Quiz 5 PPT's #2 Flashcards
Phlegmasia Alba Dolens (PAD):
in reference to very extreme cases of DVT
causes limb ischemia/limb loss (blanching of extremities, edema and discomfort)
diminished arterial pulse due to vasospasm
Phlegmasia AD is also known as
milk leg
Signs of phlegmasia AD:
swollen, white leg because of early compromise of arterial flow secondary to extensive DVT
Phlegmasia Cerulean Dolens:
more advanced than PAD precursor for venous gangrene significant swelling, pain, and cyanosis surgical emergency irreversible ischemia, necrosis and gangrene
What affects only the deep venous channels (not collaterals)?
PAD
What affects the deep, superficial and collateral veins?
PCD - and extends into capillaries 40-60% of the time
Later stages of treatment for PCD?
incision into the vein, pass catheter into the clot, and balloon and clot is retreated with the balloon. Risk of PE but they take heparin first
Early stages for PCD?
thrombolysis (i think that’s what she said)
Trousseau’s Sign:
concerns hypercoagulability associated with cancer
spontaneous recurring venous thrombosis in ppl who have no known risk factors
What’s the difference of having a DVT with malignancy?
more extensive
more aggressive
very swollen and painful leg
Malignancies associated with venous thrombosis typcally arise in:
breast GI tract GU tract (genitourinary) lung brain
Patients with DVT related to Trosseau’s syndrome usually clinically manifest within
1-2 years
Subclavian Vein Obstruction:
detection can be difficult
diagnosis relies on secondary signs of obstruction (color)
pressure fluctuations are transmitted into veins, producing a pulsatile vein..so if it’s a flat signal u know it ain’t good (indicates a proximal obstruction)
In many cases of SCV thrombosis, _____ ________ can be involved
IJV thrombosis
Lemierre’s syndrome:
or jugular vein thrombosis in a patient with neck infection of enlarged lymph nodes
bacterial that is usually from throat infections and it spreads into major blood vessels and poisons the bloodstream (sepsis)
Behcet’s Disease:
inflammation of blood vessels (veins or arteries)
causes redness, pain and swelling in extremitites
can cause blood clot to form because of inflammation
can
**What’s affected
Virchow’s classic description:
hyper coagulability
venous stasis
endothelial damager
IVC thrombosis due to tumors:
most familiar is RCC
seminomas/teratomas (if gonadal veins are affected it can be because of genitourinary tumors)
What else can cause IVCT?
less common tumors in an anatomical location close to IVC
retroperitoneal leiomyosarcoma, adrenal cortical carcinoma, renal angiomyolipoma, hepatic hemangioma (due to compression)
Extrinsic compression:
can result from non-tumor compression
causes stasis and turbulent flow
AAA’s (although uncommon)
Don’t mistake a ________ for a thrombus within the IVC
enlarged lymph nose in a patient with chronic lymphatic leukemia
There’s a lot of shit on the PPT (collateral flow)
so make sure to read it over too
Inability for body to produce coagulants to stop bleeding is a
dysfunctional coagulation system and fibrinolytic system
Nephrotic syndrome:
patients have urinary protein losses
diminished levels of antihrombin III (this deficiency of AIII can cause blood to clot more easily than normal)
renal vein thrombosis and IVCT have been described
Iatrogenic:
no known cause
hx of medical care including: hepatic transplant, dialysis access, FV catheters, pacemaker wires, and IVC filters
Other conditions that are associated with IVC thrombosis:
developmental anomalies of IVC
retroperitoneal fibrosis (excess growth of tissue)
pregnancy
OC use
May Thurner Syndrome:
rare condition more often in women
compression of common venous outflow tract
causes discomfort, pain, swelling and blood clots form (stasis)
Lt common iliac vein is compressed by the overlying rt. common iliac artery
DVT in iliofemoral vein may be cause
May Thurner is more common in what side?
Left - the artery acutely overlaps the left iliac vein
What can be some causes of leg swelling that can mimic DVT?
Baker's cyst hematoma/muscle injury superficial thrombophlebitis iliac nodes/pelvic masses AVF lymphedema knee joint effusion Rt. heart failure
Hematoma/muscle tears
anechoic structure b/w medial gastroc and soleus muscle
must examine fluid collection to differentiate from vessel
Baker’s cyst:
identification of the neck between the tendons is necessary for definitive diagnosis (look for neck into joint space)
popliteal medial knee is most common location
can contain internal debris
If Baker’s cyst is seen, what must be assessed also?
deep veins as a coexistent DVT may be overlooked
Superficial thrombophlebitis
inflammation of the vein with thrombus
SPJ
saphenopopliteal junction
Knee joint effusions:
patients with arthritis, recent trauma or knee surgery and infection
causes pain and swelling
Rt heart failure will show:
bilateral leg swelling
fluid can back up into abdomen
Lymphedema:
siginificant swelling in one or more extrmeities that result from impared flow of the lymphatic system
can mimic DVT
cellulitis is complication
IV drug use:
risk factor for *secondary DVT of upper extremitity
repeated trauma can cause S/DVT
Cellulitis:
infectious process in soft tissue
difficult to see sonographically
tenderness, dimpling, and erythema are clues
Abscess:
well-circumscribed fluid collection
gas bubbles are bright reflectors
inc vascularity within the walls
Soft tissue tumors
Lipoma is most common
incidentalomas
benign or malignant ( vascularity depends on this)
sarcoma/lymphoma/melanoma are m/c malignant
mets
Arterial ulcers are located:
toes, feet and lateral aspect of ankle/calf
Venous ulcers are located:
medial aspect of calf and ankle (not toes or feet)
