Venous thromboembolism is the formation of a blood clot in the vein. It mainly consists of 2 life-threatening conditions-deep venous thrombosis and pulmonary embolism. Deep venous thrombosis is a potentially dangerous condition with grave sequelae, the worst of which is pulmonary embolism. Venous thromboembolism can also lead to multiple other conditions with significant morbidity and mortality that include extension of thrombi, pulmonary hypertension, recurrence, and postthrombotic syndrome. An update on the epidemiology, etiology, and pathogenesis of venous thromboembolism will be reviewed in this article.
Upper and lower extremity deep venous thrombosis (DVT) is defined as a blood clot within the deep veins of the affected extremities. These blood clots can either occur spontaneously or be associated with specific risk factors. Regardless of the cause, DVT is associated with significant morbidity and mortality and has the potential for lethal complications. The most notable complication is the potential for development of pulmonary embolism from a lower extremity DVT. As studies have reported, more than 90% of acute pulmonary emboli arise from the proximal veins. Venous thromboembolism is also associated with a significant economic burden on the health care system and the individual patient. In this article, we review DVT of the upper and lower extremity including risk factors, signs and symptoms, diagnosis, and management.
May-Thurner syndrome (MTS) is a rare disease that causes deep vein thrombosis (DVT) in young females (age 20 to 50). DVT is caused by mechanical obstruction of the left common iliac vein by the right common iliac artery resulting in stasis rather than a primary hypercoagulable state. Although MTS is found in 22% of cadavers, it causes <5% of lower extremity venous disorder. Greater than 70% compression is needed to cause DVT. MTS patients usually present with acute left leg edema. Many cases are recurrent with a past workup negative for other etiologies of DVT or pulmonary embolism (PE). Cases rarely present as PE rather than DVT. We present a case of this syndrome at a younger-than-typical age with PE as the first presentation. Femoral stick venogram is the gold standard for diagnosing MTS as therapeutic procedures can be done concurrently. Anticoagulation therapy alone is insufficient to prevent recurrence.
Acute fibrinous and organizing pneumonia (AFOP) is a histological pattern characterized by intra-alveolar fibrin deposition and associated organizing pneumonia. AFOP has been associated with many rheumatologic disorders in the literature but has not been described in association with Sjogren's syndrome.This paper shows a rare association of AFOP with Sjogren's syndrome. Patient's symptoms promptly improved after treatment with steroid.
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