Recurrent Deep Vein Thrombosis and Vena Caval Filter Obstruction Detected by Bedside Ultrasound

Year 2016, Volume: 18 Issue: 1, 42 - 44, 01.03.2016

Özcan Yavaşi Tuba Durakoğlugil Kamil Kayayurt Gökhan Ersunan Asım Kalkan Barış Giakoup Özlem Bilir

Abstract

Introduction: Venous thromboembolism patients usually present to emergency departments.The diagnosis of these patients are diagnosed with bedside ultrasound examination. We reporta case of recurrent Deep Vein Thrombosis (DVT) in a young patient who had his first attackfollowing pregnancy in the emergency department.Case: A 23 year old female presented with pain and swelling on right leg. Following pregnancy,she had DVT on left leg and an IVC filter was placed with cocomittant thrombectomy. Her rightleg was swollen and tense. Homan’s test was positive. Distal pulses were palpable. She wasconscious and well-appearing. The rest of the physical examination was unremarkable. Bedsideultrasonography performed by emrgency physician revealed non compressible deep andsuperficial veins compatible with DVT. There was also thrombus in IVC from subhepatic regionto femoral veins with no blood stream. At tenth day following mechanical venous thrombectomyshe was discharged for outpatient follow up. Conclusion: Emergency physicians are able to use ultrasound in many clinical scenarios. Inthis patient with previous DVT attack, both lower leg veins and IVC filter were evaluated bybedside ultrasound and early diagnosis was made

Keywords

Recurrent Deep Vein Thrombosis, Vena Caval Filter, Bedside Ultrasound, Emergency Department

VENA KAVA FİLTRE OBSTRÜKSİYONU VE TEKRARLAYAN DERİN VEN TROMBOZUNUN YATAKBAŞI ULTRASONOGRAFİYLE TESPİTİ

Abstract

Giriş: Venöz tromboemboliye sahip hastalar genellikle acil servise başvurmaktadır. Bu hastalar,hasta başı yapılan ultrasonografik inceleme sonucunda tanı almaktadır. Biz acil serviste, gebeliğitakiben ilk atağı görülen genç bir hastadaki rekürren derin ven trombozunu sunmayı amaçladık. Olgu: 23 yaşında bayan hasta, sağ bacakta şişlik ve ağrı nedeniyle acil servise başvurdu.Gebeliği takiben sol bacakta DVT nedeniyle IVC filtresi yerleştirilerek aynı zamandatrombektomi yapılmış. Sağ bacak şiş ve gergindi. Homan’s testi pozitif, distal nabızları ellepalpabldı. Hastanın bilinci açık, genel durumu iyiydi. Diğer sistem muayenelerinde özellikyoktu. Acil hekimi tarafından hasta başı yapılan ultrasonografide, derin ve yüzeyel venlerinkomprese edilemeyip DVT ile uyumlu görüntü tespit edildi. Ayrıca femoral vende kan akımınınolmadığı ve subhepatik alanda IVC’da trombüsün olduğu görüldü. Hasta mekanik venöztrombektomi sonrasında onuncu günde ayaktan takip edilmek üzere taburcu edildi. Sonuç: Acil hekimleri birçok klinik tabloda kendi ultrasonografilerini kullanabilme yeteneğinesahiptir. Bu hastada da öncelikli olarak DVT atağı düşünülmüş, alt ekstremite bacak venlerineve IVC filtresi yatakbaşı ultrasonografiyle değerlendirilerek erken tanı konulmuştur

Keywords

Rekürren Derin Ven Trombozu, Vena Cava Filtresi, YatakbaşıUltrasonografi, Acil Servis

References

• Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350: 2257–2264.
• Yusuf H, Tsai J, Sıddıki A,et al. Emergency department visits by patients with venous thromboembolism, 1998-2009. J Hosp Adm 2012; 1: 1–8.
• Prandoni P, Cogo A, Bernardi E, et al . A simple ultrasound approach for detection of recurrent proximal-vein thrombosis. Circulation . 1993; 88: 1730 - 1735.
• Hajduk B, Tomkowski WZ, Malek G, Davidson BL. Vena cava filter occlusion and venous thromboembolism risk in persistently anticoagulated patients: a prospective, observational cohort study. Chest 2010; 137: 877-882
• Wells PS, Owen C, Doucette S, et al. Does this patient have deep vein thrombosis? JAMA 2006; 295: 199-207.
• Perrier A. Review: the Wells clinical prediction guide and D- dimer testing predict deep venous thrombosis. ACP J Club 2006; 145: 24.
• Pomero F, Dentali F, Boretta V, et al. Accuracy of emergency physician-performed ultrasonography in the diagnosisof deep vein thrombosis: a systematic review and meta-analysis. Thromb Haemost 2013; 109: 137-145.
• Lynch FC. A method for following patients with retrievable inferior vena cava filters: result sand lessons learned from the first 1,100 patient. J Vasc Interv Radiol 2011; 22: 1507–1512.
• PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Pr_vention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005; 112: 416–422.
• Wells P, Anderson D. The diagnosis and treatment of venous thromboembolism. Hematology Am Soc Hematol Educ Program 2013; 2013: 457–463.