Quiz 5 (second half) Flashcards
what does Phlegmasia mean?
greek word phlegma meaning inflammation
what does PAD stand for?
Phlegmasia alba dolens
what is Phlegmasia alba dolens used for?
in the medical literature in reference to extreme cases of lower-extremity deep venous thrombosis (DVT) that cause critical limb ischemia and possible limb loss
what does Phlegmasia alba dolens (PAD) describe?
the patient with swollen and white leg becuase of early compromise of arterial flow secondarty to extensive DVT
what is Phlegmasia alba dolens also known as?
milk leg
who does milk leg effect?
women in the third trimester of pregnancy or post partum
what does PCD stand for?
Phlegmasia cerulean dolens
when is the diagnosis of phlegmasia alba dolens (PAD) or phlegmasia cerulaea dolens (PCD) made?
clinical grounds in patients who have extensive DVT on imaging
is PAD or PCD more advanced?
Phlegmasia cerulea dolens (PCD)
what is PCD considered a precursor for?
frank venous gangrene
what is PCD characterized by?
severe swelling and cyanosis and blue discoloration of the extremity
points to remember about Phlegmasia alba dolens?
- known as milk leg or white leg
- blanching of extremities, edema, and discomfort
- leg is pale and cool
- diminished arterial pulse due to spasm
points to remember about Phlegmasia cerulen dolens?
- painful blue edema
- pain and cyanosis
- DVT in deep, superficial and collateral veins
- extends into capillaries 40-60% of the time
- irreversible ischemia, necrosis and gangrene
- surgical emergency
what is Trousseau’s sign?
concerns hypercoagulability associated with cancer
what is DVT in occult malignancy based on
the finding of spontaneous venous thrombosis in patients with underlying malignancy
what us a concern when patients present with DVT and have no known risk factors?
they may have an occult malignancy
is DVT with or without malignancy more extensive and aggresive?
DVT associated with malignancy
what does DVT malignancy clinincaly demonstrate?
a very swollen and painful extremity
Patients with DVT related to Trousseau’s syndrome usually clinically manifest cancer within ____________
1-2 years
where do malignancies associated with venous thrombosis typically arise in?
- breast
- GI tract
- GU tract
- lung
- brain
why can detection of thrombus in the SVC be difficult?
due to the frequency of it occuring centrally in the vein
what makes compression impossible for the SVC?
overlying bones (clavicle)
what does diagnosus of subclavian vein obstruction rely on?
secondary signs of obstruction
what does the SCV look like on spectral?
close to the right atrium, so pressure flucuations in the atrium are readily tramsitted into the vein, producing a pulsatile waveform
when is the normal pulsatility of subclavian vein obstruction blunted?
when there is a venous obstruction between the heart and the site where doppler waveform is obtained
what is diagnostic for subclavian vein obstruction?
demonstrating the asymmetry between the right and left SVC waveform
what should be apart of the SVC thrombosis examination?
many involve IJV thrombosis
what should be a potential cause in subclavian vein obstructon?
extrinsic compression as in large lymoh nodes due to breast cancer
if the SVC is the site of obstruction, what may occur?
collateral flow in the internal mammary veins may occur (flow appears reversed)
what is Lemierre’s syndrome?
jugular vein thrombosis
where do we see Lemierre’s syndrome?
in a patient with a neck infection and enlarged lymph nodes
what does IJV compression result in?
thrombus formation due to stasis
what is behcet’s disease/syndrome?
inflammation in blood vessels (veins and arteries)
what is the etiology of behcet’s disease/syndrome?
unknown or is autoimmune (bodys immune system attacks healthy cells)
what does behcet’s disease/syndrome cause in the arms and legs?
redness, pain, and swelling in the arms and legs
what can behcet’s disease/syndrome cause in the vessels?
blood clot to form
what can imflammation in large arteries lead to?
complications such as aneurysms or blockage of a vessel
what else does behcet’s disease/syndrome affect?
mouth, skin, genitals, eyes, joints, digestive system and the brain (causeing a stroke)
The etiology of IVC thrombus mirrors what?
that of DVT in general
what does IVC thrombus relate to?
specific situations relate to the IVC only but the wide variety of these situations all relate in one or more ways to VIRCHOWS CLASSIC DESCRIPTION
Virchow’s classic description
- wall damage
- hypercoagulability
- venous stasis
what are numerous malignancies associated witha?
IVCT (IVC thrombus)
what is the most familar malignancy associated with IVCT?
renal cell carcinoma
what is the path of spread of RCC?
the intravascular tumor extends from the renal vein and can propagate as far as the heart
what are Other genitourinary tumors that reportedly cause IVCT?
seminomas and teratomas
what can any structure that is anatomically related to the IVC generate?
either a direct compression or vascular invasion
what have all presented in association with IVCT?
- retroperitoneal leiomyosarcoma
- adrenal cortical carcinoma
- renal angiomyolipooma
hepatic hemagioma has caused IVCT from __________
extrinsic compression
what is a risk factor for DVT and the extension into the IVC?
malignancy itself
what may extrinis compression result from?
nontumoral sources and increase the likelihood of IVCT
what generates both venous stasis and turbulent flow?
the distortion of the normal caval anatomy
what is an uncommon clinical situation that can compress the IVC?
abdominal aortic aneurysms
what can hepatic abscesses form?
amebae or echinococci and generate thrombosis of the IVC from compression
what disease has been reportadly clinnically associated with thrombosis of the IVC?
polycystic disease of the right kidney
what with the pancreas may cause thrombosis of the IVC?
pancreatic pseudocysts and acute pancreatitis
what should not be confused with thrombus in the IVC?
enlarged retroperitoneal lymoh nodes impressing the IVC in a patient with chronic lymphatic leukemia
dealing with blood, what can cause IVCT?
psoas hematomas and other hematomas of the retroperitoneim
what does trauma include?
sequlae of virchows triad
- vessel injury
- hypercoagulability
- stasis
what may direct trauma of the IVC be the result of?
either penetrating or blunt trauma
the balance between what is both delicate and dynamic?
balance between coagulation system and the fibrinolytic system
disorders that disrupt the balance in the coagulation sysetm can cause what?
IVC thrombus formation may occur (nephrotic system is a classic example)
what do people with nephrotic system have?
massive urinary protein losses and diminished levels of antithrombin 3
what have been describes with nephrotic syndrome?
both renal vein thrombosis and IVCT
patients with what may present with iatrogenic IVCT?
recent history of medical care
the expansion of what has led to increased recognition of iatrogenic IVCT?
endovascular techonolgy
what are interventions that reportedly been identifiable rates of IVCT include?
- hepatic transplantation
- dialysis access
- femoral venous cathedars
- pacemaker wires
- vena caval filters
what is an inferior vena cava filter?
small cone-shaped device that is implanted in the IVC just below the kidneys
what is the vena cava filter designed to capture?
am embolism, a blood clot that has broken loose from one of the deep veins in the legs on its way to the heart and lungs
what are numerous other clinical situations that have been associated with IVCT?
- developmental anomalies of the IVC
- retroperitoneal fibrosis
- pregnancy
- OC
Is May Thurner syndrome a common or rare condition?
rare
what may compression of the common venous outflow tract of the left lower extremity may cause?
discomfort, swelling, pain or blood clots
what may be the cause of the May-Thurner syndrome?
DVT in the iliofemoral vein
what is the specific problem of May-Thurner syndrome?
compression of the left common iliac vein by the overlying right common iliac artery
what does compression of the common illiac veins lead to?
pooling or stasis of blood, predisposing the individual to the formation of blood clots
where is May-thurner syndrome more common?
in the left leg as the artery acultely overlaps the left iliac vein
wha does May-Thurner syndrome frequently manifests as?
pain when the limb is dependant and/or significant swelling of the whole limb
what are other causes of leg swelling, pain or tenderness?
Popliteal(Baker’s) cysts-ruptured Hematoma/muscle injury Superficial thrombophlebitis Iliac nodes/pelvic masses Arteriovenous fistula Lymphedema Knee joint effusion Rt heart failure
wat does a hematoma/muscle tear look like?
an anechoic structure between the medial gastrocnemius and the soleus muscle
what are the differential diagnosis of hematoma/muscle tear?
- hematoma caused by a gastrocnemius muscle rupture
- a hematoma caused by a plantaris tendon rupture
- ruptured bakers cyst
how do we differentiate a hematoma/muscle tear?
it is important to examine the fluid collection in its full length and a coexistent DVT must be ruled out
if a ruptured bakers cyst is seen, what must be assessed?
deep veins as coexistant DVT may be overlooked
what does a bakers cyst look like?
A cyst with a ‘neck’ at its deepest extent, extending into the joint space between the semimembranosus tendon and the medial head of the gastrocnemius muscle
what identification makes a definitive diagnosis for a bakers cyst?
neck between the tendons
when may lymph nodes in the groin swell?
injury or infection in the foot, leg, groin, or genitals
when may a lump form in the groin?
testicular cancer, lymphoma, or melanoma
what is superficial thrombophleitis?
inflammation of the vein with thrombus
what is considered threatening for PE?
thrombus at the SFJ and SPJ
who presents with knee joint effusion?
patients with arthritis, recent trauma, or knee surgery and infection
what wil fluid in the joint cause?
pain and swelling
what is presented with Rt heart failure?
- bilateral leg edema
- fluid may back up into your abdomen, legs and feet, causing swelling
what is lymphedema?
swelling in one or more extremities that results from impaired flow of the lymphatic system
in lymphedema, where is it most effected?
single arm or leg
what can the sign and symptoms of lymphedema mimic?
DVT
who has a higher risk of developing lymphedema?
patients with cardiovascular diseases, such as those with DVT venous leg ulcers and varicose veins
what is a complication of lymphedem?
cellulitis
what is considered a risk factor for developing secondary deep vein thrombosis of the upper extremity?
injecting drug use
what are the main causes of superficial and deep venous thrombosis?
the repeated trauma of venapuncture, local infections, and the irritating qualities of the drugs
what is responsible for bacteremia?
septic thrombosis
what is the most common bacteremia with septic thrombosis?
aureus
what are high risk locations for septic thrombosis?
upper limb deep veins
how is primary deep vein thrombosis caused?
idipoathic or caused by effort induced activity
what is cellulits?
infectous process in the soft tissues
what are clues to the diagnosis of cellultis?
tenderness and erythema
what may be identified with cellultis?
skin thickening, edema, and swelling of subcutaneous tissues
what is cellulits caused by?
bacterial infection
what does cellulitis result from?
break in the skin from trauma, surgery, or bite
what is a abscess?
Well-circumscribed fluid collections within the soft tissues
what does abscess look like?
- Well defined walls,simple or complex fluid
- Gas bubbles appear as bright reflectors
- May be increased vascularity within the walls of the abscess
how do soft tissue tumors appear?
isoechoic to hyperechoic with scant vascularity
what are benign soft tissue tumors?
Lipoma-MOST COMMON Fibroma Leiomyoma Desmoid tumor Neurofibroma Hemangioma
what are malignant soft tissue tumors-most common?
- sarcoma and lymphoma
- melanoma
what are malignant metastitic soft tissue tumors?
- lymphoma
- leukemia
how do malignant soft tissue tumors appear?
hypervascular
where are most major collateral routes?
in the abdomen and pelvis
what is an interesting long, collateral route?
flow may bypass an aortoiliac obstruction utilizing the subclavian artery as a source of flow
what gives rise to the superior epigastric arteries?
blood from the SCA courses distally through the internal mammary artery
what do the superior epigastric arteries communicate with?
- external iliac artery
- inferior epigastric branches
when does the superior epigastric arteries not communicate????
if the obstruction is acute
when the infrarenal portion of the abdominal aorta or common illiac arteries are involved in atherosclerotic disease where may flow originate from?
the SMA via the colic arteries to the rectal, vesical and hemorrhoidal arteries via the IMA
how may the lumbar arteries provide flow to the external iliac system?
via deep iliac circumflex artery or from the iliolumbar arteries of the internal iliac system
when the external iliac or common femoral arteries are blocked, where may flow be reconstructed through?
arising from the internal iliac (hypogastric) artery
an obstruction of the deep femoral artery may result in collateral flow from where?
developing from the common femoral artery via the superfical iliac circumflex artery or the superficil femoral artery
what happens if the superficial femoral artery becomes occluded at the adductor canal?
the deep femoral artery may provide flow through the descending lateral circumflex artery to the popliteal artery
what is flow below the knee common through?
collateral circulation is common through an extensive network of muscualr and genicular branches
when do collateral flows occur?
in the presence of DVT in chronic phase
what dilate to take flow up to the groin?
superficial vessels - long and short saphenos as well as their branches
