Venous thrombosis in atypical locations means thrombosis of upper extremity deep vein, cerebral venous sinus, splanchnic vein including portal, hepatic, mesenteric and splenic vein, renal vein, ovarian vein and retinal vein. This thrombosis rarely occurred and could be affected by the involved organ when compared to the incidence and cause of deep vein thrombosis in lower extremity with or without pulmonary embolism. There is a limitation to perform a large-scaled randomized trial for these rare conditions, and several recommendations based on results of small-sized studies and observational registries are available now. Therefore, we need multi-department and international collaboration to test the efficacy and safety of anticoagulation including new oral anticoagulants in the treatment of venous thrombosis in atypical locations.
Anticoagulants ; Budd-Chiari Syndrome ; Cerebral Veins ; Cooperative Behavior ; Incidence ; Lower Extremity ; Pulmonary Embolism ; Registries ; Renal Veins ; Retinal Vein ; Splenic Vein ; Thrombosis ; Upper Extremity ; Upper Extremity Deep Vein Thrombosis ; Veins ; Venous Thrombosis*

Extensive visceral vein thrombosis, including the femoral vein, iliac vein, superior mesenteric vein, splenic vein and portal vein, is an uncommon type of thrombosis that is associated with significant mortality and morbidity. Making an early diagnosis and adequate management are very important. We present here the case of a 39-year-old woman with extensive visceral vein thrombosis and complicated small bowel necrosis and perforation. She had no known prothrombotic conditions, but the laboratory findings showed an elevated level of factor VIII. The patient's condition improved without complication after resection of the infarcted and perforated small bowel along with immediate postoperative anticoagulant therapy. On the follow up, the size of the thrombosis was decreased and there was no complication.
Adult ; Early Diagnosis ; Factor VIII ; Female ; Femoral Vein ; Follow-Up Studies ; Humans ; Iliac Vein ; Mesenteric Veins ; Necrosis ; Portal Vein ; Splenic Vein ; Thrombosis ; Veins ; Venous Thrombosis

An association between nephrotic syndrome and thromboembolic phenomena has been known for many years. Most common sites of venous throm-bosis in nephrotic syndrome are al vein and deep vein of lower extremity. We report a case of minimal change nephrotic syndrome associated with unusual extensive venous thrombosis. A 29-year-old man was transferred to our hospital with severe abdominal pain and ascites. 2 months before admission, he was diagnosed as minimal change nephropathy at another hospital and treated with steroid therapy but he had persistent proteinuria on admission. The abdominal ultrasonography and CT scan revealed diffuse thrombosis of left renal vein, splenic vein, superior mesenteric vein and portal vein. Deep vein thrombosis of lower extremity was also found but not pulmonary embolism. There was no evidence of other primary hypercoagulable disease. He was treated with intravenous heparin immediately and three days later, abdominal pain disappeared. Prednisolone and cyclophosphamide were administered as well. After 1 month of therapy, proteinuria was resolved. Abdominal CT scan, taken after 2 months of therapy, revealed that diffuse thrombosis were almost resolved. From this case, diffuse abdominal thrombosis should be included as a diffrential diagnosis in a nephrotic patient with abdominal pain.
Abdominal Pain ; Adult ; Ascites ; Axis, Cervical Vertebra* ; Cyclophosphamide ; Diagnosis ; Heparin ; Humans ; Lower Extremity ; Mesenteric Veins ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Portal Vein ; Prednisolone ; Proteinuria ; Pulmonary Embolism ; Renal Veins ; Splenic Vein ; Thrombosis ; Tomography, X-Ray Computed ; Ultrasonography ; Veins ; Venous Thrombosis*

BACKGROUND: Behcet's disease (BD) is a systemic disease of unknown cause, belonging to vasculitis pathologically. There are only few reports describing the frequency and clinical features of cardiovascular involvement in BD, even though the vascular lesions involving artery and large-sized vein has been reported to be important in prognosis. We performed a retrospective study to address the clinical features of Behcet's disease involving cardiovascular system. METHODS: We studied 155 patients with BD who fulfilled the international criteria. The frequency and clinical characteristics of cardiovascular involvement were studied retrospectively. RESULTS: Among 155 patients with BD, 27 patients (17.4%) have cardiovascular involvement. When they were compared with patients without cardiovascular lesions, male proportion was significantly higher (OR 5.541, 95% CI 2.033~15.105, p=0.001) and the age at onset was younger (OR 1.059, 95% CI 1.003~1.118, p=0.037). Nine patients (5.8%) had arterial lesions which included 10 cases of arterial aneurysm and 3 cases of arterial occlusion. Arterial aneurysm occurred at aorta (3 cases) and pulmonary artery (3 cases) most frequently. Arterial occlusion occurred at coronary artery, brachial artery and digital artery. There were 4 patients with cardiac valvular lesions which included aortic regurgitation (3 cases) and tricuspid stenosis (1 case). Nineteen patients (12.3%) had venous lesions. Among them deep vein thrombosis were 25 cases, and transverse sinus thrombosis was one case. When the patients with deep vein thrombosis were divided by the site of the lesion, the cases involving deep femoral and popliteal vein were the most frequent (6 patients respectively), which were followed by iliac vein, superficial femoral vein, and superior vena cava. When the patients were divided into arterial and venous involvement groups, they showed no significant differences in clinical features. CONCLUSION: In BD patients, the frequency of cardiovascular involvement was 17.4% of which that of deep vein thrombosis was the highest. Arterial aneurysm was the most frequent among arterial lesions. The patients with cardiovascular involvement had significantly higher male proportion and younger onset age than the patients without cardiovascular lesions.
Age of Onset ; Aneurysm ; Aorta ; Aortic Valve Insufficiency ; Arteries ; Brachial Artery ; Cardiovascular System ; Constriction, Pathologic ; Coronary Vessels ; Femoral Vein ; Humans ; Iliac Vein ; Lateral Sinus Thrombosis ; Male ; Popliteal Vein ; Prognosis ; Pulmonary Artery ; Retrospective Studies ; Vasculitis ; Veins ; Vena Cava, Superior ; Venous Thrombosis

Central venous stenosis or occlusion is commonly associated with placement of central venous catheters or devices. Although rare, central venous stenosis or occlusion may also develop without a history of previous central venous catheter placement. Here we report a case of central venous stenosis without a previous central catheter placement. A 76-year-old woman with hypertensive nephropathy was admitted due to deterioration of renal function. Tunneled cuffed catheter for hemodialysis was inserted in the right external jugular vein, and we intended to insert central venous catheter because of poorly functioning peripheral vein. But, left internal jugular vein was not cannulated. The patients had a history of pulmonary tuberculosis and chest x-ray revealed extensive calcified lesions mainly in left upper lung. Venography and CT angiogram showed complete occlusion at the confluent point of the left subclavian vein and left internal jugular vein, and left brachiocephalic vein by calcified lesion. The anterior cervical vein and jugular venous arch forming an anastomosis between the neck vein were marked dilated. The patient did not show any clinical symptoms and signs associated with central venous stenosis, and the central venous catheter functioned well, correction of central vein stenosis was not necessary. After the supportive care including temporary hemodialysis, the patient improved from renal dysfunction.
Aged ; Brachiocephalic Veins ; Catheters ; Central Venous Catheters ; Constriction, Pathologic ; Female ; Humans ; Hypertension, Renal ; Jugular Veins ; Lung ; Neck ; Nephritis ; Phlebography ; Renal Dialysis ; Subclavian Vein ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary ; Veins

PURPOSE: Computed-tomography (CT) is known as a useful modality to diagnose the occurrence and extent of deep vein thrombosis (DVT) and the existence of pulmonary embolism (PE). This article will focus on the availability of DVT-CT at Kyungpook National University Hospital. METHOD: From 1994 to 2006, 403 DVT patients were documented for the extent of thrombus and the existence of PE. DVT-CTs, according to our protocol, were obtained for 136 patients; there were 112 CT scans taken that were limited to the abdomen and lower extremity, and 47 patients underwent only chest CT to diagnose PE. Other modalities such as duplex scan and venography for DVT and lung scan for PE were also performed for 155 patients. RESULT: The patients in the CT group (248 patients) demonstrated that the extent of the thrombus was in the inferior vena cava (IVC) in 38 (16%), the iliac veins (IVs) in 98 (40%), the femoral veins (FVs) in 73 (29%), the popliteal veins (PVs) in 3 (1%), and the mesenteric veins in 24 (10%). For the group that underwent venography or duplex scanning (155 patients), the extent of thrombus was in the IVC in 4 (3%), the IVs in 47 (30%), the FVs in 73 (47%), and the PVs in 21 (14%). For the 136 patients who underwent DVT-CTs, 38 (28%) cases had PE. The DVT-CT and lung scan were in agreement for all the 12 cases who underwent both two tests. CONCLUSION: In the present study, DVT-CT accurately revealed the extent of DVT and it is a useful tool for making the diagnosis of PE.
Abdomen ; Diagnosis ; Femoral Vein ; Gyeongsangbuk-do ; Humans ; Iliac Vein ; Lower Extremity ; Lung ; Mesenteric Veins ; Phlebography ; Popliteal Vein ; Pulmonary Embolism ; Thrombosis ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Venous Thrombosis*

PURPOSE: Computed-tomography (CT) is known as a useful modality to diagnose the occurrence and extent of deep vein thrombosis (DVT) and the existence of pulmonary embolism (PE). This article will focus on the availability of DVT-CT at Kyungpook National University Hospital. METHOD: From 1994 to 2006, 403 DVT patients were documented for the extent of thrombus and the existence of PE. DVT-CTs, according to our protocol, were obtained for 136 patients; there were 112 CT scans taken that were limited to the abdomen and lower extremity, and 47 patients underwent only chest CT to diagnose PE. Other modalities such as duplex scan and venography for DVT and lung scan for PE were also performed for 155 patients. RESULT: The patients in the CT group (248 patients) demonstrated that the extent of the thrombus was in the inferior vena cava (IVC) in 38 (16%), the iliac veins (IVs) in 98 (40%), the femoral veins (FVs) in 73 (29%), the popliteal veins (PVs) in 3 (1%), and the mesenteric veins in 24 (10%). For the group that underwent venography or duplex scanning (155 patients), the extent of thrombus was in the IVC in 4 (3%), the IVs in 47 (30%), the FVs in 73 (47%), and the PVs in 21 (14%). For the 136 patients who underwent DVT-CTs, 38 (28%) cases had PE. The DVT-CT and lung scan were in agreement for all the 12 cases who underwent both two tests. CONCLUSION: In the present study, DVT-CT accurately revealed the extent of DVT and it is a useful tool for making the diagnosis of PE.
Abdomen ; Diagnosis ; Femoral Vein ; Gyeongsangbuk-do ; Humans ; Iliac Vein ; Lower Extremity ; Lung ; Mesenteric Veins ; Phlebography ; Popliteal Vein ; Pulmonary Embolism ; Thrombosis ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Venous Thrombosis*

Left isomerism is characterized by bilateral left-sidedness and multiple associated cardiac and visceral anomalies. The clinical manifestation of left isomerism mainly depends upon the cardiac lesions. Occasionally an individual will have a normal heart and be presented with the extracardiac anomalies. A 3-year-old girl with a diagnosis of left isomerism was presented with pulmonary hypertension and intermittent hypoglycemia. Computerized tomography of the abdomen revealed absence of the portal vein and portosystemic shunt. The superior mesenteric and splenic veins joined as a common trunk, bypassed the liver and drained the left renal vein and hemiazygos vein. Her pulmonary hypertension was considered as a consequence of the portosystemic shunt. We report a case of left isomerism in association with absence of the portal vein and a review of literatures.
Abdomen ; Child, Preschool ; Diagnosis ; Female ; Heart ; Humans ; Hypertension, Pulmonary* ; Hypoglycemia ; Isomerism* ; Liver ; Portal Vein* ; Portasystemic Shunt, Surgical ; Renal Veins ; Splenic Vein ; Veins

The primary site for a hemodialysis catheter insertion is the right internal jugular vein (IJV) followed by the left IJV and subclavian vein. In cases when veins of the upper extremities are exhausted, femoral veins are an alternative insertion location. Femoral catheter insertions should only be used for short periods because of the increased risk of infection. There is a percutaneous technique to recanalize occluded central veins for hemodialysis catheter insertion. We experienced success with a cut-down method for permcath through a completely occluded IJV. We, therefore, find surgical recanalization to be better than percutaneous method in terms of cost and safety.
Catheters ; Femoral Vein ; Humans ; Jugular Veins ; Methods ; Renal Dialysis ; Subclavian Vein ; Upper Extremity ; Veins

Subclavian and internal jugular vein catheters are widely employed for temporary hemodialysis access. Placement of subclavian venous catheter has many complications such as pneumothorax and hemothorax, etc. Incidence of subclavian vein obstruction due to thrombosis is probably greater than is commonly appreciated. Subclavian vein obstruction may cause no specific complaints, but thrombosis in the presence of an arteriovenous fistula may produce severe symptoms such as massive edema and pain. This is report of one patient, who developed massive edema of upper extremity and in whom proximal subclavian vein occlusion developed after previous percutaneous dialysis catheter. Right internal jugular vein to axillary vein bypass with 8mm PTFE provided prompt and effective venous outflow, with complete resolution of venous engorgement of the affected limb and preservation of the dialysis fistula.
Arteriovenous Fistula ; Axillary Vein ; Catheters ; Dialysis ; Edema ; Extremities ; Fistula ; Hemothorax ; Humans ; Hyperemia ; Incidence ; Jugular Veins ; Pneumothorax ; Polytetrafluoroethylene ; Renal Dialysis* ; Subclavian Vein* ; Thrombosis ; Upper Extremity