scholarly journals A Rare but Reversible Cause of Hematemesis: “Downhill” Esophageal Varices

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Lam-Phuong Nguyen ◽  
Narin Sriratanaviriyakul ◽  
Christian Sandrock
Keyword(s):  
Portal Hypertension ◽  
Superior Vena ◽  
Portal Pressure ◽  
Vena Cava ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Extensive Evaluation ◽  
Intrahepatic Portosystemic Shunt ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion

“Downhill” varices are a rare cause of acute upper gastrointestinal bleeding and are generally due to obstruction of the superior vena cava (SVC). Often these cases of “downhill” varices are missed diagnoses as portal hypertension but fail to improve with medical treatment to reduce portal pressure. We report a similar case where recurrent variceal bleeding was initially diagnosed as portal hypertension but later found to have SVC thrombosis presenting with recurrent hematemesis. A 39-year-old female with history of end-stage renal disease presented with recurrent hematemesis. Esophagogastroduodenoscopy (EGD) revealed multiple varices. Banding and sclerotherapy were performed. Extensive evaluation did not show overt portal hypertension or cirrhosis. Due to ongoing bleeding requiring resuscitation, she underwent internal jugular (IJ) and SVC venogram in preparation for transjugular intrahepatic portosystemic shunt (TIPS), which demonstrated complete IJ and SVC occlusion. She underwent balloon angioplasty with stent placement across SVC occlusion with complete resolution of her varices and resolved hematemesis. “Downhill” varices are extremely rare, though previously well described. Frequently, patients are misdiagnosed with underlying liver disease. High index of suspicion and investigation of alternative causes of varices is prudent in those without underlying liver diseases. Prompt diagnosis and appropriate intervention can significantly improve morbidity and mortality.

scholarly journals “Downhill” Esophageal Varices due to Dialysis Catheter-Induced Superior Vena Caval Occlusion: A Rare Cause of Upper Gastrointestinal Bleeding

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Suresh Kumar Nayudu ◽  
Anil Dev ◽  
Kalyan Kanneganti
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Superior Vena ◽  
Superior Vena Caval ◽  
Surgical Interventions ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion ◽  
Upper Gastrointestinal

“Downhill” varices are a rare cause of acute upper gastrointestinal bleeding. Rarely these varices are reported in patients receiving hemodialysis as a complication of chronic dialysis vascular access. We present a case of acute upper gastrointestinal bleeding in an individual with end-stage renal disease receiving hemodialysis. Esophagogastroduodenoscopy revealed “downhill” varices in the upper third of the esophagus without any active bleeding at the time of the procedure. An angiogram was performed disclosing superior vena caval occlusion, which was treated with balloon angioplasty. Gastroenterologists should have a high index of suspicion for these rare “downhill” varices when dealing with acute upper gastrointestinal bleeding in patients receiving hemodialysis and manage it appropriately using endoscopic, radiological, and surgical interventions.

scholarly journals Chylothorax and Chylopericardium: A Complication of Long-Term Central Venous Catheter Use

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
James Livesay ◽  
Isaac Biney ◽  
J. Francis Turner
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Disease Patient ◽  
Vena Cava ◽  
Venous Catheter ◽  
Central Venous ◽  
Vena Cava Syndrome ◽  
Stage Renal Disease ◽  
End Stage

The development of chylothorax and chylopericardium is an uncommon complication of the long-term use of central venous catheters. We describe a unique case of an end stage renal disease patient on hemodialysis with a left jugular tunneled catheter who developed superior vena cava syndrome. Our patient presented with both a large pleural and pericardial effusion that despite drainage continued to reaccumulate. Further imaging with CT scan of the thorax revealed stenosis of the superior vena cava leading to recurrent chylothorax and chylopericardium.

scholarly journals Cardiac mucormycosis: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Darshan Krishnappa ◽  
Sanjeev Naganur ◽  
Dinesh Palanisamy ◽  
Ganesh Kasinadhuni
Keyword(s):  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Interatrial Septum ◽  
Needle Aspiration ◽  
Predisposing Factors ◽  
Diffuse Infiltration ◽  
Extensive Evaluation ◽  
Mediastinal Involvement ◽  
High Index Of Suspicion

Abstract Background Mucormycosis is an invasive fungal infection (IFI) most commonly seen in immunocompromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the classical risk factors. While cutaneous and rhino-sinusoidal forms may be seen in immunocompetent (IC) individuals, cardiac and mediastinal involvement is rare. In this report, we describe a young patient without predisposing factors who presented as mediastinal mucormycosis with extensive cardiac involvement. Case summary A 19-year-old male presented with complaints of dry cough and dyspnoea on exertion over the last 4 months. Echocardiography showed diffuse infiltration of both atria along with multiple pedunculated freely mobile masses. A computed tomography chest was done to further delineate the true extent of the disease and revealed diffuse infiltration of the mediastinum, bilateral atria and interatrial septum, pulmonary veins, and superior vena cava. A fine needle aspiration cytology from a mediastinal mass revealed broad aseptate fungal hyphae with right angled branching consistent with Mucor. Extensive evaluation could not find any predisposing factors. The patient was started on Amphotericin B and surgical debridement was contemplated. However, owing to the diffuse infiltration around the heart and mediastinal vasculature, debridement could not be performed and the patient eventually succumbed to the illness. Discussion Mediastinal mucormycosis though rare in IC patients, is a rapidly progressive condition with a high fatality. A high index of suspicion needs to be maintained in individuals presenting with infiltrative disorders of the mediastinum for early diagnosis and prompt treatment.

scholarly journals Intracardiac fistula: an unusual complication of catheter-related blood stream infection

JRSM Open ◽  
2017 ◽  
Vol 8 (9) ◽  
pp. 205427041772823 ◽  
Author(s):  
Abhilash Koratala ◽  
Hussain Aboud ◽  
Robert Gibson ◽  
Karen K Hamilton
Keyword(s):  
End Stage Renal Disease ◽  
Blood Stream Infection ◽  
Significant Risk ◽  
Blood Stream ◽  
Unusual Complication ◽  
Early Use ◽  
Venous Fistula ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion

Lesson In end stage renal disease patients on dialysis, the use of catheter as a vascular access is associated with a significant risk of sepsis compared to an arterio-venous fistula. Our case emphasizes the importance of having high index of suspicion for unusual complications in patients presenting with possible catheter-related blood stream infection and early use of complementary tools such as trans-oesophageal echocardiography whenever applicable.

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