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CNIH > Vasc- pathologies and collateral circulation > Flashcards

Vasc- pathologies and collateral circulation Flashcards

1
Q

what does phlegmsia mean?

A
  • inflammation

- used in reference to extreame cases of lower extremity DVT that cause critical limb ischemia and possible limb loss

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2
Q

Phlegmasia alba dolens (PAD) describes?

A

parient with swollen and white leg bevause of early compromise of arterial flow secondary to extensive DVT

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3
Q

What is milk leg? who does it mainly affect?

A
  • milk leg is white leg associated with Phlegmasia albe dolens
  • affects women in 3rd tri of pregnancy or post partum
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4
Q

Phlegmasia cerulea dolens is more advanced and considered a persursor for what?

A

frank venous gangrene

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5
Q

what is Phlegmasia cerulea dolens charaterized by? (3)

A
  • severe swelling
  • cyanosis
  • blue discoloration of the extremity
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6
Q

Phlegmasia alba dolens 4 clinical presentations?

A
  1. milk leg/ white leg
  2. edema and discomfort
  3. leg pale and cool
  4. diminished arterial pulse due to spasm
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7
Q

Phlegmasia cerulen dolens clinical presentation?

A
  • painful blue adema
  • pain
  • cyanosis
  • irreversible ischemia
  • necrosis
  • gangrene
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8
Q

Phlegmasia cerulen dolens vs. Phlegmasia alba dolens?

A

cerulen- affects deep veins, superficial veins, and collaterals (more severe) (medical emergency)

alba- affects deep veins only

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9
Q

Phlegmasia cerulen dolens extends into capillaries in what % of cases?

A

40-60%

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10
Q

what is trousseau’s sign?

A
  • concerns hypercoagulability associated with cancer

- based on spontaneous venous thrombosis in patients with underlying malignancy

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11
Q

When patients present with DVT and have no known risk factors, what is the underlying concern?

A

they may have an occult malignancy

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12
Q

T or F- DVT associated with malignancy tends to be much more extensive and aggressive than DVT in the nonmalignant setting?

A

true

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13
Q

clinical presentation of DVT in occult malignancy?

A

very swollen and painful extremity

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14
Q

Patients with DVT related to Trousseau’s syndrome usually clinically manifest cancer within how many years?

A

1-2 years

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15
Q

Malignancies associated with venous thrombosis typically arise in? (5)

A
  1. breast
  2. GI tract
  3. GU tract
  4. lung
  5. brain
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16
Q

SCV obstruction is difficult to diagnose due to a lack of visualization and location of clavicle so diagnosis relies on what?

A
  • secondary signs of obstruction
  • pressure fluctuation in the atrium are readily transmitted into the vein producing a pulsatile waveform
  • when pulsatility is absent SVC obstruction is present
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17
Q

many cases of SCV thrombosis involve?

A

IJV thrombosis- therefore should be part of the examination

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18
Q

if the SVC is the site of obstruction what may occur?

A
  • collateral flow in the internal mammary veins may occur (flow appears reversed)
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19
Q

What is Lemierre’s syndrome also known as?

A
  • jugular vein thrombosis
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20
Q

what is lemierres syndrome?

A
  • patient with a neck infection and enlarged lymph nodes
  • IJV compression results in thrombus formation due to stasis
  • bacteria from throat can spread to major blood vessels and poison blood stream leading to patient becoming septic
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21
Q

what is Behcet’s disease?

A
  • inflammation in blood vessels
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22
Q

what does Behcet’s disease cause?

A
  • redness
  • pain
  • swelling in arms and legs
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23
Q

Behcet’s disease in large arteries?

A
  • inflammation that can lead to complications such as aneurysms or blockage of vessel
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24
Q

Behcet’s disease can affect? (7)

A
  1. mouth
  2. genitals
  3. eyes
  4. joints
  5. digestive system
  6. brain
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25
Q

What is the etiology of IVC thrombus? (3)

A
  • mirrors that of DVT in general
  1. wall damage
  2. hypercoagulability
  3. venous stasis
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26
Q

tumors associated with IVC thrombosis? (3)

A
  • RCC, seminomas, teratomas
  • extends from renal vein and can propagate to the heart
  • can partially or completely occlude IVC
27
Q

Less common tumors that involve IVC? (3)

A
  • retroperitoneal leiomyosarcoma
  • adrenal cortical carcinoma
  • renal angiomyolipoma
28
Q

what kind of compression may cause thrombosis of the IVC?

A
  • hepatic abscess
  • polycystic disease
  • pancreatic pseudocyst
  • acute pancreatitis
29
Q

How do enlarged lymph nodes correspond with thrombus in the IVC?

A
  • they may compress the IVC in patients with chronic lymphatic leukemia and should not be confused with thrombus in the IVC
30
Q

What is nephrotic syndrome? symptoms?

A
  • patients with this syndrome have urinary protein losses

s/s:

  • massive urinary protein loss
  • diminished levels of antithrombin III
31
Q

Iatrogenic IVCT may be seen in?

A
  • patients with recent history of medical care
32
Q

Iatrogenic IVCT- Interventions that reportedly have identifiable rates of IVCT include the following? (5)

A 
Hepatic transplantation
Dialysis access
Femoral venous catheters
Pacemaker wires
Vena caval filters
33
Q

Vena cava filters are placed where?

A
  • ivs just below kidneys
34
Q

Numerous other clinical situations have been associated with IVCT including? (4)

A

developmental anomalies of the IVC
retroperitoneal fibrosis
pregnancy
oral contraceptives

35
Q

May-Thurner syndrome occurs when?

A
  • rare

- compression of the common venous outflow tract of the left lower extremity

36
Q

May-Thurner syndrome clinical presentation? (4)

A
  • discomfort
  • swelling
  • pain
  • blood clots
37
Q

what might cause May-Thurner syndrome?

A

DVT in the iliofemoral vein

38
Q

problem in May-Thurner syndrome?

A
  • compression of the left common iliac vein by overlying right common iliac artery
39
Q

May-Thurner syndrome leads to?

A
  • pooling or stasis of blood

- formation of blood clots

40
Q

causes of leg swelling, pain, or tenderness? (8)

A 
Popliteal(Baker’s) cysts-ruptured
Hematoma/muscle injury
Superficial thrombophlebitis
Iliac nodes/pelvic masses
Arteriovenous fistula
Lymphedema
Knee joint effusion
Rt heart failure
41
Q

what is Hematoma/muscle tear?

A

An anechoic structure between the medial gastrocnemius and the soleus muscle

42
Q

Hematoma/muscle tear D/D?

A
  • A hematoma caused by a gastrocnemius muscle rupture,
  • A hematoma caused by a plantaris tendon rupture
  • A ruptured Baker’s cyst
43
Q

how to make a diagnosis of a hematoma/muscle tear

A
  • examine fluid collection in its full length

- DVT must be ruled out

44
Q

Baker’s cyst is located?

A

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

45
Q

what is necessary for a definitive diagnosis of a baker’s cyst?

A
  • the ‘neck’ between the tendons is necessary for a definitive diagnosis
  • usually anechoic and may contain internal debris
46
Q

what is Groin Lymphadenopathy?

A

The lymph nodes in the groin (femoral or inguinal lymph nodes) may swell from an injury or infection in the foot, leg, groin, or genitals

47
Q

what is Superficial thrombophlebitis?

A
  • inflammation is vein with thrombus
48
Q

thrombus at the junctions are concidered a risk for PE?

A
  • SFJ, SPJ
49
Q

In right heart failure what might be seen?

A
  • bilateral leg adema

- fluid in abdo, leg, feet, causing swelling

50
Q

What is Lymphedema?

A
  • swelling in one or more extremities that result from impaired flow of the lymphatic system
51
Q

what is a complication of lymphedema?

A

cellulitis

52
Q

what is a risk for developing secondary deep vein thrombosis of the upper extremity?

A

IV drug use

53
Q

primary DVT may be caused by?

A
  • idiopathic or caused bu effort induced activity
54
Q

what is cellulitis?

A
  • infectious process in soft tissue
55
Q

clues to diagnosing cellulitis?

A
  • tenderness
  • erythema
  • skin thickening
  • edema
  • swelling
56
Q

cellulitis can result from?

A
  • break in skin from trauma
  • surgery
  • bite
57
Q

what might be seen in an abcess? (4)

A

Well-circumscribed fluid collections within the soft tissues
Well defined walls, simple, or complex fluid
Gas bubbles appear as bright reflectors
May be increased vascularity within the walls of the abscess

58
Q

most common soft tissue tumor?

A

lipoma

59
Q

soft tissue tumors examples 6?

A 
Lipoma-most common
Fibroma
Leiomyoma
Desmoid tumor
Neurofibroma 
Hemangioma
60
Q

malignant masses primary and metastatic?

A

primary: most common
- sarcoma and lymphoma
- melanoma

metastatic: uncommon
- lymphoma
- leukemia
appear hypervascular

61
Q

Flow may bypass an aortoiliac obstruction utilizing what collateral?

A

Subclavian artery

62
Q

Flow may bypass an aortoiliac obstruction utilizing what collateral?

A

Subclavian artery

63
Q

Some major collateral routes are most often in the? (2)

A

1, abdomen

2. pelvis

CNIH (69 decks)

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