22 - Púrpura Flashcards
Doença de Mondor?
INTRODUÇÃO
Mondor syndrome is characterized by superficial thrombophlebitis of subcutaneous veins within the anterolateral thoracoabdominal wall, i.e. lateral thoracic, thoracoepigastric, and superior epigastric veins.
PATOGÉNESE
Common pathogenic factors in chest wall thrombophlebitis include trauma, excessive physical activity, a surgical procedure on the breast, mastitis, a breast abscess, and pendulous breasts. Up to 10% of patients with Mondor syndrome have an underlying breast carcinoma. Occasionally, the condition is associated with rheumatoid arthritis, filariasis, pregnancy, oral contraceptive use, intravenous drug use, intravenous catheters, a non-breast malignancy, or a hypercoagulable state (e.g. hereditary protein C deficiency, anti-cardiolipin antibodies).
CLÍNICA
Sudden onset of chest pain followed by the appearance of one or more visible or palpable cords (representing thrombophlebitic veins) typify this syndrome.
Associated findings include tenderness, a sensation of tension, erythema, ecchymosis, pruritus, arthralgia, and rarely fever. Symptoms worsen on pulling the skin or elevating the breast and the ipsilateral upper extremity. The condition is usually unilateral and is three times more common in women than in men.
HISTOPATOLOGIA
A biopsy is rarely required. The process may involve arteries and lymphatic vessels as well as veins. Sclerosing endophlebitis with complete or partial obliteration of the lumen by thrombus and inflammatory cells is typical. The time period between the onset of the condition and ultimate recanalization of the affected vessels varies from 2 weeks to more than 6 months.
DIAGNÓSTICO DIFERENCIAL
The clinical presentation is unique, and etiologic factors should be identified. Recurrent superficial thrombophlebitis (migratory thrombophlebitis) is frequently associated with an underlying malignancy (Trousseau syndrome; most often pancreatic or lung carcinoma), a hypercoagulable state (inherited or acquired), or an inflammatory condition (e.g. Behçet disease).
TRATAMENTO
The disease is usually benign and self-limited, except when associated with breast cancer. Aching pain typically ends within 10 days, but the cord often persists for weeks to months and may be tender. Local heat, rest of the arm, and breast support can improve symptoms. The rate of recurrence is ~5%.
Superficial venous thrombophlebitis may occur in other locations (e.g. lower extremities), but is not considered Mondor syndrome. In a Cochrane review of treatment options for superficial thrombophlebitis of the lower extremity, NSAIDs and low-molecular-weight heparin reduced extension or recurrences by ~70% (compared to placebo). Superficial venous thrombosis involving the main trunk of the saphenous vein has the strongest association with venous thromboembolism, and when the thrombosis is at or near the sapheno-femoral or sapheno-popliteal junction, it should probably be removed, followed by venous ligation/stripping and possibly three months of low-molecular-weight heparin.
