Deep venous thrombosis of the lower extremity with massive pulmonary embolism

Deep venous thrombosis of the lower extremity with massive pulmonary embolism
    • The commonest site of venous thrombosis is in the deep veins of the muscles, shown here diagrammatically. The observation of local tenderness deep in the calf muscles to finger pressure and pain in the calf muscles on forceful dor – siflexion of the foot, a positive Homans’ sign, is the earliest signal of this condi­tion. Other signs such as edema and dilatation of the superficial veins are seen later. The observation of tenderness usually indicates an inflammatory process; under these conditions it is termed thrombophlebitis. The local condition in the calf is seldom serious, but the clot that propagates from a calf vein nidus into the popliteal and femoral veins is a threat to life because it often is nonadherent to the venous intima except at its origin, as shown. This floating type of clot has been termed “silent venous thrombosis” because there are no signs or symptoms of it. It is in this stage, however, that proximal vein ligation can be life-saving therapy, as the clot may result in a fatal pulmonary embolism if it breaks loose.
    • This shows a massive pulmonary embolus occluding both the right and left pulmonary arteries that has arisen from the floating thrombus in the popliteal and femoral veins. Pulmonary emboli of this magnitude result in sudden death unless they are removed. Fortunately few are so massive, so that the pulmonary arteries are not so completely occluded. This allows time to move the patient to the operating room to remove the thrombi from the pulmonary arteries with use of a cardiopulmonary bypass. It should be pointed out that, with careful attention to the postoperative examination of the legs, proximal vein interruption when early leg signs are detected is a much better method of treatment by localization of the process to the extremity. In addition, it is recommended that anticoagulant therapy with Coumadin be used after the venous interruption.
Deep venous thrombosis of the lower extremity with massive pulmonary embolism

deep venous thrombosis of the lower extremity with massive pulmonary embolism

 

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