Leg edema with deep venous thrombosis-like symptoms as an unusual complication of occult bladder distension and right May-Thurner syndrome in a stroke

Leg edema with deep venous thrombosis-like symptoms as an unusual complication of occult bladder distension and right May-Thurner syndrome in a stroke patient: a case report.

Arch Phys Med Rehabil. 2009 May

Im S, Lim SH, Chun HJ, Ko YJ, Yang BW, Kim HW.
Department of Rehabilitation Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-ku, Seoul, Republic of Korea.

Overt bladder distension can compress the iliac vessels and result in lower extremity swelling mimicking deep venous thrombosis (DVT). This phenomenon has been reported in patients with bladder outlet obstruction due to prostatism but no report has been made in relation to poststroke urinary retention (UR). The authors experienced a rare case of abrupt leg edema with DVT-like symptoms due to iliac vein compression by an overdistended bladder that had developed after cerebrovascular stroke. A 74-year-old woman with left striatocapsular infarction and situs inversus presented with severe right leg swelling. Imaging studies revealed external compression of the right iliac veins by an overdistended bladder and underlying May-Thurner syndrome (MTS). The presence of situs inversus totalis resulted in the rare clinical finding of a right-sided MTS. The patient's symptoms were largely attributable to external compression of right iliac veins by bladder distension and they resolved completely after prompt bladder drainage. Follow-up imaging findings showed complete regression of right external iliac vein stenosis. This case provides the first description of lower extremity swelling manifest as an unusual complication from UR in a stroke patient. Proper and strict bladder screening with appropriate management should be implemented as important therapeutic components during the rehabilitative management of stroke patients.

Abbreviations: CT, computed tomography; DVT, deep venous thrombosis; MTS, May-Thurner syndrome; UR, urinary retention

Elsevier

A 62-year-old woman with non-pitting leg oedema

A 62-year-old woman with non-pitting leg oedema
Tidsskr Nor Laegeforen. 2009 Apr 16

Bergersen TK, Mørk C.
kristin.bergersen@rikshospitalet.no

A patient presented with non-pitting lymphoedema of the legs and finger clubbing. A skin biopsy showed epidermal hyperkeratosis and abundant mucinous material (Alcian blue positive) in reticular dermis. Treatment (radioactive iodine) for Grave's disease (with exophthalmus) 20 years ago, raised suspicion of thyroid dermopathy. Together, these three extrathyroidal manifestations of Graves' disease are typical of the EMO syndrome. In addition, the patient had elevated serum concentrations of thyroid-stimulating hormone receptor autoantibodies. Autoimmune mechanisms are involved in the stimulation of fibroblasts and the production of large amounts of mucin. Pretibial myxoedema relates to scars, mechanical factors, and dependent position. Lack of steroid treatment during radioactive iodine therapy and smoking, may have exacerbated the thyroid dermopathy in this case. Awareness of pretibial myxoedema as a late autoimmune manifestation of Graves' disease, may contribute to earlier diagnosis and correct treatment.

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Post -tracheal extubation pulmonary oedema - Case report

Castro MD, Chaves P, Canas M, Moedas ML.
Interna de Anestesiologia, Hospital de S. António dos Capuchos, Centro Hospitalar de Lisboa Central - EPE (CHLC - EPE).

Negative pressure pulmonary oedema is an uncommon complication of traqueal extubation ( approximately 0,1%) mostly caused by acute upper airway obs truction. Upper airway obstruction from glottis closure leads to marked inspiratory effort, which generates negative intrathoracic pressure transmitting to pulmonary interstitium, and inducing fluid transudation from pulmonary capillary bed1 -5. We report a case of post- -extubation pulmonary oedema in a fifteen years old patient, submitted to surgery following traumatic amputation of his left leg. We review the pathophysiology, radiological findings, potential risk factors and preventive measures of this post -anaesthetic respiratory complication. Rev Port Pneumol 2009; XV (3): 537-541 Key-words: Post -extubation pulmonary oedema, upper airway obstruction, laryngospasm, intra -thoracic negative pressure.

PMID: 19401801 [PubMed - as supplied by publisher]

Persistent Subcutaneous Oedema and Aseptic Fatty Tissue Necrosis after Using Octenisept(R).

Persistent Subcutaneous Oedema and Aseptic Fatty Tissue Necrosis after Using Octenisept(R).
Eur J Pediatr Surg. 2009 Jun

Schupp CJ, Holland-Cunz S.
1Division of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany.

INTRODUCTION: Wound management and the prevention and treatment of tissue infections are part of daily routine. Octenisept ((R)) (Schülke & Mayr), an antiseptic with a broad antimicrobiological effect, is widely used for various indications. This paper reports prolonged oedema and tissue swelling after treatment of deep wounds with Octenisept ((R)) in three children.

CASE REPORTS: Three paediatric patients, aged between 2 months and 4 years, were treated with Octenisept ((R)) in different hospitals. One initially presented with an abscess of the gluteal area, two with deep wounds of the cheek following injury with a wooden stick. The wounds were cleaned and washed out with Octenisept ((R)). Adequate drainage was in place at all times.

COMMON FINDINGS: We observed aseptic, non painful subcutaneous tissue swelling and oedema in all three cases after wound lavage with Octenisept ((R)). This occurred shortly after the wound was initially treated and lasted for weeks until the symptoms slowly declined. It was not accompanied by persistent general infection parameters. A biopsy taken from one patient demonstrated an aseptic inflammatory reaction and oedema of the subcutaneous tissue, with partial tissue necrosis. Neither surgical revision nor antibiotic therapy brought any improvement.

CONCLUSIONS: Retrospectively, one can consider these occurrences as a consequence of the use of Octenisept ((R)), since the changes are consistent with those described by Schülke & Mayr when Octenisept ((R)) was accidentally administered by subcutaneous injection or under pressure to flush deep hand stab wounds that were not drained. The underlying pathobiological mechanism remains unclear. Hence, we recommend not to apply Octenisept ((R)) in any wound cavity until further investigation has taken place. If aseptic fatty tissue necrosis and oedema develop after using Octenisept ((R)), further surgical intervention or antibiotic treatment will not give any benefit. Changes subside slowly. So far, adequate treatment is not available.

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