Dural sinus thrombosis (DST), or cerebral venous thrombosis, is an uncommon cause of stroke. It has a variable presentation, and the symptoms and signs can be non-specific. The diagnosis of DST can be difficult to make and is often delayed or missed. Computed tomography venography or magnetic resonance venography are the typical imaging modalities used to diagnose DST. However, computed tomography venography and magnetic resonance venography both have limitation for emergency department patients. In this article, we report the use of point-of-care ultrasound to facilitate the diagnosis of DST.
Diagnosis ; Diagnostic Imaging ; Emergencies ; Emergency Service, Hospital ; Humans ; Phlebography ; Point-of-Care Systems* ; Sinus Thrombosis, Intracranial* ; Stroke ; Thrombosis ; Ultrasonography* ; Venous Thrombosis

BACKGROUNDThere is increasing evidence that CT pulmonary arteriography and venography allow a better diagnostic yield for deep vein thrombosis (DVT) in suspected acute pulmonary embolism (PE). The aim was to investigate the value for using such an approach in a multiracial Asian population.

METHODSA total of 135 consecutive subjects with clinically suspected PE in various clinical settings (postoperative in 23 subjects) were referred and evaluated for venous thromboembolism using CT pulmonary arteriography and venography in a tertiary hospital, Malaysia. The distribution of DVT was assessed based on the frequency rate of thrombosis in a particular anatomical region (inferior vena cava, pelvic, femoral and popliteal).

RESULTSIn 130 subjects, excluding 5 subjects having poor images, both DVT and PE were detected in 11.5% (15/130) subjects and DVT alone was detected in 6.9% (9/130) subjects giving a combined rate of venous thromboembolism of 18.4%. A history of malignancy was significantly associated with positive scans, P = 0.02. It was found that left pelvic veins (18.2%) and left femoral veins (19.5%) were more commonly thrombosed in this population.

CONCLUSIONCT pulmonary arteriography and venography is a useful technique in the evaluation of venous thromboembolism in a multi-racial Asian population.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Artery ; diagnostic imaging ; Pulmonary Embolism ; diagnostic imaging ; Pulmonary Veins ; diagnostic imaging ; Tomography, X-Ray Computed ; methods ; Venous Thromboembolism ; diagnostic imaging ; Venous Thrombosis ; diagnostic imaging

BACKGROUNDDifferential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT). This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.

METHODSA retrospective case series of 35 ICMVT (M:F, 21:14; mean age (64.5 ± 10.6) years) and 23 gastrocnemius hematoma (M:F, 16:7; mean age (75.4 ± 11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012. Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein, great saphenous vein, calf muscles, skin, and soft tissue were examined.

RESULTSICMVT hypoechoic signals were characterized by long, tube-like masses on longitudinal sections and oval masses on transverse sections, with apparent muscle thrombosis boundaries, distal and proximal venous connections, and, often, lower limb DVT. Gastrocnemius hematoma hypoechoic signals were characterized by large volumes, enhanced posterior hematoma echo, hyperechoic muscle boundaries, no hematoma blood flow, and no DVT, and clear differences in trauma/exercise- and oral anticoagulant-induced hematomas were readily apparent. According to the measurement, the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0, whereas in gastrocnemius hematoma patients the ratio was more than 2.0. Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas. Partial muscle fibers in the hematoma due to muscle fractures were apparent.

CONCLUSIONHigh-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.

Aged ; Diagnosis, Differential ; Female ; Humans ; Leg ; diagnostic imaging ; Male ; Middle Aged ; Muscle, Skeletal ; diagnostic imaging ; Retrospective Studies ; Ultrasonography ; Venous Thrombosis ; diagnostic imaging

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.
Adolescent ; Chronic Disease ; Esophageal and Gastric Varices/complications ; Esophageal and Gastric Varices/diagnostic imaging ; Esophageal and Gastric Varices/therapy ; Female ; Gastrointestinal Hemorrhage/complications ; Gastrointestinal Hemorrhage/diagnostic imaging ; Gastrointestinal Hemorrhage/therapy ; Humans ; Jejunum/pathology ; Portacaval Shunt, Surgical ; Portal Vein/diagnostic imaging ; Portal Vein/pathology ; Portal Vein/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Venous Thrombosis/complications ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/therapy

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Middle Aged ; Multidetector Computed Tomography ; methods ; Pulmonary Embolism ; diagnosis ; diagnostic imaging ; Retrospective Studies ; Venous Thrombosis ; diagnosis ; diagnostic imaging ; Young Adult

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

OBJECTIVETo evaluate color Doppler ultrasonography (CDU) appearances of renal vein thrombosis (RVT) and its diagnostic value.

METHODSTen patients with RVT were analyzed retrospectively. Renal structure, distributions of intrarenal flow signals, echogenicity, and flow fullness in main renal veins were observed with CDU. Resistance index (RI) was recorded from the waveforms of segmental or interlobar renal artery.

RESULTSTen kidneys in nine patients were confirmed to have thrombus within the main renal veins, and one patient was confirmed to have thrombus within the small intrarenal veins. The appearances of the main renal vein thrombosis included full of solid echogenicity or strip echogenicity and complete or partial filling defect within the main renal veins, and absent or a few intrarenal venous flow signals in 70% of kidneys involved. The appearances of intrarenal vein thrombosis included obscure renal structure and no venous flow signal within the involved part of the kidneys. Reverse diastolic flow in the intrarenal artery had only a sensitivity of 36% (4/11); in other 7 kidneys without intrarenal arterial reverse diastolic flow, increased RI (mean, 0.84; range, 0.74-0.96) was found.

CONCLUSIONCDU is helpful for rapid clinical diagnosis and follow-up of RVT, and therefore can be the first imaging modality of choice for RVT.

Humans ; Renal Circulation ; Renal Veins ; diagnostic imaging ; Retrospective Studies ; Thrombolytic Therapy ; Ultrasonography, Doppler, Color ; methods ; Venous Thrombosis ; diagnostic imaging ; drug therapy

INTRODUCTIONThe 2005 American Association for Study of Liver Diseases (AASLD) diagnostic criteria allow non-invasive diagnosis of hepatocellular carcinoma (HCC) based on their enhancement pattern but we have observed a high incidence of atypical enhancement characteristics in HCC associated with portal vein thrombosis. This study seeks to examine the radiological features of this particular subgroup.

MATERIALS AND METHODSPatients with HCC and portal vein thrombosis who underwent pre-treatment multiphasic CT imaging were drawn from a surgical database. The arterial, portal venous and delayed phase images were assessed qualitatively and quantitatively (with region of interest [ROI] analysis) for lesion hypervascularity and washout. The background enhancement of the left and right lobes of the liver was also quantifi ed by ROI analysis.

RESULTSTwenty-fi ve lesions in 25 patients were selected for analysis. Qualitative analysis showed that 10/25 (40%) lesions demonstrated arterial hypervascularity while 16/25 (64%) lesions showed washout. Ten out of 25 (40%) lesions demonstrated both arterial hypervascularity and washout. Quantitative analysis showed that the average absolute lesion enhancement from precontrast to arterial phases was 49.1 (± 17.1) HU for hypervascular lesions compared to 23.8 (± 16.6) HU for non-hypervascular lesions (P <0.01). The mean absolute enhancement of the background liver parenchyma in the arterial phase was 13.79 (± 7.9) HU for hypervascular lesions compared to 36.6 (± 30.6) HU for non-hypervascular lesions (P = 0.03).

CONCLUSIONA large proportion of HCC with portal vein thrombosis lack characteristic arterial hypervascularity, which may be secondary to compensatory increased arterial supply to the background liver. This is a potential pitfall when applying imaging criteria for diagnosis of HCC.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Pattern Recognition, Automated ; Portal Vein ; diagnostic imaging ; physiopathology ; Retrospective Studies ; Tomography, X-Ray Computed ; methods ; Venous Thrombosis ; diagnostic imaging ; etiology

Diagnostic Errors ; Female ; Humans ; Hysterectomy ; Leiomyoma ; diagnosis ; surgery ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography ; Uterine Neoplasms ; diagnosis ; surgery ; Uterus ; blood supply ; diagnostic imaging ; Venous Thrombosis ; diagnosis ; surgery

OBJECTIVETo Explore the significance of preoperative screening of deep vein thrombosis (DVT) on the prevention from pulmonary embolism (PE) with color Doppler flow imaging (CDFI) in patients of lower limb fractures.

METHODSA total of 2 000 patients with lower limb fractures were retrospectively analyzed from January to September in 2010. All the patients were scheduled to be operated. There were 1 140 males and 860 females, ranging in age from 18 to 94 years, with a mean of (54.78 +/- 21.45) years. Swollen limbs could be observed in all patients when admitted and traditional Chinese medicine therapies were given by both internal and external administrations. Selective internal or external fixations were scheduled 3 to 14 days after injured and the swell relieved. CDFI screenings for DVT were applied to all the patients one day before operations and clinical data, such as gender, age, fracture site and course of diseases, were analyzed.

RESULTSOf all the 2 000 patients, 128 patients had lower limbs DVTs (6.4%). Among all the DVT patients, 52 patients had DVT within vena iliacas or femoral veins,20 patients had DVT within popliteal veins or vena crualis, 56 patients had DVT within small muscular veins of legs. Thrombolytic therapies or inferior vena cava filters were taken to 72 patients with DVTs proximal to vena cruralises and thrombi disappeared in 20 cases. Inferior vena cava filters were placed in 17 patients. There were 28 patients with either failed thrombolytic or no filters placement. All above 65 patients were treated with fracture reduction, and other 7 patients were treated with conservative methods. Of all the operated patients, one patient had PE during operation and recovered after immediately rescue. Among 56 patients with DVT within small muscular veins of legs, 51 patients were treated with reduction without other special treatment, and other 5 patients were treated with conservative methods. There was no relationship between DVT occurrence and gender. The youngest sufferer was 22 years old. DVT occurrences of patients over 41 years old were significantly higher than that of patients under 40 years old. Higher occurrences were also observed in patients with multiple fractures, fracture of femurs compared with those with tibia or fibula fractures. DVT was found as early as 3 days after injury in one case. The longer the time from injuries to operations, the higher the occurrences of DVTs.

CONCLUSIONRoutine CDFI screenings should be applied to traumatic fractured patients before operations no matter whether there are DVTs existing or not. That is very important for the prevention of fatal PE during both anesthesias and operations.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Preoperative Period ; Pulmonary Embolism ; prevention & control ; Ultrasonography ; Venous Thrombosis ; diagnosis ; diagnostic imaging ; Young Adult