Bilateral deep vein thrombosis in pregnancy as first manifestation of an anomalous inferior vena cava
Bilateral deep vein thrombosis in pregnancy as first manifestation of an anomalous inferior vena cava
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妊娠期双侧深静脉血栓是下腔静脉异常的首发表现
DOI：
10.1007/s12574-022-00570-z
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发表时间：
2022
影响因子：
1.6
通讯作者：
Watanabe Hiroyuki
中科院分区：
文献类型：
--
作者：
Kato Tsukasa;Sato Wakana;Umeta Yuri;Suto Yuta;Sato Teruki;Watanabe Hiroyuki
一名33岁的妇女，怀孕10周，出现左下肢局部疼痛和肿胀。血液检查显示D-二聚体水平升高（50 μg/mL）。血管超声检测到从左腘静脉延伸至髂外静脉的静脉血栓形成。虽然开始肝素抗凝治疗，血管超声意外地显示双边DVT 1周后。增强计算机断层扫描（CT）显示肾下IVC充满长血栓，延伸至两侧髂总静脉，扩张并完全闭塞（图1A）。我们通过右颈内静脉置入了IVC滤器，但滤器扩张不足。为了挽救母亲的生命，进行了流产，抗凝治疗转为溶栓治疗。三周后，CT显示血栓消退，对溶栓治疗有反应，腹主动脉右侧有两个IVC。被血栓闭塞的中间IVC由两条髂总静脉的联合形成（图1 C-E，黑色箭头）。在重新评估之前的CT时，我们注意到中间IVC在肾脏水平逐渐变细（图1 B）。置入滤器的侧下腔静脉是卵巢右静脉的延续（图1C，*）。双侧肾静脉引流至外侧IVC（图1 C-E，白色箭头）。无内脏异位综合征及内脏位置倒置。为了探索两个IVC之间的通信，我们使用了CT/超声智能融合成像技术（日本佳能医疗系统公司），该技术对先前采集的CT和实时超声图像进行“容积到容积融合”。彩色多普勒成像显示两个IVC之间的通信（图1 F，G）。在左股静脉注射搅拌的生理盐水溶液后，对比增强超声显示内侧IVC中的微泡随后移动到外侧IVC，如在线动画1所示。双IVC的发生率为0.2-3%[1]。同侧下腔静脉重复畸形极为罕见[2，3]。在妊娠和产后期间，单侧DVT是DVT的最常见形式[4]，然而，在我们的病例中，左股静脉血栓形成发展为双侧DVT。双侧DVT发展的潜在机制可以通过两次打击模型来解释：由双IVC（“第一次打击”）引起的血瘀在她怀孕时触发DVT（“第二次打击”），这导致了异常IVC的发现。
A 33 year-old woman who was 10 weeks pregnant presented with localized pain and swelling in the left lower extremity. A blood test revealed an elevated D-dimer level (50 μg/mL). Vascular ultrasound detected venous thrombosis extending from the left popliteal vein through the external iliac vein. Although anticoagulant therapy with heparin was initiated, vascular ultrasound surprisingly revealed bilateral DVT 1 week later. Enhanced computed tomography (CT) showed that the infra-renal IVC was filled with a long thrombus that extended into both common iliac veins, dilating and completely occluding them (Fig. 1 A). We placed an IVC filter via the right internal jugular vein but filter expansion was insufficient. An abortion was performed to save the mother’s life and the anticoagulant therapy was switched to thrombolytic therapy. Three weeks later, CT revealed regression of the thrombus in response to thrombolytic therapy and two IVCs on the right side of the abdominal aorta. The medial IVC, which had been occluded by the thrombus, was formed by the union of two common iliac veins (Fig. 1 C–E, black arrow). On re-evaluating the previous CT, we noticed that the medial IVC was tapered at the renal level (Fig. 1 B). The lateral IVC, into which the filter had been inserted, was a continuation of the right ovarian vein (Fig. 1 C,*). The bilateral renal veins drained into the lateral IVC (Fig. 1 C–E, white arrow). There were no heterotaxy syndrome and visceral situs inversion. To explore communication between the two IVCs, we used the CT/ultrasound Smart Fusion imaging technique (Canon Medical Systems, Japan), which performs “volume-to-volume fusion” of previously acquired CT and real-time ultrasound images. Color Doppler imaging revealed communication between the two IVCs (Fig. 1 F, G). After injection of agitated saline solution into the left femoral vein, contrast-enhanced ultrasound revealed microbubbles in the medial IVC that subsequently moved to the lateral IVC as shown in Online Animation 1. The incidence of double IVC is 0.2–3%[1]. IVC duplication on the ipsilateral side is extremely rare [2, 3]. During pregnancy and the postpartum period unilateral DVT is the most common form of DVT [4], however, the left femoral vein thrombosis developed into bilateral DVT in our case. Underlying mechanisms for bilateral development of the DVT may be explained by a two-hit model: blood stasis induced by the double IVC (“first hit”) triggered DVT when she became pregnant (the “second hit”), which led to the discovery of the anomalous IVC.
气管和支气管营养不良性骨化
DOI：
10.1111/crj.12060
发表时间：
2014
期刊：
The Clinical Respiratory Journal
影响因子：
--
作者：
Min Suk Kim;Junehwa Lee
通讯作者：
Junehwa Lee
右双下腔静脉 (IVC) 与主动脉前髂骨汇合 - 病例报告和文献综述。
DOI：
10.7860/jcdr/2014/6785.4028
发表时间：
2014
期刊：
Journal of clinical and diagnostic research : JCDR
影响因子：
--
作者：
Chittapuram Srinivasan Ramesh Babu;R. Lalwani;Indra Kumar
通讯作者：
Indra Kumar
影响因子：
168.9
作者：
Ruggeri, M;Tosetto, A;Rodeghiero, F
通讯作者：
Rodeghiero, F