Thrombose post traumatique de la veine sous clavière droite sans fracture de la clavicule: à propos d'un cas

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Abstract

Les thromboses veineuses profondes du membre supérieur apparaissent aujourd'hui plus fréquentes du fait de l'utilisation plus large des cathéters veineux centraux; Sa survenue après traumatisme thoracique sans fracture osseuse est exceptionnelle et ses complications mortelles. Leur diagnostic clinique est parfois difficile. Le syndrome du défilé thoraco-brachial est de diagnostic plus rare et nécessite une collaboration multidisciplinaire. La recherche d'une thrombophilie ne doit pas être systématique, ce d'autant que sa découverte ne modifie en règle pas la thérapeutique. L'enquête étiologique en présence d'une thrombose des membres supérieurs doit être rigoureuse, guidée par l'interrogatoire et l'examen clinique et en aucun cas une série systématique d'examens complémentaires ne doit être effectuée. Les auteurs rapportent le cas d'une thrombose post traumatique de la veine sous Clavière gauche sans fracture de la clavicule.

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Most cited references 15

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Upper-extremity deep vein thrombosis: a prospective registry of 592 patients.

, Samuel Z Goldhaber, Victor F Tapson … (2004)

Upper-extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long-term use of a central venous catheter (CVC), or cancer. To improve our understanding of UEDVT, we compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 324 (6%) patients with central venous catheter (CVC)-associated UEDVT, 268 (5%) patients with non-CVC-associated UEDVT, and 4796 (89%) patients with lower-extremity DVT from a prospective US multicenter DVT registry. The non-CVC-associated UEDVT patients were younger (59.2+/-18.2 versus 64.2+/-16.9 years old; P<0.0001), less often white (65% versus 73%; P<0.01), leaner (body mass index [BMI] 26.8+/-7.1 versus 28.5+/-7.3 kg/m2; P<0.001), and more likely to smoke (19% versus 13%; P=0.02) than the lower-extremity DVT patients. By way of propensity analysis and multivariable logistic regression analysis, we determined that an indwelling CVC was the strongest independent predictor of UEDVT (odds ratio [OR], 7.3; 95% confidence interval [CI], 5.8 to 9.2). An age of <67 years, a BMI of <25 kg/m2, and hospitalization were the independent predictors of non-CVC-associated UEDVT. Most (68%) UEDVT patients were evaluated while they were inpatients. Only 20% of the 378 UEDVT patients who did not have an obvious contraindication to anticoagulation received prophylaxis at the time of diagnosis. UEDVT risk factors differ from the conventional risk factors for lower-extremity DVT. Our findings identify deficiencies in our current understanding and the prophylaxis of UEDVT and generate hypotheses for future research efforts.

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Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications.

P Prandoni, Kelli L. Benedetti, P Polistena … (1997)

Little is known about the clinical, diagnostic, and prognostic aspects of upper-extremity deep vein thrombosis (UEDVT). To identify the clinical and laboratory parameters associated with this disease, to assess the diagnostic accuracy of ultrasonographic methods for its detection, and to establish the frequency of both early and late complications. After a careful history was taken, 58 consecutive patients with signs and symptoms that were clinically suggestive of UEDVT underwent the determination of antithrombin III and protein C and S levels and resistance to activated protein C and lupuslike anticoagulants. Compression ultrasonography, color flow Doppler imaging, and Doppler ultrasonography were performed prior to venography. Patients with confirmed UEDVT underwent objective tests to detect a pulmonary embolism and were followed up prospectively to record recurrent thromboembolic events and postthrombotic sequelae. Findings from venography confirmed UEDVT in 27 patients (47%). Central venous catheters, thrombophilic states, and a previous leg vein thrombosis were statistically significantly associated with UEDVT. Sensitivity and specificity of compression ultrasonography (96% and 93.5%, respectively) and color flow Doppler imaging (100% and 93%, respectively) were comparable and better than those of Doppler ultrasonography (81% and 77%, respectively). Objective findings suggestive of a pulmonary embolism were recorded in 36% of the patients with UEDVT. After a mean follow-up of 2 years, 2 patients with UEDVT experienced recurrent thromboembolic events, and 4 had postthrombotic sequelae. Symptomatic UEDVT is associated with central venous catheters, thrombophilic states, and a previous leg vein thrombosis. Both compression ultrasonography and color flow Doppler imaging are accurate methods for its detection. A pulmonary embolism is a common complication of the disease. Finally, this disorder may recur and may be followed by postthrombotic sequelae.

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Deep vein thrombosis of the axillary-subclavian veins: epidemiologic data, effects of different types of treatment and late sequelae.

L Tengborn, B Lindblad, D Bergqvist (1988)

Upper extremity deep venous thrombosis (DVT) is uncommon. In the city of Malmö, Sweden (240,000 inhabitants), 296 cases undergoing phlebography due to a suspicion of upper extremity DVT, during 1971-1986 were analysed. 165 arm phlebograms did not reveal any thrombi (56%). In 11 cases (4%) external compression of the vein was found. Thrombi in the axillary or subclavian vein were found in 120 cases (40%) and were classified as primary in 73 cases and secondary in 47 cases. Only seven cases of effort thrombosis were found. Four cases had neurovascular symptoms mimicking thoracic outlet syndrome and underwent elective first rib resection. None of the patients with primary DVT had a fatal pulmonary embolism (FPE). One patient had clinical signs suspicious of pulmonary embolism (PE), however, scintigraphy of the lungs was negative. Of the cases with secondary thrombi three cases had fatal, and one case had contributory PE at autopsy. Additionally, one patient had a non-fatal PE verified scintigraphically. Post-thrombotic sequelae from the arm were in no case so severe that the patient had to change occupation. Patients with primary DVT had moderate complaints in three and mild in fifteen cases. Those with secondary arm thrombi experienced only moderate symptoms in two cases and mild sequelae in fourteen. There was no correlation between the type of treatment and late post-thrombotic symptoms. From this study it can be concluded that phlebography must be undertaken before treatment can be started in patients with a suspected arm DVT. Primary DVT seems to be a "benign" disease, and in general treatment with anticoagulants is sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

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Journal

Journal ID (nlm-ta): Pan Afr Med J

Journal ID (iso-abbrev): Pan Afr Med J

Journal ID (publisher-id): PAMJ

Title: The Pan African Medical Journal

Publisher: The African Field Epidemiology Network

ISSN (Electronic): 1937-8688

Publication date (Electronic): 17 March 2015

Publication date Collection: 2015

Volume: 20

Electronic Location Identifier: 256

Affiliations

[1 ]Département d'Anesthésie Réanimation Centre Hospitalier Universitaire Hassan II Fes, Maroc

Author notes

[& ]Corresponding author: Youssef Bibiche, Service d’‘Anesthésie Réanimation Centre Hospitalier Universitaire Hassan II Fès, Maroc

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Publisher ID: PAMJ-20-256

DOI: 10.11604/pamj.2015.20.256.5728

PMC ID: 4484317

SO-VID: 59a8c745-62e2-41da-b445-cc57216632bd

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The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Thrombose post traumatique de la veine sous clavière droite sans fracture de la clavicule: à propos d'un cas Translated title: Post traumatic thrombosis of the subclavian vein without right clavicle fracture: report of a case

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Pan African Medical Journal

Most cited references 15

Upper-extremity deep vein thrombosis: a prospective registry of 592 patients.

Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications.

Deep vein thrombosis of the axillary-subclavian veins: epidemiologic data, effects of different types of treatment and late sequelae.

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