Semin Thromb Hemost 2014; 40(01): 081-087
DOI: 10.1055/s-0033-1363471
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Venous Thrombosis in Rare or Unusual Sites: A Diagnostic Challenge

Antonio Girolami
1   Department of Medicine, University of Padua Medical School, Padua, Italy
,
Martina Treleani
1   Department of Medicine, University of Padua Medical School, Padua, Italy
,
Emanuela Bonamigo
1   Department of Medicine, University of Padua Medical School, Padua, Italy
,
Valentina Tasinato
1   Department of Medicine, University of Padua Medical School, Padua, Italy
,
Bruno Girolami
2   Division of Medicine, Padua City Hospital, Padua, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
17 December 2013 (online)

Abstract

Venous thrombosis usually involves the veins of the limbs, most frequently the leg veins. All other venous districts may sometimes be affected by the thrombotic process. Sometimes, the thrombotic occlusion of the veins of a given region show typical signs and symptoms. In other cases, the picture may not be clear and a high degree of clinical suspicion is needed for a correct approach to patient diagnosis and management. Thrombosis of retinal and jugular veins, right heart thrombosis including thrombosis of coronary sinus and thrombosis of the azygos system may be included in this group. In addition, thromboses of umbilical, renal, ovarian, spermatic, and iliac veins also require attention. Finally, the dorsal veins of the penis may also be affected by thrombotic events. The main clinical features of these thromboses are reviewed herein with suggestions for a correct diagnostic approach. The importance of sonography and of other imaging techniques is emphasized. A prompt diagnosis is of paramount importance as most of these thromboses in rare or unusual sites may still cause severe systemic complications (pulmonary embolism, sepsis, and heart failure).

 
  • References

  • 1 Moll S. Unusual bleeds, unusual clots. Hamostaseologie 2007; 27 (3) 191-199
  • 2 Buehl W, Sacu S, Schmidt-Erfurth U. Retinal vein occlusions. Dev Ophthalmol 2010; 46: 54-72
  • 3 Ehlers JP, Fekrat S. Retinal vein occlusion: beyond the acute event. Surv Ophthalmol 2011; 56 (4) 281-299 Review
  • 4 London NJ, Brown G. Update and review of central retinal vein occlusion. Curr Opin Ophthalmol 2011; 22 (3) 159-165 Review
  • 5 Vergou T, Moustou AE, Maniateas A, Stratigos AJ, Katsambas A, Antoniou C. Central retinal vein occlusion following infliximab treatment for plaque-type psoriasis. Int J Dermatol 2010; 49 (10) 1215-1217
  • 6 Viola MI, Meyer D, Kruger T. Association between clomiphene citrate and visual disturbances with special emphasis on central retinal vein occlusion: a review. Gynecol Obstet Invest 2011; 71 (2) 73-76
  • 7 Tilleul J, Glacet-Bernard A, Coscas G, Soubrane G, Souied EH. [Underlying conditions associated with the occurrence of retinal vein occlusion]. J Fr Ophtalmol 2011; 34 (5) 318-324
  • 8 Lemierre A. On certain septicemias due to anaerobic organism. Lancet 1936; 227: 701-703
  • 9 Arya R, Shehata HA, Patel RK , et al. Internal jugular vein thrombosis after assisted conception therapy. Br J Haematol 2001; 115 (1) 153-155
  • 10 Castro-Marín F, Kendall JL. Diagnosis of Lemierre syndrome by bedside emergency department ultrasound. J Emerg Med 2010; 39 (4) 436-439
  • 11 Courtin P, Toro A, Gazagnes M, Berrouba A, Gallardo M, Dembele A. [Lemierre's syndrome]. Ann Fr Anesth Reanim 2010; 29 (11) 799-802
  • 12 Hoffman MA, Birge ND, Chatterjee A , et al. Lemierre-like syndrome: a series of unique cases. Clin Pediatr (Phila) 2010; 49 (9) 893-896
  • 13 Lakshminarayana PH, Woodske ME. A unique case of lemierre syndrome associated with thrombophilia in an adult and the role of anticoagulation. Case Rep Med 2010; 2010: 1-4
  • 14 Thakker A, Karande S. Lemierre syndrome in the antibiotic era. Indian Pediatr 2010; 47 (3) 285
  • 15 Ulug U, Aksoy E, Erden H, Bayazit N, Bahçeci M. Bilateral internal jugular venous thrombosis following successful assisted conception in the absence of ovarian hyperstimulation syndrome. Eur J Obstet Gynecol Reprod Biol 2003; 109 (2) 231-233
  • 16 Allana AM, Teo LL, Chuah BY, Liu TC, Cheah WK. Effort thrombosis in a young triathlete: an unusual presentation of painless neck swelling secondary to right brachiocephalic vein thrombosis. Singapore Med J 2011; 52 (3) e37-e39
  • 17 Ko SF, Huang CC, Ng SH , et al. Imaging of the brachiocephalic vein. AJR Am J Roentgenol 2008; 191 (3) 897-907
  • 18 Thomas R, Christopher DJ, Roy A , et al. Chylothorax following innominate vein thrombosis—a rare complication of transvenous pacemaker implantation. Respiration 2007; 74 (3) 338-340
  • 19 Ishikura H, Kimura S, Fukumura Y, Ohtani T. Resection of an azygos vein aneurysm with thrombosis. Gen Thorac Cardiovasc Surg 2010; 58 (4) 209-211
  • 20 Moise MA, Hadro N, El-Arousy H, Alvarez-Tostado JA. The azygos system as a rare alternative for chronic indwelling catheters placement. J Vasc Surg 2009; 50 (3) 655-658
  • 21 Mouton KT, Zehnder T, Wagner HE, Mouton WG. Follow-up after deep venous thrombosis in azygos continuation. Vasa 2005; 34 (4) 266-268
  • 22 Nakamura Y, Nakano K, Nakatani H, Fukuda T, Honda K, Homma N. Surgical exclusion of a thrombosed azygos vein aneurysm causing pulmonary embolism. J Thorac Cardiovasc Surg 2007; 133 (3) 834-835
  • 23 Smith T, Prasad A, Lane T, Franklin I. Azygous collateral thrombosis presenting as ureteric colic. Vasc Endovascular Surg 2011; 45 (6) 557-558
  • 24 Yang JY, Kim DH, Lee JH, Suk EH. Evaluating a thrombosed azygous vein aneurysm combined with pulmonary arterial thromboembolism by ECG-gated multidetector CT: a case report. Korean J Radiol 2011; 12 (6) 754-756
  • 25 Girolami A, Berti De Marinis G, Treleani M, Tasinato V, Girolami B. Congenital thrombophilia and intracardiac thrombosis probably an underdiagnosed event. Cardiol Res 2013; 4 (3) 105-115
  • 26 Deluca G, Correale M, Ieva R, Di Biase M. Voluminous mass adherent to the eustachian valve. Echocardiography 2008; 25 (1) 100-101
  • 27 Frogel JK, Weiss SJ, Kohl BA. Transesophageal echocardiography diagnosis of coronary sinus thrombosis. Anesth Analg 2009; 108 (2) 441-442
  • 28 Huang HL, Yeh KH. Successful treatment of acute coronary sinus thrombosis utilizing a Judkins right catheter in a patient receiving cardiac resynchronization therapy. Europace 2009; 11 (12) 1674
  • 29 Yeo KK, Davenport J, Raff G, Laird JR. Life-threatening coronary sinus thrombosis following catheter ablation: case report and review of literature. Cardiovasc Revasc Med 2010; 11 (4) e1-e5
  • 30 Kitazawa S, Kitazawa R, Kondo T , et al. Fatal cardiac tamponade due to coronary sinus thrombosis in acute lymphoblastic leukaemia: a case report. Cases J 2009; 2: 9095
  • 31 Berkovich GY, Ramchandani P, Preate Jr DL, Rovner ES, Shapiro MB, Banner MP. Renal vein thrombosis after martial arts trauma. J Trauma 2001; 50 (1) 144-145
  • 32 Cinemre H, Bilir C, Akdemir N. Isolated renal vein thrombosis associated with MTHFR-1298 and PAI-1 4G gene mutations. Clin Appl Thromb Hemost 2010; 16 (6) 708-710
  • 33 Decoster T, Schwagten V, Hendriks J, Beaucourt L. Renal colic as the first symptom of acute renal vein thrombosis, resulting in the diagnosis of nephrotic syndrome. Eur J Emerg Med 2009; 16 (4) 170-171
  • 34 O'Brien AA, O'Donnell JP, Keogh JA. Renal vein thrombosis with recurrent pulmonary emboli in the nephrotic syndrome: use of the Greenfield filter. Postgrad Med J 1986; 62 (725) 223-225
  • 35 Janda SP. Bilateral renal vein thrombosis and pulmonary embolism secondary to membranous glomerulonephritis treated with percutaneous catheter thrombectomy and localized thrombolytic therapy. Indian J Nephrol 2010; 20 (3) 152-155
  • 36 Chaturvedi S, Brandao L, Geary D, Licht C. Primary antiphospholipid syndrome presenting as renal vein thrombosis and membranous nephropathy. Pediatr Nephrol 2011; 26 (6) 979-985
  • 37 Skalova S, Minxova L, Lukes A, Dedek P, Tousovska K, Podhola M. Renal vein thrombosis with pulmonary embolism: first manifestation of lupus nephritis. J Paediatr Child Health 2011; 47 (5) 315-316
  • 38 Freitas C, Fructuso M, Rocha MJ , et al. Late venous thrombosis of renal allograft: two cases with different treatment and outcome. Nefrologia 2011; 31 (1) 115-117
  • 39 Mabjeesh NJ, Bar-Yosef Y, Schreiber-Bramante L, Kaver I, Matzkin H. Spermatic vein tumor thrombus in renal cell carcinoma. ScientificWorldJournal 2004; 4 (Suppl. 01) 192-194
  • 40 Shinsaka H, Fujimoto N, Matsumoto T. A rare case of right varicocele testis caused by a renal cell carcinoma thrombus in the spermatic vein. Int J Urol 2006; 13 (6) 844-845
  • 41 Avagliano L, Marconi AM, Candiani M, Barbera A, Bulfamante G. Thrombosis of the umbilical vessels revisited. An observational study of 317 consecutive autopsies at a single institution. Hum Pathol 2010; 41 (7) 971-979
  • 42 Rubabaza P, Persadie RJ. Two cases of umbilical vein thrombosis, one with associated portal vein thrombosis. J Obstet Gynaecol Can 2008; 30 (4) 338-343
  • 43 Vanrykel K, Bruneel E, Van Hoestenberghe MR, Buekenhout L, Gyselaers W, Theyskens C. Neonatal disseminated intravascular coagulation after thrombosis of a fetal intra-abdominal umbilical vein varix. J Obstet Gynaecol 2010; 30 (3) 315
  • 44 Williams S, Chan AK. Neonatal portal vein thrombosis: diagnosis and management. Semin Fetal Neonatal Med 2011; 16 (6) 329-339
  • 45 Witters P, Reynaert N, Pattyn L , et al. Intrauterine thrombosis of the ductus venosus leading to neonatal demise. Arch Dis Child Fetal Neonatal Ed 2012; 97 (1) F17
  • 46 Gharehbaghi MM, Nemati M, Hosseinpour SS, Taei R, Ghargharechi R. Umbilical vascular catheter associated portal vein thrombosis detected by ultrasound. Indian J Pediatr 2011; 78 (2) 161-164
  • 47 Diana A, Gaze H, Laubscher B, De Meuron G, Tschantz P. A case of pediatric Henoch-Schönlein purpura and thrombosis of spermatic veins. J Pediatr Surg 2000; 35 (12) 1843
  • 48 Gleeson MJ, McDermott M, McDonald G, McDermott TE. Spontaneous thrombosis of the left spermatic vein. Br J Urol 1992; 70 (5) 567
  • 49 Hashimoto L, Vibeto B. Spontaneous thrombosis of the pampiniform plexus. Scand J Urol Nephrol 2006; 40 (3) 252-254 Review
  • 50 Isenberg JS, Ozuner G, Worth MH, Ferzli G. Effort-induced spontaneous thrombosis of the left spermatic vein presenting clinically as a left inguinal hernia. J Urol 1990; 144 (1) 138
  • 51 Maas C, Müller-Hansen I, Flechsig H, Poets CF. Acute scrotum in a neonate caused by renal vein thrombosis. Arch Dis Child Fetal Neonatal Ed 2011; 96 (2) F149-F150
  • 52 Castillo OA, Diaz M, Vitagliano GJ, Metrebian E. Pulmonary thromboembolism secondary to left spermatic vein thrombosis: a case report. Urol Int 2008; 80 (2) 217-218
  • 53 Barrellier MT, Lezin B, Monsallier JM. [Isolated iliac deep venous thrombosis. Study of 48 cases seen in 7 years among 18,297 echo-Doppler evaluations of the lower limbs]. J Mal Vasc 2001; 26 (5) 290-298
  • 54 Goodwin TM, Gazit G, Gordon EM. Heterozygous protein C deficiency presenting as severe protein C deficiency and peripartum thrombosis: successful treatment with protein C concentrate. Obstet Gynecol 1995; 86 (4 Pt 2) 662-664
  • 55 Karaosmanoglu D, Karcaaltincaba M, Karcaaltincaba D, Akata D, Ozmen M. MDCT of the ovarian vein: normal anatomy and pathology. AJR Am J Roentgenol 2009; 192 (1) 295-299
  • 56 Klima DA, Snyder TE. Postpartum ovarian vein thrombosis. Obstet Gynecol 2008; 111 (2 Pt 1) 431-435
  • 57 Fraser DG, Moody AR, Martel A, Morgan PS. Re-evaluation of iliac compression syndrome using magnetic resonance imaging in patients with acute deep venous thromboses. J Vasc Surg 2004; 40 (4) 604-611
  • 58 Peters M, Syed RK, Katz M , et al. May-Thurner syndrome: a not so uncommon cause of a common condition. Proc (Bayl Univ Med Cent) 2012; 25 (3) 231-233 (Bayl Univ Med Cent)
  • 59 Wolpert LM, Rahmani O, Stein B, Gallagher JJ, Drezner AD. Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovascular Surg 2002; 36 (1) 51-57
  • 60 Brodmann M, Gary T, Hafner F, Tiesenhausen K, Deutschmann H, Pilger E. Massive pulmonary embolism caused by internal iliac vein thrombosis with free-floating thrombus formation in the inferior vena cava. Ann Vasc Surg 2012; 26 (3) e5-e7
  • 61 Girolami A, Prandoni P, Zanardi A, Girolami B, Zanon E. Isolated iliac vein thrombosis durino oral contraceptive therapy in three “normal” women. Clin Appl Thromb Hemost 1997; 3: 284-287
  • 62 Merhi Z, Awonuga A. Acute abdominal pain as the presenting symptom of isolated iliac vein thrombosis in pregnancy. Obstet Gynecol 2006; 107 (2 Pt 2) 468-470
  • 63 de Perrot T, Righini M, Bounameaux H, Poletti PA. Contrast-enhanced sonographic diagnosis of unsuspected internal iliac vein thrombosis. J Clin Ultrasound 2011; 39 (9) 553-555
  • 64 Arango O, Lorente JA, Nohales G, Rijo E, Bielsa O. Superficial dorsal penile vein thrombosis: a little-known complication of subinguinal varicocelectomy. BJU Int 2011; 107 (1) 95-98
  • 65 Han HY, Chung DJ, Kim KW, Hwang CM. Pulsed and color Doppler sonographic findings of penile Mondor's disease. Korean J Radiol 2008; 9 (2) 179-181
  • 66 Kolbenstvedt A, Jenssen G, Hedlund H. Priapism of the glans and corpus spongiosum. Report of two cases with angiography. Acta Radiol 2003; 44 (4) 456-459
  • 67 Molina Escudero R, Cabello Benavente R, Monzó Gardiner JI , et al. [Mondor's syndrome. Case review and bibliographic review]. Arch Esp Urol 2009; 62 (4) 317-319