Search

Necrotizing fasciitis of the head and neck is a rare, life-threatening, soft tissue infection rapidly involving superficial fat and fascia with necrosis of the overlying skin. If septic thrombophlebitis of the internal jugular vein complicates a parapharyngeal abscess, the clinical condition is referred to as Lemierre syndrome, also known as post-anginal sepsis. A lethal case of necrotizing fasciitis of the neck is herewith reported that developed following tooth extraction and was complicated by thrombosis of the internal jugular vein and superior vena cava in an elderly diabetic patient.

Pylephlebitis, a septic thrombophlebitis of the portal vein, is a life-threatening complication of intraabdominal infections, commonly associated with acute appendicitis in children, and diverticulitis in adults. A 13-year-old boy was admitted for high fever and jaundice. On the fifth day of hospitalization, ultrasound Doppler flow and Computer Tomography scan studies showed thrombosis of the portal vein and acute appendicitis. The patient was treated with antibiotics, anticoagulation and laparotomy with appendectomy. No thrombophilic risk factors were diagnosed. Our aim is to improve physicians' awareness of this complication and emphasize the importance of early diagnosis and appropriate therapy in children in order to reduce serious complications and long-term sequels.

The experience of surgical treatment of 170 patients for an acute varicothrombophlebitis of the lower extremities subcutaneous veins was summarized. There was proved the efficacy and safety of application of an acute radical surgical tactics for prophylaxis of the pulmonary artery thromboembolism and for radical treatment of varicose disease as well.

Objectives: Acute purulent pericarditis is a lifethreatening disease, although it is becoming uncommon in the era of antibiotics., Materials and Methods: We present a case of fatal acute massive purulent pericarditis in a kidney transplant recipient., Results: A 46-year-old woman had an unrelated commercial renal transplant in 2003. She had a history of diabetes mellitus and hepatitis C infection. Kaposi sarcoma developed in the posttransplant period. Her last admission was prompted by the development of acute rejection confirmed by transplant biopsy, and she was treated with intravenous methylprednisolone. Three days before her death, thrombophlebitis of the right forearm was noted. We postulate that this could have been the source of the fulminant purulent pericarditis, as the organism in the pericardial fluid was Staphylococcus aureus, a common pathogen in thrombophlebitis. She was initially resuscitated after cardiac arrest but died shortly after., Conclusions: Severe purulent pericarditis in the immunocompromised patient can occur abruptly. The source of infection may show minimal signs and symptoms. Thrombophlebitis and other apparently minor infections should not be overlooked in such patients.

Lemierre's syndrome is characterized by a primary oropharyngeal infection in a young healthy person who subsequently develops septic thrombophlebitis of the internal jugular vein and metastatic abscesses. We here report an uncommonly severe case of Lemierre's syndrome with acute respiratory distress syndrome (ARDS), in which polymyxin B-immobilized fiber (PMX) was used as supportive therapy. A 30-year-old, previously healthy man presented with sore throat, fever, rigor, and dyspnea. Chest computed tomography scan revealed multiple bilateral peripheral pulmonary nodules with small bilateral pleural effusions. The patient's condition rapidly deteriorated into ARDS after admission. Intubation followed by mechanical ventilation was required, and hemoperfusion with PMX was useful in alleviating the patient's condition. Isolation of Fusobacterium necrophorum from the blood culture and the contrast-enhanced scan revealed thrombosis and thrombophlebitis in the left internal jugular vein. The patient was diagnosed with Lemierre's syndrome, and an alternative treatment regimen with prolonged administration of ampicillin, clindamycin, and metronidazole resulted in improvement of the patient's respiratory function and general condition. Our case indicated that PMX might be an effective supportive therapy in severe cases of Lemierre's syndrome with ARDS that possessed no indication of surgical interventions.

Intestinal vasculitis is an infrequent entity in the absence of systemic vasculitis or chronic inflammatory bowel disease. The primary involvement of gut restricted to mesenteric venous territory is exceedingly rare. We report a pseudotumoural lesion of the cecum caused by localized phlebitis and venulitis associated with thrombosis, with a putative immune etiology, in a young adult presenting with obstructive intestinal crisis.

Although superficial thrombophlebitis is a common disorder until recently it was considered as benign disorder. Also it is associated with varicose vein at legs and it was treated effectively with conservative methods, walking and non-steroid anti-inflammatory drugs. Aims of our investigation were: determine frequency of clinically silent deep vein thrombosis at legs in patient with and without superficial thrombophlebitis, determine correlation between superficial thrombophlebitis and deep vein thrombosis regardless of localization of superficial thrombophlebitis in superficial veins of legs and determine adequacy and safety vein phlebography in early diagnosis clinically silent deep vein thrombosis in patients with superficial thrombophlebitis. Using flebography in prospective study was evaluated incidence of clinically silent deep vein thrombosis in 92 patients with varicose veins at legs. By phlebograpy in patients with varicose veins at legs and superficial thrombophlebitis at legs and without clinical signs of DVT at legs of the 49 patients we detected DVT in 12 patients (24, 48%), in three male and nine female. We detected localization of DVT in ilijacofemoral junction in 4,08% patients, although localization of DVT in femoropopliteal region was observed in 6, 12% patients and localization in crural region was in 14.28% patients. Localization of DVT at legs was detected in iliac vein in 16.66% patients, in femoral vein in 25% patients, popliteal vein 8.33% patients, anterior tibial vein 16.66%, posterior tibial vein in 25% and crural veins 8.33% patients. Also we deduced significant difference between two group of patients (chi2 = 10, 76). Such result proves thesis that in most patients with superficial thrombophlebitis and varicose veins is possibility of developing of DVT.

The literature review presented herein analyses the mechanism of the development of pain and othersubjective signs and symptoms in chronic venous diseases. Also discussed are numerous findings suggesting a pivotal role played by the leukocytic-endothelial inflammatory reaction as the main stimulator of the nociceptors of the venous wall and paravasal tissue, resulting information of the pain syndrome. This is followed by substantiating the necessity of early initiation of comprehensive conservative therapy making it possible to block the molecular and cellular mechanisms damaging the venous wall and microcirculatory bed in patients presenting with various stages of venous chronic diseases.

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.

Introduction: The absolute risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) as well as extension and/or recurrence in superficial vein thrombosis (SVT) of the leg is considerable and underestimated. We retrospectively evaluated therapeutic management, thrombophilic risk factors and clinical outcome of SVT., Methods: A database search was performed for consecutive patients with a suspected SVT of the lower extremities referred to our institution between 1 January 1999 and 31 December 2004. The primary outcome measure was pain reduction at follow-up. Secondary outcome measures were progression or recurrence of SVT in the leg and the occurrence of (a)symptomatic DVT or symptomatic PE at follow-up., Results: In 73 patients follow-up information was present (3/76 non-evaluable patients). In 9/32 (28%) of the patients treated with carbasalate calcium, there was progression of SVT as assessed by ultrasonographic evaluation, compared with 3/11 (27%) in the low-molecular-weight heparin (LMWH) group and 3/6 (50%) in the no treatment group. DVT was diagnosed in 5/36 (14%) of the patients treated with carbasalate calcium compared with 1/13 (1%) in the LMWH and 1/3 (33%) in the other treatment groups at follow-up. Furthermore, 34 were tested for thrombophilic defects, 27 of whom had one or more thrombophilic defect., Conclusion: The results of our study show that SVT may be prone to venous thromboembolism and therefore needs to be treated or carefully followed up.

We present an unusual case in a post phlebitic lower limb that had previously developed an area of lipodermatosclerosis. An area within this broke down as a result of an angiosarcoma rather than the more probable: formation of a venous ulcer.

Phlegmasia dolens is a rare disorder caused by massive venous thrombosis. The clinical condition is subclassified as phlegmasia cerulea dolens (PCD) and phlegmasia alba dolens. The 2 forms differ in the venous area affected and remaining blood flow, causing arterial involvement and resulting in a difference in therapeutic strategy and prognosis. In PCD, the mortality rate is high, and amputation for venous gangrene is needed. Phlegmasia alba dolens is a mild form of PCD; the collateral venous system is intact, and the prognosis is better than for PCD. We experienced a rare case of bilateral phlegmasia dolens associated with Trousseau's syndrome. The patient was diagnosed with phlegmasia alba dolens because the artery was not occluded. She was treated with anticoagulant therapy, the placement of a vena cava filter, and a rehabilitation program. The bilateral soleus muscles underwent necrosis, and the occurrence of equinus foot disturbed her walking, but careful rehabilitation with stretching, a range of passive motion exercises by a physical therapist, a tilting table, and ergometer training strengthened the muscles and allowed the patient to walk unaided 8 months after onset. Through this case, we hope to learn more about the pathogenesis of phlegmasia dolens and clinical treatment measures.

Superficial vein thrombophlebitis (SVTP) appears in two distinct forms: varicose vein thrombophlebitis (TP) represents the principal cause. It is characterized by a large thrombus in a varicose vein and a modest inflammatory process localized in the vessel surrounding but not in its wall. Rarely, SVTP affects a non-varicose vein. Abundant intima proliferation and media fibrosis with non-important thrombosis are the hallmark of this form which may be associated with a systemic disease. Although SVTP is perceived as trivial and benign coexistence of (mostly distal) deep venous thrombosis (DVT), propagation to popliteal or femoral DVT, and even pulmonary embolism (PE) have been reported. Data for prevalence vary greatly: 6-53% for coexistence, 2.6-15% for propagation, and 0-33% for (asymptomatic) PE. Risk factors for these complications are those known for DVT. SVTP is diagnosed in a clinical setting but ultrasonography is useful to check for concomitant DVT. Anticoagulant treatment is mandatory if DVT is present and thrombectomy should be considered in cases of thrombus propagation into the deep veins. Historical therapy of uncomplicated SVTP consists of compression with bandages or stockings and local or systemic anti-inflammatory agents. Low-molecular-weight heparin (LMWH) has been given in high-prophylactic doses and found equally effective when compared with anti-inflammatory agents and full-therapeutic dose LMWH. Prophylactic saphenous vein ligation alone was found less effective than conservative therapy. Ligation combined with stripping proved the potential of eliminating at once all problems associated with SVTP but was associated with a complication rate of 10% or higher. Careful patient selection and saphenous vein thrombectomy prior to stripping may be the clue for better results.

Background: Mondor's disease (MD) is considered an inflammatory condition of superficial vasculitis that develops mainly in the anterolateral thoracoabdominal wall. The pathogenesis of the disease has been controversial, however, because of the lack of histopathologic methods for differentiating between the small vein and the lymphatic vessel., Aim: To objectively examine the origin of vascular lesions in MD, we investigated the endothelial cells of their blood and lymphatic vessels., Methods: Immunohistochemical examinations were carried out on specimens involving vascular lesions from 16 patients with MD, using antibodies against von Willebrand factor and human lymphatic vessel endothelial hyaluronan receptor-1, which specifically discriminate between lymphatic and blood vessels., Results: The histopathologic findings clearly showed thrombophlebitis in 14 patients, a lesion originating in the lymphatic vessel in one patient, and sclerosis that consisted of the artery together with veins in another., Conclusion: This study suggests that almost all cases of MD are due to thrombophlebitis, with a small minority due to lymphangitis or other conditions. We believe this study will contribute to the better recognition of the factual changes in the condition designated MD.

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 work presents an analysis of results of conservative treatment of 48 patients aged from 32 through 76 years having postthrombophlebitic syndrome with symptoms of chronic venous insufficiency. The system of complex pharmacotherapy included phlebothropic medicines of flavonoid series (detralex) and of synthetic origin (tribenosid). The course of treatment was 2-3 months. Long-term results of the treatment were followed-up during the period from 6 months to 2 years in 44 patients. The complex treatment resulted in reliably less degree of clinical manifestations (chronic venous insufficiency). Recurrence of trophic ulcers appeared in 6 patients.

Phlegmasia cerulea dolens is an uncommon but potentially life-threatening complication of acute deep vein thrombosis. It is an emergency and delay in treatment may cause death or loss of the patient's limb. Surgical thrombectomy is the recommended treatment in venous gangrene. Catheter-directed intrathrombus thrombolysis has been reported as successful, but it may require a lengthy infusion. Manual aspiration thrombectomy may clear the entire thrombus with no need for thrombolytic administration and provide rapid and effective treatment for patients with phlegmasia cerulea dolens with impending venous gangrene.

Study Design: Case report., Objective: To present a rare anomaly of the inferior vena cava associated with radicular pain and to illustrate its imaging characteristics., Summary of Background Data: Irritation of the trigeminal nerve by vascular anomalies, resulting in neuralgia is a well-recognized entity. Recently, compression of peripheral nerve roots due to enlarged epidural venous plexus has been described as a possible cause of back and radicular pain, too., Methods: A 26-year-old man presented with acute exacerbation of lower back pain associated with radiculopathy down his left thigh. On radiologic workup, a prolapse of a lumbar intervertebral disc was ruled out, but agenesis of the infrarenal segment of the inferior vena cava was found, which has caused bilateral deep venous thrombosis. Venous flow was redirected mainly via enlarged lumbar epidural, ascending lumbar, and paravertebral veins., Results: No associated congenital heart or abdominal organ defects were found and screening for thrombophilia was negative. The patient was successfully treated with anticoagulation under which symptoms gradually resolved., Conclusion: The authors believe that epidural venous enlargements should be considered as a cause of radicular and/or back pain in patients with anomalies of the inferior vena cava, because pathologic processes compressing nervous structures can cause pain.

Background: Phlegmasia cerulea dolens is an extremely rare condition caused by complete venous occlusion and often results in tissue necrosis, limb amputation, or death. Treatment options include systemic anticoagulation, systemic thrombolytic therapy, fasciotomy, or surgical thrombectomy. Rare case reports have described the use of catheter-directed thrombolysis in the treatment of this condition. Prompt diagnosis and treatment initiation are important to prevent gangrene, amputation, and ultimately death., Case: We report two unusual cases of phlegmasia cerulea dolens that presented in patients with aggressive gynecologic malignancies and who were successfully treated with catheter-directed thrombolytic therapy., Conclusion: To maximize the opportunity for limb salvage, catheter-directed venous thrombolytic therapy should be considered in the treatment of phlegmasia cerulea dolens that presents in the gynecologic oncology patient.

Objectives: Lemierre syndrome is usually caused by an acute oropharyngeal infection in previously healthy young adults, resulting in thrombophlebitis of the internal jugular vein, leading to metastatic septic embolization and bacteraemia. The usual organism is Fusobacterium necrophorum. Lemierre syndrome, not so long ago labeled as the "forgotten disease," is on the rise. Today with increasing antibiotic-resistant organisms, and decreasing awareness of the syndrome, subsequent re-emergence of this "forgotten disease" is becoming more common in clinical settings. Lemierre syndrome has significant morbidity. Cranial nerve complications associated with the condition have been increasingly diagnosed in the last few years. Looking back at literature on Lemierre syndrome, there have been review articles in medical and microbiology journals but rarely in otolaryngology journals. By presenting our cases we demonstrate the diverse presentations and severity of the illness., Methods: A review of the literature and a case report on two cases seen in our institution in the last year are presented. Each of these had varied presentations and neurologic complications-one developed 9th to 12th cranial nerve palsies and Horner syndrome, which have not been described in previous literature, and the other developed polyneuropathy and a frontal lobe infarct among other multisystem complications., Conclusions: Diagnosis of Lemierre syndrome is not always straightforward as clinical features are variable and blood cultures are often negative. Awareness of the syndrome and a high degree of suspicion are needed.

Phlegmasia dolens is a rare form of massive venous thrombosis of the lower extremities that is associated with a high degree of morbidity, including venous gangrene, compartment type syndrome, and arterial compromise. We report the sonographic findings in a patient who presented with phlegmasia dolens., ((c) 2007 Wiley Periodicals, Inc.)

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.

Background: Portal-mesenteric vein thrombosis, pylephlebitis and liver abscesses are rare complications of inflammatory bowel disease (IBD). The purpose of this case report is to relate an unusual presentation of CD in order to show how conservative treatment could be an appropriate option as a bridge to the surgery, in patients with septic thrombophlebitis and multiple liver abscesses with CD., Case Presentation: We report a case of a 25-year-old man with Crohn's disease (CD) who developed a superior mesenteric venous thrombosis, multiple liver abscesses and pylephlebitis, diagnosed through abdominal ultrasound and an abdominal computed tomography (CT) scan. The patient was successfully treated with conservative treatment consisting of intravenous antibiotics, subcutaneous anticoagulation and percutaneous catheter drainage of liver abscesses., Conclusion: We reported an unnusual case of pylephlebitis in CD. Until now this association has not been reported in adult patients at onset. We hypothesise that the infection developed as a result of mucosal disease and predisposed by corticoid therapy. Adequated management was discussed.

Thrombophlebitis is caused by superficial venous thrombosis and vascular inflammatory changes affecting the lower limbs. The condition is often encountered in pregnancy and symptomatic treatment including compression and analgesia are commonly employed. The obstetrician may become involved in the management of thrombophlebitis; however the potential for embolic complications, and need for adequate assessment remain widely unrecognised. This case report highlights pitfalls in the management of thrombophlebitis, in particular the dangers of clinical assessment without the use of Doppler ultrasound and the potential for deep venous extension and embolic complications. The case also documents the use of low molecular-weight heparin in pregnancy to prevent such complications and promote thrombus resolution; a review of the available treatment options, including surgery, is included. Whilst thromboembolism remains a leading cause of maternal death, the potential dangers of symptomatic thrombophlebitis should not be overlooked.

Objective: To report a clinical case of bladder exstrophy adenocarcinoma., Methods: 57-year-old female presenting with a hypogastric mass. The biopsy of the mass revealed bladder adenocarcinoma. We performed radical cystectomy., Results: Pathologic study was compatible with moderately differentiated adenocarcinoma., Conclusions: After six months of follow-up patient is disease-free.

Hepatic portal venous gas is a rare radiological finding with a wide spectrum of underlying pathologies. We describe a case of hepatic portal venous gas due to septic thrombophlebitis of the superior mesenteric vein. The clinical management of portomesenteric venous gas and the importance of computed tomography in delineating its underlying causes are discussed.

Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. Currently, an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasonography imaging allows for safe and convenient estimation of suspected lower-limb thrombosis. The mainstay of treatment is anticoagulation therapy. The use of low-molecular-weight heparin or pentasaccharide (fondaparinux) allows for outpatient management of most patients with DVT. The duration of anticoagulation depends on whether the primary event was idiopathic or secondary to a transient risk factor. Interventions such as thrombolysis and placement of inferior vena cava filter are reserved for special situations.

During an episode of thrombophlebitis, the 72-year-old correspondent came down with a common cold presumably, but not provenly, due to infection by one of the rhinoviruses. During the 96 hr period of coryza, all symptoms of thrombophlebitis vanished completely. There is experimental evidence that rhinovirus infections elicit cytokine production [Stöckl et al. (1999): J Clin Invest 104: 957-965], and that IL-10 can assuage thrombosis in rats [Downing et al. (1998): J Immunol 161: 1471-1476].

A 44-year-old man developed bilateral blindness following severe periorbital cellulitis and pansinusitis. CT and MR imaging demonstrated bilateral cavernous sinus thrombosis. Diffusion-weighted imaging revealed reduced apparent diffusion coefficient in bilateral optic nerves, suggesting optic nerve ischemia caused by the cavernous sinus thrombophlebitis (CST). Following surgical debridement of pansinusitis, antimicrobial therapy, and anticoagulation, the patient recovered from the infectious episode but sustained permanent bilateral blindness. This case shows that both retinal and optic nerve ischemia can be the cause of blindness after CST. Arguments supporting an arterial-versus-venous origin for the ischemia are discussed.

An 80-year-old woman with type II diabetes mellitus was admitted to hospital with high-grade fever and leg pain for the previous three days. Physical examination revealed marked distention of the peripheral veins in both lower legs and she complained of pain. Spontaneous superficial suppurative thrombophlebitis was diagnosed and transfusion of cefazolin every 8 hours was started immediately after blood cultures. After 48 hours, the distention of the peripheral veins was improved; however, she suffered from a severe back pain thereafter. Two sets of blood culture yielded Group B streptococcus. Therefore the antibiotic was changed to ampicillin every 6 hours. To investigate the cause of back pain, MRI of the lumbar vertebral body was taken. Saggital gadolinium T1-weighted MRI demonstrated a high signal intensity lesion from Th7 to Th11, suggesting vertebral osteomyelitis following Group B streptococcal bacteremia from superficial suppurative thrombophlebitis. One week later, the clinical symptoms mostly disappeared. After six weeks of treatment, she was discharged. Suppurative thrombophlebitis is an inflammation of the vein wall by microorganisms and sometimes causes secondary metastatic abscess. Aging and diabetes are also risk factors for group B streptococcal invasive infection. This case suggests vertebral osteomyelitis should be taken into consideration during the course of group B streptococcal bacteremia in an elderly patient complaining back pain.

Pylephlebitis, also called septic thrombophlebitis of the portal vein, is a life-threatening complication of intra-abdominal infection. Although rare, it remains a less recognized entity with a high rate of mortality. We present a 66-year-old man with acute infected choledocholithiasis complicated with Bacteroides fragilis bacteremia. The contrast-enhanced computed tomography scan of the abdomen showed nearly total thrombotic occlusion of the left portal vein. The comprehensive studies for hypercoagulation disorders all yielded negative results. After endoscopic extraction of bile duct stones and broad-spectrum antibiotic therapy, the patient recuperated with complete recanalization of the occluded portal vein. To our knowledge, pylephlebitis associated with acute infected choledocholithiasis has never been reported. This report details the clinical features, radiographic findings, pathogenesis, and treatment of this distinctly unusual manifestation. Early identification of pylephlebitis and underlying intra-abdominal infection can be achieved by exquisite imaging studies with raised awareness in the clinical setting. Eradication of infectious foci and judicious administration of antimicrobials are essential to reduce the catastrophic morbidity and mortality of pylephlebitis.

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.

In the 26th year of life a young woman suffered a portal and mesenteric thrombosis followed by portal hypertension with splenomegaly, esophageal varices and pancytopenia. After splenorenal shunt surgery and splenectomy hematologic parameters resolved rapidly. Also, she was suffering of Proteus syndrome, which is an extremely rare and sporadic hamartomatous disorder characterized by a variety of cutaneous and subcutaneous tumors including vascular malformations, several types of nevi, partial gigantism of the hands and/or feet and cystic visceral affections. It has been demonstrated that concurrence of several prothrombotic risk factors occur relatively often in patients with portal vein thrombosis. An extensive investigation of thrombophilic factors revealed reproduced high anti-beta2-glycoprotein I antibody titers together with mildly increased homocysteine levels. Other coagulation parameters were normal or negative. The presence of myeloproliferative moglobinuria was ruled out. Together with the history of recurrent superficial thrombophlebitis and portal vein thrombosis in the absence of other underlying diseases allowed for diagnosis of primary antiphospholipid syndrome being aggravated by hyperhomocysteinemia and vascular malformations caused by Proteus syndrome. Because of combined risk factors for further thrombembolisms permanent oral anticoagulant therapy was initiated.

This case report describes a patient diagnosed with ongoing portal venous gas, initiated by a rather common Campylobacter enterocolitis and maintained by septic thrombophlebitis and possibly by chronic cholecystitis. Cholecystectomy attenuated the patient's septic condition. The etiology of portal venous gas determines both the patient's prognosis and the choice for either conservative or surgical treatment. This report describes persistence of portal venous gas for a long period and a possible role for chronic cholecystitis as a cause.