Vasc- pathologies and collateral circulation Flashcards
what does phlegmsia mean?
- inflammation
- used in reference to extreame cases of lower extremity DVT that cause critical limb ischemia and possible limb loss
Phlegmasia alba dolens (PAD) describes?
parient with swollen and white leg bevause of early compromise of arterial flow secondary to extensive DVT
What is milk leg? who does it mainly affect?
- milk leg is white leg associated with Phlegmasia albe dolens
- affects women in 3rd tri of pregnancy or post partum
Phlegmasia cerulea dolens is more advanced and considered a persursor for what?
frank venous gangrene
what is Phlegmasia cerulea dolens charaterized by? (3)
- severe swelling
- cyanosis
- blue discoloration of the extremity
Phlegmasia alba dolens 4 clinical presentations?
- milk leg/ white leg
- edema and discomfort
- leg pale and cool
- diminished arterial pulse due to spasm
Phlegmasia cerulen dolens clinical presentation?
- painful blue adema
- pain
- cyanosis
- irreversible ischemia
- necrosis
- gangrene
Phlegmasia cerulen dolens vs. Phlegmasia alba dolens?
cerulen- affects deep veins, superficial veins, and collaterals (more severe) (medical emergency)
alba- affects deep veins only
Phlegmasia cerulen dolens extends into capillaries in what % of cases?
40-60%
what is trousseau’s sign?
- concerns hypercoagulability associated with cancer
- based on spontaneous venous thrombosis in patients with underlying malignancy
When patients present with DVT and have no known risk factors, what is the underlying concern?
they may have an occult malignancy
T or F- DVT associated with malignancy tends to be much more extensive and aggressive than DVT in the nonmalignant setting?
true
clinical presentation of DVT in occult malignancy?
very swollen and painful extremity
Patients with DVT related to Trousseau’s syndrome usually clinically manifest cancer within how many years?
1-2 years
Malignancies associated with venous thrombosis typically arise in? (5)
- breast
- GI tract
- GU tract
- lung
- brain
SCV obstruction is difficult to diagnose due to a lack of visualization and location of clavicle so diagnosis relies on what?
- 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
many cases of SCV thrombosis involve?
IJV thrombosis- therefore should be part of the examination
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 also known as?
- jugular vein thrombosis
what is lemierres syndrome?
- 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
what is Behcet’s disease?
- inflammation in blood vessels
what does Behcet’s disease cause?
- redness
- pain
- swelling in arms and legs
Behcet’s disease in large arteries?
- inflammation that can lead to complications such as aneurysms or blockage of vessel
Behcet’s disease can affect? (7)
- mouth
- genitals
- eyes
- joints
- digestive system
- brain
What is the etiology of IVC thrombus? (3)
- mirrors that of DVT in general
- wall damage
- hypercoagulability
- venous stasis
tumors associated with IVC thrombosis? (3)
- RCC, seminomas, teratomas
- extends from renal vein and can propagate to the heart
- can partially or completely occlude IVC
Less common tumors that involve IVC? (3)
- retroperitoneal leiomyosarcoma
- adrenal cortical carcinoma
- renal angiomyolipoma
what kind of compression may cause thrombosis of the IVC?
- hepatic abscess
- polycystic disease
- pancreatic pseudocyst
- acute pancreatitis
How do enlarged lymph nodes correspond with thrombus in the IVC?
- they may compress the IVC in patients with chronic lymphatic leukemia and should not be confused with thrombus in the IVC
What is nephrotic syndrome? symptoms?
- patients with this syndrome have urinary protein losses
s/s:
- massive urinary protein loss
- diminished levels of antithrombin III
Iatrogenic IVCT may be seen in?
- patients with recent history of medical care
Iatrogenic IVCT- Interventions that reportedly have identifiable rates of IVCT include the following? (5)
Hepatic transplantation Dialysis access Femoral venous catheters Pacemaker wires Vena caval filters
Vena cava filters are placed where?
- ivs just below kidneys
Numerous other clinical situations have been associated with IVCT including? (4)
developmental anomalies of the IVC
retroperitoneal fibrosis
pregnancy
oral contraceptives
May-Thurner syndrome occurs when?
- rare
- compression of the common venous outflow tract of the left lower extremity
May-Thurner syndrome clinical presentation? (4)
- discomfort
- swelling
- pain
- blood clots
what might cause May-Thurner syndrome?
DVT in the iliofemoral vein
problem in May-Thurner syndrome?
- compression of the left common iliac vein by overlying right common iliac artery
May-Thurner syndrome leads to?
- pooling or stasis of blood
- formation of blood clots
causes of leg swelling, pain, or tenderness? (8)
Popliteal(Baker’s) cysts-ruptured Hematoma/muscle injury Superficial thrombophlebitis Iliac nodes/pelvic masses Arteriovenous fistula Lymphedema Knee joint effusion Rt heart failure
what is Hematoma/muscle tear?
An anechoic structure between the medial gastrocnemius and the soleus muscle
Hematoma/muscle tear D/D?
- A hematoma caused by a gastrocnemius muscle rupture,
- A hematoma caused by a plantaris tendon rupture
- A ruptured Baker’s cyst
how to make a diagnosis of a hematoma/muscle tear
- examine fluid collection in its full length
- DVT must be ruled out
Baker’s cyst is located?
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 is necessary for a definitive diagnosis of a baker’s cyst?
- the ‘neck’ between the tendons is necessary for a definitive diagnosis
- usually anechoic and may contain internal debris
what is Groin Lymphadenopathy?
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
what is Superficial thrombophlebitis?
- inflammation is vein with thrombus
thrombus at the junctions are concidered a risk for PE?
- SFJ, SPJ
In right heart failure what might be seen?
- bilateral leg adema
- fluid in abdo, leg, feet, causing swelling
What is Lymphedema?
- swelling in one or more extremities that result from impaired flow of the lymphatic system
what is a complication of lymphedema?
cellulitis
what is a risk for developing secondary deep vein thrombosis of the upper extremity?
IV drug use
primary DVT may be caused by?
- idiopathic or caused bu effort induced activity
what is cellulitis?
- infectious process in soft tissue
clues to diagnosing cellulitis?
- tenderness
- erythema
- skin thickening
- edema
- swelling
cellulitis can result from?
- break in skin from trauma
- surgery
- bite
what might be seen in an abcess? (4)
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
most common soft tissue tumor?
lipoma
soft tissue tumors examples 6?
Lipoma-most common Fibroma Leiomyoma Desmoid tumor Neurofibroma Hemangioma
malignant masses primary and metastatic?
primary: most common
- sarcoma and lymphoma
- melanoma
metastatic: uncommon
- lymphoma
- leukemia
appear hypervascular
Flow may bypass an aortoiliac obstruction utilizing what collateral?
Subclavian artery
Flow may bypass an aortoiliac obstruction utilizing what collateral?
Subclavian artery
Some major collateral routes are most often in the? (2)
1, abdomen
2. pelvis
