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Background: Deep venous thrombosis (DVT) poses a substantial disease burden. Lymphedema may present with similar symptoms making the diagnosis process more difficult. Data on the epidemiology of lymphedema are lacking. Methods: The German nationwide inpatient sample served to analyze all patients hospitalized owing to DVT and/or thrombophlebitis (referred to as DVT) of the legs in Germany between 2005 and 2020. We stratified these patients for additional lymphedema and analyzed the impact of lymphedema on adverse in-hospital events. Results: Overall, 1,136,574 hospitalizations related to DVT were recorded in Germany during 2005-2020 (53.3% women; 51.3% aged ≥70 years). Lymphedema was coded in 9974 (0.9%) patient-cases (82.0% not elsewhere classified, 17.7% secondary lymphedema). Annual numbers of hospitalizations with lymphedema among DVT patients increased from 450 (2005) to 613 (2016) (β 0.57; 95% confidence interval [CI]: 0.48-0.66], p  < 0.001) and decreased thereafter. Despite similar age, DVT patients with lymphedema had higher prevalence of cardiovascular diseases, chronic organ failure, and all types of investigated cancer. Prevalence of pulmonary embolism (PE) with shock/CPR (4.1% vs. 1.5%), acute renal failure (6.7% vs. 2.5%), and stroke (5.2% vs. 4.2%) was higher in DVT patients with lymphedema than without. Lymphedema was independently associated with PE with shock/CPR (OR: 2.1; 95% CI: 1.9-2.3) as well as death (OR: 1.3; 95% CI: 1.2-1.4). Conclusions: Comorbidity conditions like cancer, obesity, and cardiovascular risk factors, and also infectious complications, were more prevalent in DVT patients with lymphedema than in those without. Lymphedema was independently associated with severe in-hospital complications, particularly when its genesis was related to severe comorbidities.

Septic pulmonary embolism (SPE) is a rare clinical entity that is distinct from the classic and more common non-septic thrombotic pulmonary embolism. SPE should be suspected in patients with a systemic acute inflammatory reaction or sepsis who develop signs and symptoms of pulmonary involvement. The diagnosis of SPE depends on the specific radiologic finding of multiple, peripheral, nodular, possibly cavitated lesions. SPE should prompt an immediate search for the primary source of infection; typically, right-sided infective endocarditis, cardiac implantable electronic devices, and septic thrombophlebitis as a complication of bone, skin, and soft tissue infection including Lemierre's syndrome, indwelling catheters, or direct inoculation via injection drug use. Invasive treatment of the infection source may be necessary; in thrombophlebitis, the efficacy and safety of anticoagulation remain undefined. Blood cultures may be negative, particularly among patients with recent antibiotic exposure, and broad-spectrum antimicrobial therapy should be considered. The in-hospital mortality of SPE ranges up to 20% in published case series. While trends in the incidence of SPE are unknown, the opioid epidemic, the growing use of cardiac implantable electronic devices worldwide, and the reported increase in cases of septic thrombophlebitis may be leading to an escalation in SPE cases. We provide a contemporary profile of SPE and propose a clinical management algorithm in patients with suspected or confirmed SPE., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Septic pulmonary embolism (SPE), deep vein thrombophlebitis (DVT), and acute osteomyelitis (AOM) form a triad that is rarely seen in children and is usually associated with a history of trauma on long bones. Unfortunately, a delay in diagnosis is frequently observed in this syndrome, which places the patient at risk of life-threatening complications. This delay can largely be attributed to the failure to consider osteomyelitis as a potential underlying cause of DVT., Case Presentation: In this case report, we present the case of a 16-year-old Arabian male who presented with limb trauma and fever. The patient had a delayed diagnosis of osteomyelitis, which resulted in the formation of an abscess and subsequent joint destruction. Surgical drainage and joint replacement surgery were deemed necessary for treatment., Conclusions: persistent fever along with a history of trauma on a long bone with signs of DVT of the limb in a child should raise concern for osteomyelitis and an MRI evaluation of the limb should be obtained., (© 2023. The Author(s).)

Background: Venous thromboembolism (VTE) and atherosclerosis are accompanied by substantial cardiovascular mortality; links between both disease entities were reported. We aimed to investigate the impact of systemic atherosclerosis on adverse outcomes in patients with deep venous thrombosis or thrombophlebitis (DVT) and to identify differences in DVT patients with and without systemic atherosclerosis., Methods: The German nationwide inpatient sample was used for this analysis. Patients admitted for DVT were included in this study and stratified by systemic atherosclerosis (composite of coronary artery disease, myocardial infarction, ischemic stroke, and/or atherosclerotic arterial diseases). We compared DVT patients with (DVT+Athero) and without (DVT-Athero) systemic atherosclerosis and analysed the impact of systemic atherosclerosis on adverse outcomes., Results: Overall, 489,679 patients with DVT (55.7% females) were included in this analysis. Among these, 53,309 (10.9%) were coded with concomitant systemic atherosclerosis with age-dependent incline. Concomitant PE (4.1% vs.3.8%, P=0.001) was more frequently in DVT-Athero and risk for PE in DVT patients was independently associated with absence of systemic atherosclerosis (OR 0.87 [95%CI 0.83-0.91], P<0.001). In-hospital mortality (3.4% vs.1.4%, P<0.001) and adverse in-hospital events (2.2% vs.0.8%, P<0.001) were more prevalent in DVT+Athero compared to DVT-Athero; both, in-hospital mortality (OR 1.52 [95%CI 1.41-1.63], P<0.001) and adverse in-hospital events (OR 1.49 [95%CI 1.40-1.58], P<0.001) were affected independently of sex, age and comorbidities by systemic atherosclerosis., Conclusions: Systemic atherosclerosis in DVT patients was accompanied by poorer outcomes. Systemic atherosclerosis was associated with higher bleeding rate and with isolated DVT (without concomitant PE)., Competing Interests: Declaration of Competing Interest KK, TM and MAO report no conflict of interest. TM is PI of the DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany. LH reports having received lecture honoraria from MSD. M.L. reports having received consultancy and lecture honoraria from Actelion, Bayer, Daiichi-Sankyo, MSD, Pfizer – Bristol-Myers Squibb and research funding from BRAHMS – Thermo Fisher scientific. S.K. reports having received consultancy and lecture honoraria from Bayer, Boehringer Ingelheim, Daiichi-Sankyo, MSD and Pfizer – Bristol-Myers Squibb; and institutional grants from Actelion, Bayer, Boehringer Ingelheim, Daiichi-Sankyo and Pfizer – Bristol-Myers Squibb., (Copyright © 2021 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Puerperal ovarian vein thrombophlebitis is a rare pathology. We present the case of a 23-year-old female who presented with fever and cough that occurred after vaginal delivery and persisted after several courses of antibiotics between the 2nd and 20th day postpartum. CT pulmonary angiography revealed right subsegmental pulmonary embolism. An abdominal ultrasonographic examination led to the diagnosis of ovarian vein thrombosis. She was treated with warfarin for 2 weeks with a good response. Our case highlights the importance of prompt ultrasonographic diagnosis and clinical treatment of ovarian vein thrombosis to prevent morbidity and mortality., (© 2020 Wiley Periodicals, Inc.)

Background:: We report the case of a 90-year old woman who presented with septic pulmonary emboli due to suppurative thrombophlebitis at an old peripheral intravenous site., Methods:: After unsuccessful treatment with antibiotics, the patient was taken to the operating room for excision and drainage of the purulent superficial vein., Results:: We review the literature and discuss the presentation, risk factors, treatment options, and complications of this often-overlooked disease entity., Conclusions:: Suppurative thrombophlebitis is a rare but morbid disease that requires a high level of clinical suspicion to diagnose.

Competing Interests: Competing interests: None declared.

The authors review the history and risk factors of thrombophlebitis of the lower limb, and describe the main points of surgical and conservative treatment of varicophlebitis. They present the case of a 71-year-old woman who had ascending varicophlebitis and bilateral pulmonary embolism. The authors draw attention to important points: patients must be followed after phlebitis of the lower limb, and their thrombotic factors must be examined to prevent the new thromboembolic events.

Although patent foramen ovale is a relatively common disease, the presence of paradoxical embolism is a rare clinical condition, representing less than 2% of arterial ischemias. We report the case of a 55-year-old male diagnosed with massive pulmonary embolism and paradoxical embolism in the right arm, secondary to patent foramen ovale. We also highlight some uncertainties in the diagnosis and treatment of patients with paradoxical embolism., (Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.)

We present the clinical course of an 11-year-old child with septic pulmonary embolism secondary to community acquired methicillin-resistant Staphylococcus aureus (MRSA) septic deep venous thrombosis. The aim is to emphasize the non-specific symptoms of septic pulmonary embolism in pediatrics, the frequent association with septic deep venous thrombosis and osteomyelitis, and to highlight that MRSA is the most frequently isolated organism. Pediatricians should consider septic pulmonary embolism in cases of septic deep venous thrombosis even in the absence of respiratory symptoms. The initial antibiotic management should include glycopeptides, as community acquired MRSA is increasingly the isolated organism in this disorder.

In September of 1974, Richard Nixon resigned the Presidency of the United States during an impeachment investigation concerning the Watergate Affair. One month after his resignation, the former President had an exacerbation of his chronic deep vein thrombosis. He also received a Presidential pardon from Gerald Ford on the same day that his recurrent deep vein thrombosis was diagnosed. The political, legal, and medical events that unfolded in the fall of 1974 are the substance of this report. Presidents often receive medical care that stretches the ordinary as a result of their position and the importance of their actions. The events surrounding Richard Nixon's care for deep vein thrombosis and its complications were not unusual for Presidential health care but were closely intertwined with the legal proceedings during the prosecution of the Watergate defendants.

Acute pulmonary embolism is an important emergency disease which frequently results in life-threatening complication. Systemic fibrinolysis is recommended as standard, first-line therapy in patients with massive pulmonary embolism. In the case described in this report, a 95-year-old woman was treated with low-dose prolonged infusion of tissue plasminogen activator for acute pulmonary embolism and mobile thrombus in the main pulmonary artery and right pulmonary artery. On the basis of echocardiographic findings, acute thrombolysis with low-dose prolonged infusion of tissue plasminogen activator was performed resulting in hemodynamic stabilization of the patient and complete resolution of the pulmonary artery thrombus.

Our study was concerned with the role of ultrasound examination of the lower extremity veins to detect deep venous thrombosis and to evaluate complex prophylaxis of thromboembolism of pulmonary arteries (TEPA). The procedure involved vena cava filter placement in patients with neoplasia and high risk of TEPA as compared with controls receiving conservative therapy alone. A positive correlation was established between surgery and/or polychemotherapy, on the one hand, and higher stage and high risk of TEPA, on the other. Patients with deep venous thrombosis and neoplasia were referred to groups of extremely high risk of that pathology. Angiological history, physical examination and ultrasound check-ups of the lower vein must be carried out in cancer patients. Vena cava filter placement proved to be an effective and safe measure of TEPA prophylaxis. It lowered the risk of lethal outcome in 24 during surgery and polychemotherapy. Lethality rate among controls was 43.5 +/- 0.51%.

Aim: Superficial thrombophlebitis (ST) ascending the lower limbs is a common disease, which may be associated with deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of this study was to investigate the prevalence of DVT and PE as complications of ascending ST of the lower limbs in the great saphenous vein (GSV) or SSV (SSV) and probable risk factors., Methods: For this study 60 consecutive patients were enrolled with ascending ST of the GSV or SSV, seen between 2000 and 2003 at a public hospital in Botucatu, SP, Brazil. All patients were assessed clinically, by venous Duplex scanning of the lower limbs to confirm ST and test for DVT, and by means of pulmonary scintigraphy to test for PE., Results: In 13 ST cases (21.67%) there was concomitant DVT and 17 ST patients (28.33%) also had PE. Eleven patients had a clinical status suggestive of DVT, but only in eight of these (61.5%), this clinical diagnosis was confirmed. Fourteen patients had a clinical status suggestive of PE, and this diagnosis was confirmed in six cases (35.30%). ST patients who also had DVT and/or PE were given anticoagulant treatment with heparin and warfarin. None of the variables studied was predictive of DVT or PE (P>0.05). However, the presence of varicose veins reduced the risk of patients having DVT (relative risk=9.09; 95%CI:1.75 - 50.00 and P=0.023)., Conclusions: The prevalence rates of PE (28.3%) and DVT (21.6%) were elevated in this sample of ascending ST cases, indicating a need for detailed assessment of patients for signs of these complications, including for therapeutic management decision making.

Unlabelled: The purpose was to evaluate the benefits of compression and early mobilization in comparison with compression and bed rest in the acute stage of proximal deep venous thrombosis (DVT) in pregnant women., Method: Thirty-two consecutive pregnant women with proximal DVT diagnosed by color duplex ultrasound were divided into two groups. Group A consisted of 15 patients who received elastic compression bandages and early mobilization, and group B including 17 patients with compression bandages and bed rest. All patients received heparin therapy. The clinical characteristics of the two groups were comparable. We assessed the reduction of subjective pain daily with a Visual Analogue Scale (VAS) and the objective pain using Lowenberg test, the reduction of edema was recorded initially and on day 2, 4 and 7. Ultrasound was repeated after seven days., Results: Resolution of subjective pain was faster during the first three days and near absent at the end of the study period in group A (p < 0.001). Objective pain seriously reduced in group A during the observation period while in group B decreased during the first three days almost by half but remained constantly present over the remaining days (p < 0.001). The same was true for the measurement of leg circumference (p < 0.05). There was no pulmonary embolism and progression of thrombus diameter., Conclusion: Pregnant women with proximal deep vein thrombosis may benefit from leg compression and early mobilization for a faster resolution of the signs and symptoms and this method does not seem to be an additional risk factor for pulmonary embolism.

Lemierre's syndrome is characterized by acute oropharyngeal infection, complicated by internal jugular venous thrombosis secondary to septic thrombophlebitis, and by metastatic infections in various distant organs-most commonly in the lungs. We report a case of Lemierre's syndrome in a 56-year-old female who presented with right-sided neck mass and fever. Right internal jugular venous thrombosis was demonstrated on an ultrasound. A computed tomography scan of the chest revealed multiple opacities throughout both lungs. An open surgical biopsy was performed due to suspicion of pulmonary metastases. Anatomopathological examination revealed septic emboli in lung parenchyma. Retrospectively, the patient reported a history of pharyngitis two weeks prior to hospitalization. After the diagnosis had been made, the patient was treated with broad-spectrum antibiotics (cefuroxime for 7 days and azithromycin for 5 days; subsequently, because fever persisted, cefepime for 7 days). One month later, a computed tomography scan of the chest revealed resolution of the opacities.

Objectives: The purpose of this study was to evaluate the incidence of great saphenous vein (GSV) thrombosis in symptomatic patients and its possible relationship to complications usually attributed to deep venous thrombosis (DVT)., Methods: To quantitate the frequency of GSV thrombosis and evaluate its possible morbidity, we reviewed all the venous studies, both inpatient and outpatient, at a Level I Trauma Center over one year. The charts of all patients who had a thrombus in the GSV, either alone or in combination with a DVT, were examined., Results: A total of 2646 lower extremity venous scans were done in the year studied. In this group, there were 388 (14.5%) positive studies for a DVT. There were 36 (9.3%) patients in this group who had a DVT of the lower extremity and a thrombus in the GSV. In the total group, there were 30 patients (1.1%) with a superficial thrombophlebitis of the GSV alone. In these patients, 22 (73%) either showed cephalad progression of the thrombus, symptoms of shortness of breath, a mobile tip in the thrombus or extension of the thrombus into the common femoral vein. Five patients (16.6%), after failing medical therapy (heparin, bed rest and antibiotics), underwent surgical treatment., Conclusions: Thrombophlebitis of the GSV, although not very common, needs to be carefully followed with a repeat duplex scan to determine if there is propagation of the thrombus. This study shows that thrombophlebitis of the GSV can cause many of the complications attributed to deep venous thrombi and, therefore, must be thoroughly evaluated, followed, and, if necessary, treated.

The paper presents the results of clinical evaluation of combined prevention of leg deep vein thrombosis and pulmonary thromboembolism in 130 neurosurgical patients undergoing intracranial interventions for brain tumors. Combined prevention comprises mechanical (compression knitted wear + periodic pneumatic leg compression by a special device) and pharmacological (subcutaneous injection of low molecular-weight heparins on postoperative day 2, followed by the daily administration of acetylsalicylic acid from the moment of a patient's activation) treatments. The study has indicated that this preventive procedure is effective and at the same time safe against the development of intracranial hemorrhagic complications.

Objective: To determine the value of computed tomography (CT) angiography of the chest as a diagnostic test to exclude pulmonary embolism and to assess compliance with diagnostic protocols for thromboembolic disease., Patients and Methods: We retrospectively studied patients who underwent CT angiography of the chest because of suspected pulmonary embolism in 2004. All the patients were followed for 3 months. The percentage of patients diagnosed with a thromboembolic event based on an objective test during the follow-up period was determined. We analyzed the percentage of patients with a negative CT angiogram on whom additional diagnostic tests (ultrasound of the lower limbs and/or ventilation-perfusion lung scintigraphy) were performed., Results: One hundred sixty-five patients underwent CT angiography of the chest because of suspected pulmonary embolism in 2004. Four of the patients were excluded from the study because they were on chronic anticoagulation therapy and a further 2 were excluded because they had a life expectancy of under 3 months. Of the remaining 159 patients, 60 had CT angiograms that were interpreted as high probability for pulmonary embolism (prevalence of 38%). Thirty-nine of the 99 patients with a negative CT angiogram experienced an objectively confirmed thromboembolic event (63% sensitivity; 95% confidence interval, 53%-73%). Other diagnostic tests were not performed in 46% of the cases., Conclusions: In our setting, a negative single-detector helical CT angiogram was not sensitive enough to exclude the diagnosis of pulmonary embolism. Furthermore, compliance with internationally accepted diagnostic protocols was far from optimal.

Objective: To determine the risk of arterial and venous complications after a spontaneous superficial venous thrombophlebitis (SVTP) in the leg in a general practice population., Study Design: Retrospective cohort study (LOE: 2b [CEBM]). Exposure consisted of the diagnosis of SVTP of the lower limbs on an index date. The exposed cohort was compared with an (unexposed) cohort of practice-, age-, and sex-matched controls without SVTP., Population: Patients with spontaneous SVTP in the leg were identified through diagnostic coding in the medical registers of 40,013 patients, enlisted with 5 health centers in Amsterdam, The Netherlands., Outcomes: Primary outcomes were deep venous thrombosis (DVT), pulmonary embolism (PE), acute coronary events, or ischemic stroke over a 6-month follow-up period. Odds ratios (OR) were used to quantify the associations between SVTP and outcome events., Results: No statistically significant odds ratios were found for PE, coronary events or stroke. DVT was the only primary outcome to show a significant relationship. DVT occurred in 2.7% of all SVTP patients as compared with 0.2% in the controls (OR=10.2; 95% confidence interval [CI], 2.0-51.6). When controlling for prior history of DVT, the OR decreased to 7.1 and the confidence interval crossed 1.0 (95% CI, 0.9-65.6)., Discussion: Spontaneous SVTP in the leg is a risk factor for DVT, but is less predictive in patients with prior DVT. Although effective treatments for the prevention of DVT are available, the absolute risk is too low to advocate prophylaxis in a general practice population. More research on prophylaxis is needed to stratify these patients at risk.

It has been suggested that a previous viral or bacterial pharyngitis may predispose to Lemierre's syndrome, an uncommon entity nowadays. A case of Lemierre's syndrome and co-infection with Mycoplasma pneumoniae is described, association published before in only 2 other cases. A 16-year-old girl with trombophlebitis of the left jugular vein, Fusobacterium necrophorum bacteremia and septic emboli in the lung requiring mechanical ventilation due to severe respiratory insufficiency. Despite early treatment with penicillin G and clindamycin, fever and part of pulmonary affectation persisted until that an antibiotic agent active against M. pneumoniae was instaurated, after its serological confirmation. The physicians should be easily recognized this disease because of its characteristic clinical findings, and co-infection with other organisms including M. pneumoniae, should be considered.

We report an 11-year-old boy who required inferior vena cava (IVC) filtration for a prolonged period of time. A retrievable IVC filter was placed and repositioned three times, providing a total of 60 days of IVC filtration. The filter was removed when his risk of pulmonary embolus had decreased substantially. This is a relatively uncommon practice in the pediatric population. The technique is presented, and the available literature is reviewed.

Background and Objectives: The aim of this systematic review was to summarize the evidence from randomized controlled trials (RCT) concerning the efficacy and safety of medical or surgical treatments of superficial vein thrombosis (SVT) for the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE)., Design and Methods: A systematic search was performed in MEDLINE, EMBASE and the Cochrane (CENTRAL) database to identify all randomized trials that evaluated the effect of surgical or medical treatment in the prevention of venous thromboembolism (VTE) in patients with SVT of the legs., Results: Five studies were included. Pooling of the data was not possible due to the heterogeneity among the studies. Moreover, three studies had major methodological drawbacks limiting the clinical applicability of the results. One of the remaining (pilot) studies showed a non-significant trend in favor of high- compared to low-dose unfractionated heparin for the prevention of VTE. The last remaining study showed a non-significant trend in favor of short-term treatment with low-molecular-weight heparin (LMWH) or a non-steroidal anti-inflammatory drug (NSAID) as compared to placebo shortly after treatment with respect to VTE, but the apparent benefit disappeared after three months of follow-up. Active treatment of SVT reduced the incidences of SVT extension or recurrence., Interpretation and Conclusions: Treatment with a therapeutic or prophylactic dose of LMWH or a NSAID reduces the incidence of SVT extension or recurrence, but not VTE. More RCT are needed before any evidence-based recommendations on the treatment of SVT for the prevention of VTE can be given. With the present lack of solid evidence we would suggest treating patients with at least intermediate doses of LMWH.

Surgical reduction of fat surplus is usually performed on healthy individuals and is reported as a safe procedure as it is not associated with a lethal outcome. Due to the anticipation of peri- and postoperative bleeding as a result of the large wound area, which may have a negative influence on the cosmetic result, patients often receive no or only inadequate anticoagulation. We report three cases in which surgical reduction of fat surplus led to sudden collapse and cardiac arrest. In all of our patients, fatal pulmonary embolism was the cause of cardiac arrest. These patients received only inadequate or no anticoagulation. Early postoperative mobilization, elastic stockings and compressive wound-dressing did not prevent pulmonary embolism. In addition to early postoperative mobilization of the patient and even though there is a risk of perioperative bleeding complications, the use of anticoagulation is highly recommended in surgical procedures like abdominoplasty or dermolipectomy. If sudden dyspnea, chest pain, collapse or cardiac arrest occurs after surgical interventions like these, pulmonary embolism should be considered and further diagnostic steps should be initiated.

The diagnosis of acute pulmonary embolism is based on the assessment of risk factors, consistent symptoms and signs, and the lack of an alternative clinical explanation for the condition of the patient. If the probability of pulmonary embolism is low or intermediate, the diagnosis can be reliably excluded by a negative D-dimer test. A positive D-dimer test requires further evaluation by spiral angio computed tomography technique to confirm or rule out pulmonary embolism. The angiocoexisting pulmonary diseases. If the clinical probability for pulmonary embolism is high an angio-CT rather then a D-dimer should be performed at the first place. If there are signs of deep leg vein thrombosis, massive pulmonary embolism with hemodynamic instability and in other special circumstances the diagnostic approach has to be adapted accordingly. A timely diagnosis and treatment with heparin and oral anticoagulation significantly reduces the acute and chronic morbidity and mortality of pulmonary embolism.

We describe the case of a 61-year-old woman who simultaneously suffered a pulmonary embolism and a myocardial infarction due to paradoxical coronary artery embolism. Transesophageal echocardiography with injection of agitated hydroxyethyl starch revealed a patent foramen ovale. Thrombophlebistis of the left saphenous vein with extension of thrombus into the femoral vein could be identified as the source of embolism. Paradoxical coronary embolism is an underrecognized cause of MI. Diagnosis is particularly difficult, when MI and PE coincide, because of the similarity in clinical signs and symptoms of both entities. A high level of clinical suspicion and echocardiography, especially if performed soon after presentation, can be the clue to early diagnosis of PDE.

Hughes-Stovin syndrome (HSS) is a rare clinical disorder, which has been described as the presence of pulmonary artery aneurysm in the setting of systemic thrombosis. The term "Incomplete Behçet's Disease" has also been used to describe this syndrome due to the clinical and histopathological similarities between Behçet's disease and HSS. Indeed, pulmonary involvement can be indistinguishable between these two conditions of unknown pathophysiology. We describe an HSS patient who presented with a recurrent pulmonary artery aneurysm, review the clinical and pathological manifestations of HSS, discuss its similarities to Behçet's disease, and finally make the argument that HSS is in fact Behçet's disease.

There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. If imaging is deemed necessary from an initial clinical evaluation such as d-dimer testing, options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT. In many institutions, spiral CT is becoming established as the first-line imaging test in daily clinical practice. With spiral CT, thrombus is directly visualized, and both mediastinal and parenchymal structures are evaluated, which may provide important alternative or additional diagnoses. However, limitations for the accurate diagnosis of small peripheral emboli, with a reported miss rate of up to 30% with single-slice spiral CT so far, have prevented the unanimous embrace of spiral CT as the new standard of reference for imaging pulmonary embolism. The clinical significance of the detection and treatment of isolated peripheral pulmonary emboli is uncertain. Evidence is accumulating that it is safe practice to withhold anticoagulation in patients with suspected pulmonary embolism on the basis of a negative spiral CT study. Remaining concerns about the accuracy of spiral CT for pulmonary embolism detection may be overcome by the introduction of multidetector-row spiral CT. This widely available technology has improved visualization of peripheral pulmonary arteries and detection of small emboli. The most recent generation of multidetector-row spiral CT scanners appears to outperform competing imaging modalities for the accurate detection of central and peripheral pulmonary embolism. In this review, we assess the current role and future potential of CT in the diagnostic algorithm of acute pulmonary embolism.

Objective: Superficial thrombophlebitis (ST) is a frequent and potentially serious disease if complicated with venous thromboembolism (VTE). Data on risk factors and incidence rates for ST are scarce. It is also unknown whether ST is a risk factor for recurrence of VTE., Methods: After discontinuation of secondary thromboprophylaxis for a first spontaneous VTE, we prospectively observed 615 patients on average for 30 +/- 26 months. Patients with natural coagulation inhibitor deficiency, lupus anticoagulant, or cancer, who were pregnant, or were receiving long-term antithrombotic therapy were excluded. The study outcomes were occurrence of symptomatic ST or objectively documented recurrent symptomatic VTE., Results: ST developed in 45 patients (7.3%) with a first VTE. High factor VIII concentration emerged as an independent risk factor for ST (relative risk [RR], 2.0; 95% confidence interval [CI], 1.0-5.2), compared with lower levels after adjustment for age and sex; factor V Leiden and prothrombin G20210A concentration; hyperhomocysteinemia; high body mass index; and duration of oral anticoagulation therapy. VTE recurred in 12 (27%) of 45 patients with ST and in 67 (12%) of 570 patients without ST. In patients with VTE, subsequent ST emerged as an independent risk factor for recurrent VTE. Patients with ST had twofold higher RR (2.1; 95% CI, 1.0-4.2) for recurrence than did patients without ST after adjustment for putative confounding variables., Conclusion: Patients with a first spontaneous VTE and subsequent ST are at increased risk for recurrent VTE. High factor VIII concentration is an independent risk factor for ST.

The approach to take in trying to establish or disprove a diagnosis of pulmonary embolism in the presence of deep vein thrombosis is the subject of some controversy nowadays. Systematic perfusion lung scan can be proposed, given the mediocre specificity of the clinical symptoms of embolism or the high frequency of asymptomatic pulmonary embolism. This strategy, however, is not validated in terms of cost-efficacy. In practical terms, favourable evolution and the low rate of recurrent embolism observed with a well executed anticoagulant treatment pleads against systematic scintigraphy. Because of its moderate sensitivity, systematic echocardiography probably should not be an element of the assessment of asymptomatic pulmonary embolism. The advent of spiral CT scan in the management of such patients could however make it necessary to reconsider this position, by allowing complete venous and pulmonary examination in thrombo-embolic disease.

Background: The purpose of the present is to assess the effectiveness of pulmonary embolism prevention using temporary or permanent vena cava filters in deep venous thromboses of the lower extremities with a discussion of indications and complications., Methods: In the period between 1989 and 1998 we observed 46 patients (33 m, 13 f) suffering from deep venous thrombosis of the lower extremities., Results: The cases treated with cava filter showed an improvement in clinical conditions in 15-19 cases with 4/19 cases of complications: filter ascent, lipothymia, one case of pneumothorax and one case of filter ascent with thrombosis of the contralateral venous axis. All complications were solved without further sequelae. After catheterisation of the femoral vein, the thrombosis of the contralateral venous axis in patients with caval filter was a frequently observed event (in 75% of cases). In the cases without filter, an evident improvement was observed in 22/27 cases, a slight improvement in 2/27 cases, with 3/27 cases of complications: two cases of cardiocirculatory arrest and one case of severe dyspnea with suspected pulmonary embolism which survived the event., Conclusions: From our experience, the use of caval filters is unquestionably useful for the prevention of pulmonary embolism, but is not wholly free from complications.

We evaluated selection bias in a prospective study of 1,162 consecutive patients with suspected pulmonary embolism. Of these, 983 were eligible, and 627 could actually be included. During two months extensive data were collected on all non-included patients. Finally, our patient characteristics were compared with those of the PIOPED study (1990) and the study of Hull et al. (1994). Compared with included patients, the non-included patients had more often non-diagnostic V/Q scans (50% vs. 36%, p <0.01) and were more often already hospitalized (31% vs. 22%, P = 0.04). The subgroup of patients not included due to refusal or inability to give informed consent (IC) was older (mean age 61 vs. 53 years, P <0.01), more often suffered from malignancies (26% vs. 11%, P <0.01) and frequently had non-diagnostic V/Q scans (57%) as compared to included patients. In our study, 54% of all patients screened was eventually included versus 27% in the PIOPED study. In the PIOPED study patients who had contra-indications for pulmonary angiography were excluded, while in the study of Hull et al. those with inadequate cardiorespiratory reserve were excluded. In studies on new diagnostic technologies, patient selection bias does occur. The potential for such a selection bias should be taken into account when diagnostic strategies are devised to improve their generalizability and acceptability.

Objectives: Duplex ultrasonography performance in detecting embolic foci has not been proven satisfactory compared with phlebography or autopsic findings. In case of suspected pulmonary embolism, the embolic focus is only discovered in 11 to 18% of the cases compared with more than 30% with phlebography. For overt acute pulmonary embolism, the discovery rate is in the 30 to 45% range versus 70 to 80% with phlebography or autopsy findings. This discrepancy might result from the fact that duplex ultrasonographic explorations are generally limited to the deep collectors at the cruropopliteal level. The purpose of this study was to assess the prevalence of duplex ultrasonography detected venous thrombosis in patients with suspected or acute pulmonary embolism when the exploration includes the entire venous system from the inferior vena cava to the ankles and examines not only the deep collectors but also the muscle and superficial networks., Material and Methods: This study included all patients with suspected pulmonary embolism referred to the emergency unit from January 1, 1995 through December 31, 1998. The patients' hospital files were used to determine the suspected pulmonary embolism population. The acute pulmonary embolism population was defined as the patients whose files contained documented proof of pulmonary embolism (highly probable ventilation/perfusion pulmonary scintigraphy, positive pulmonary angiography, positive proximal angioscan). Thrombosis of the deep venous collectors with or without associated superficial or muscular localization was classed as "deep venous thrombi" and superficial or muscular thrombosis without involvement of the deep collectors was classed as "other venous thrombi". Subpopliteal thrombosis was classed as distal and popliteal or suprapopliteal thrombosis as proximal., Results: The suspected pulmonary embolism group included 352 patients, 118 men and 234 women aged 67.6 +/- 15.4 and 70.8 +/- 20.0 years respectively (m +/- SD). The acute pulmonary embolism group included 60 patients, 17 men and 43 women aged 66.2 +/- 12.5 and 69.7 +/- 16.6 years respectively. Overall prevalence of duplex-ultrasound detected venous thrombosis was 30.4% (107/352) (95%CI: 25.6-35.2) in the suspected pulmonary embolism group and 80% (48/60) (95%CI: 69.9-90.1) in the acute pulmonary embolism group. Deep venous thrombi reaching the collectors and proximal thrombi predominated. Prevalence of "other venous thrombi" and distal venous thrombi were 6.5% (23/352) and 11.4% (40/352) respectively in the suspected pulmonary embolism group and 15.0% (9/60) and 26.7% (16/60) in the acute pulmonary embolism group. The frequency of asymptomatic venous thrombosis of the lower limbs, irrespective of the localization, was 42.1% (45/107) in the suspected pulmonary embolism group and 52.1% (25/48) in the acute pulmonary embolism group., Conclusions: The prevalence of duplex-ultrasonography detected venous thrombosis in patients with suspected or proven pulmonary embolism found in this series was equivalent to the rates reported in phlebography and autopsy series. The prevalence was higher than usually reported for duplex-ultrasonography studies limited to the cruro-popliteal level. The difference came from the "other venous thrombi" and "distal deep venous thrombi" discovered by exploring the superficial and muscular networks and the calves. This study demonstrates the contribution of duplex-ultrasonography to the diagnostic strategy for pulmonary embolism.

Switching from heparin to acenocoumarol was complicated by severe retroperitoneal bleeding in a 50-years old patient with massive pulmonary embolism and deep venous thrombosis. The haematomas were evacuated by surgical procedure. Planned insertion of a vena cava filter was abandoned because of a mobile clot in inferior vena cava (IVC) reaching above renal veins as evidenced by spiral computed tomography (SCT). Patient was transferred to the Surgical Department of Medical Academy in Warsaw where thrombectomy was performed. In spite of mechanical and pharmacological methods of venous thrombosis prophylactic, thrombectomy was complicated by massive proximal deep venous thrombosis of right leg and distal part of IVC. Patient was successfully treated with UFH i.v. followed by low molecular weight heparins. No bleeding complications were observed. Screening for thrombophilia and cancer were negative. This case report is an example of difficulties in clinical management in a patient who has both life-threatening thromboembolic disease and bleeding.