Figure 4 Angio-CT images. (A) Axial view reproducing the echo parasternal short axis view shown in figure 3, butterfly sign is also visible *. (B, C and D) Oblique views, showing a type A interrupted aortic arch and aortopulmonary window. AAo, ascending aorta; DAo, descending aorta; LPA, left pulmonary artery; PDA, patent ductus arteriosus; PT, pulmonary trunk.
Magnetic resonance enterography showed terminal ileitis and colonoscopy revealed a strictured ileocecal valve, with oedema and nodular appearance, and terminal ileitis with cobblestone mucosa. Polymerase chain reaction for the detection of the Mycobacterium tuberculosis complex in ileal mucosa was negative. Skin biopsy demonstrated dermatitis with a granulomatous pattern, with secondary ulceration and dermal fibrosis (Figs. 2-4). No fungal microorganisms or acid-fast bacilli were identified with the Periodic Acid-Schiff stain and Ziehl-Neelsen techniques.What is the most likely diagnosis?
Vena caval filters remain as a useful tool in patients with deep vein thrombosis and contraindications to anticoagulation. Although they are rarely used in paediatric patients, they have been shown to be safe and effective when used in the inferior vena cava.
In this case report, we describe the off-label use of a retrievable vena caval filter in the superior vena cava in an adolescent with acute lymphoblastic leukaemia with extensive thrombosis of the right upper neck veins as a means to reduce the risk of pulmonary embolism.
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