesenteric ischemia and infarction of small bowel. The treatments of mesenteric venous thrombosis include anticoagulation therapy, transcatheter therapy and surgical intervention. We report a case of 45-year-old man who had acute pancreatitis with isolated superior mesenteric vein thrombosis, which was spontaneously dissolved with the resolution of underlying inflammation without anticoagulation or surgical intervention.
Acute Disease
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Humans
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Male
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*Mesenteric Veins
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Middle Aged
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Pancreatitis/complications/*diagnosis
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Tomography, X-Ray Computed
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Venous Thrombosis/*diagnosis/etiology/radiography
4.Combined Anomaly of the Right Hepatic Lobe Agenesis and Absence of the Inferior Vena Cava: a Case Report.
Hee Jung SUH ; Wan Tae KIM ; Mi Young KIM ; Yun Ku CHO
Korean Journal of Radiology 2008;9(Suppl):S61-S64
The absence of the inferior vena cava is an uncommon congenital anomaly that has recently been identified as an important risk factor contributing to the development of deep venous thrombosis. Congenital agenesis of the right hepatic lobe is a rare anomaly which is found incidentally in radiologic examinations. We present a case of a congenital absence of the infrarenal inferior vena cava, combined with agenesis of the right hepatic lobe in a 62-year-old man presented with symptoms of deep venous thrombosis.
Humans
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Liver/*abnormalities/radiography
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Magnetic Resonance Imaging
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Male
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Middle Aged
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Tomography, X-Ray Computed
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Vena Cava, Inferior/*abnormalities/radiography
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Venous Thrombosis/etiology
5.A Case of Infiltrative Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis Successfully Treated by Transarterial Chemoembolization.
Sun Jung MYUNG ; Jung Hwan YOON ; Geum Youn GWAK ; Cheol Min SHIN ; Dong Won AHN ; Su Jong YU ; Ji Won YU ; Soo Jeong CHO ; Jin Wook CHUNG ; Hyo Suk LEE
The Korean Journal of Hepatology 2006;12(1):107-111
A 63-year-old HBsAg-positive male patient was admitted for the evaluation of a liver mass that was detected on ultrasonography. Spiral computed tomography (CT) revealed infiltrative hepatocellular carcinoma (HCC) in the right hepatic lobe with main portal vein tumor thrombosis. His liver function was Child-Pugh class A and the serum alpha fetoprotein level was 7,400 ng/mL. Transarterial chemoembolization (TACE) via the right hepatic artery was performed. Following 3 sessions of TACE every 2 months, spiral CT revealed no evidence of viable tumor. The thrombi within the main portal vein disappeared with performing localized hepatic infarction at the site of the previous tumor. He is still alive 15 months after the third TACE without evidence of recurred tumor and his liver function remains well preserved. This case suggests that TACE might be effective and safe even in the patients with infiltrative HCC with main portal vein tumor thrombosis, if the extent of the tumor is limited and the liver function and portal flow via the collaterals are preserved.
Venous Thrombosis/*complications
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Portal Vein
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Middle Aged
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Male
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Liver Neoplasms/complications/radiography/*therapy
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Humans
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*Chemoembolization, Therapeutic
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Carcinoma, Hepatocellular/complications/radiography/*therapy
6.Complications of Portal Vein Embolization: Evaluation on Cross-Sectional Imaging.
Yoo Kyeong YEOM ; Ji Hoon SHIN
Korean Journal of Radiology 2015;16(5):1079-1085
Portal vein embolization (PVE) is known as an effective and safe preoperative procedure that increases the future liver remnant (FLR) in patients with insufficient FLR. However, some possible major complications can lead to non-resectability or delayed elective surgery that results in increased morbidity and mortality. Although the majority of these complications are rare, knowledge of the radiologic findings of post-procedural complications facilitate an accurate diagnosis and ensure prompt management. We accordingly reviewed the CT findings of the complications of PVE.
Aged
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Cholangiocarcinoma/radiography/therapy
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Embolization, Therapeutic/*adverse effects
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Female
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Humans
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Hypertension, Portal/etiology
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Liver Neoplasms/radiography/*therapy
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Male
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Middle Aged
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Portal Vein/*radiography
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Tomography, X-Ray Computed
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Vascular System Injuries/etiology
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Venous Thrombosis/etiology
7.A Case of Acute Respiratory Failure Presenting Lobar Consolidation.
Tae Rim SHIN ; Sun Hee MAENG ; Hyun Kyung LEE ; Hae Young KIM ; Jung Hyun CHANG
Tuberculosis and Respiratory Diseases 1998;45(3):654-660
Pulmonary embolism is one of the most common acute pulmonary disease in the adult general hospital populalion. However, the disease is still frequenfly unsuspected and underdiagnosed due to the nonspecifieity of both clinical findings and laboratory tests. The chest radiography in a patient suspected acute pulmonary embolism do not provide adequate information to establish or exclude the diagnosis of pulmonary embolism. Even in the case of infarction, there is no pathognomonic clues on the chest film. Rarely infarction presents unusual roentgenologic manifestation such as lobar consolidation, coin lesion, multinodular opacity, or massive pleural effusion. Especially, lobar consolidation in pulmonary embolism might mislead into the diagnosis of pneumonia. We experienced a case of pulmonary embolism presenting lobar consolidation in a 62 years old woman, originated from deep vein thrombosis. She took a compression stocking and underwent anticoagulant therapy with excellent outcome.
Adult
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Diagnosis
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Female
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Hospitals, General
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Humans
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Infarction
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Lung Diseases
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Middle Aged
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Numismatics
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Pleural Effusion
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Pneumonia
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Pulmonary Embolism
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Radiography
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Respiratory Insufficiency*
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Stockings, Compression
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Thorax
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Venous Thrombosis
8.Emphysematous gastritis: a case report and a review of literature.
Tsuan-Hao LOI ; Ju-Yaw SEE ; Ravishankar K DIDDAPUR ; John R ISSAC
Annals of the Academy of Medicine, Singapore 2007;36(1):72-73
INTRODUCTIONGas is rarely found within the viscera outside the lumen of the gastrointestinal tract. Emphysematous gastritis is a rare form of infection of the stomach wall by gas producing organisms.
CLINICAL PICTUREA 45-year-old Chinese lady underwent hepatectomy for hepatocellular carcinoma. Postoperatively, she turned septic and encephalopathic with worsening liver function. Computed tomography scan revealed a thickened, oedematous stomach wall with air pockets within.
TREATMENTThe patient was started on a course of broad spectrum antibiotics.
OUTCOMEShe responded and was discharged well.
CONCLUSIONEmphysematous gastritis is a rare condition with high mortality. There is however, still no preferable approach of treatment despite therapeutic advances.
Anti-Bacterial Agents ; therapeutic use ; Emphysema ; diagnostic imaging ; Female ; Gastritis ; drug therapy ; pathology ; Humans ; Middle Aged ; Portal Vein ; Radiography ; Thienamycins ; therapeutic use ; Ultrasonography ; Venous Thrombosis ; diagnostic imaging
9.Isolated Small Bowel Transplantation from a Living-Related Donor at the Catholic University of Korea: A Case Report of Rejection - Free Course -.
Myung Duk LEE ; Dong Goo KIM ; Sang Tae AHN ; In Sung MOON ; Myung Gyu CHOI ; Seok Gi HONG ; Sun Cheol PARK ; In Sik CHUNG ; Jong Young CHOI ; Seung Kew YOON ; Sang Il KIM ; Jong Ho CHOI ; Eun Sun JUNG
Yonsei Medical Journal 2004;45(6):1198-1202
The bowel transplantation team at the Catholic Medical Center, Korea, on April 9 2004, accomplished a case of isolated small bowel transplantation (SBT) in a 57 year-old female with short bowel syndrome. The primary surgery was a jejunocolostomy due to mesenteric vein thrombosis, while maintaining 30 cm of the jejunum and colon distal to the splenic flexure. Her renal function was partially unbalanced. During more than 2 years of home TPN, the superior vena cava (VC) and subclavian veins had become occluded, but the inferior VC line remained. SBT was planned due to the repeated life-threatening infections of the last central line. One hundred and fifty centimeter of the distal ileum of the 27 year-old living-related donor, the patient's daughter, was harvested. The graft mesenteric artery and vein were anastomosed to the recipient's inferior mesenteric vessels. A proximal end- to-end jejuno-ileostomy and a distal end-to-side ileo-colostomy of the graft were made, creating a Bishop-Koop enterostomy for graft surveillance. A tube jejunostomy, via a gastrostomy, was established for early feeding and simultaneous gastric drainage. Induction with Daclizumab and immunosuppression consisted of tacrolimus and methylprednisolone, given intravenously, and then mycophenolate mofetil (MMF), enterally from day 3. The patient was discharged on day 42. A CMV infection on day 83 was successfully treated with 3 weeks of gancyclovir therapy. She has been nutritionally independent, with complete oral feeding, and free of rejection until day 170 after the transplantation.
Female
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Humans
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Immunosuppression
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Intestine, Small/*transplantation
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Korea
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*Living Donors
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Mesenteric Veins
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Middle Aged
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Postoperative Care
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Short Bowel Syndrome/etiology/radiography/*surgery
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Treatment Outcome
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Venous Thrombosis/complications
10.Titanium Greenfield Inferior Vena Cava Filter: Effectiveness of Percutaneous Placement for Prevention of Pulmonary Embolism.
Journal of the Korean Radiological Society 2000;43(5):545-549
PURPOSE: To evaluate the effectiveness of percutaneous placement of a Greenfield titanium filter in the inferior vena cava (IVC) for the prevention of pulmonary embolism (PE) in patients with deep vein thrombosis (DVT). MATERIALS AND METHODS: Twelve patients with DVT underwent percutaneous Greenfield titanium filter placement. The indications included recurrent pulmonary embolism or failed anticoagulation therapy in six patients, extensive PE in three, and prophylaxis for high risk of PE in the remaining three. In all cases the filter was positioned after confirming the anatomy, patency, and presence of thrombosis of the IVC and renal veins by inferior vena cavography. Long-term follow-up study involved clinical evaluation, plain radiography, Doppler ultrasonography and CT scanning. RESULT: Filter placement [infrarenal in ten patients (83%) and suprarenal in two (17%)] was technically successful in all cases (100%). The venous approach involved the right femoral vein in eight patients (67%) and the right internal jugular vein in four (33%). Complications included overlapping of the filter legs in three patients (25%), and misplacement in one (8%). After filter placement, no further PE developed. In all of five patients followed up for two years, the IVC maintained patency without evidence of caval perforation or occlusion. CONCLUSION: In patients with DVT, percutaneous placement of a Greenfield titanium filter is a safe and effective method for the prevention of PE.
Femoral Vein
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Follow-Up Studies
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Humans
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Jugular Veins
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Leg
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Pulmonary Embolism*
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Radiography
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Renal Veins
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Thrombosis
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Titanium*
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Tomography, X-Ray Computed
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Ultrasonography, Doppler
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Vena Cava Filters*
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Vena Cava, Inferior*
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Venous Thrombosis