Roy Satarupa, Bhatt Shuchi, Rawal Rajesh, Tandon Anupama, Meena Neha
Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India.
Pol J Radiol. 2017 Feb 22;82:106-109. doi: 10.12659/PJR.900198. eCollection 2017.
Venous thromboembolism is a known but rare complication associated with infection. The reported incidence of venous thromboembolism is 1.5-3.4% of infected patients, and it occurs due to a hypercoagulable state induced by the associated inflammation.
A young woman with pulmonary tuberculosis was found to have disseminated tuberculosis and a clinically unsuspected partial thrombus in the splenic vein on imaging. Ultrasound demonstrated hepato-splenomegaly with multiple granulomas as well as ascites and a left-sided pleural effusion. An increased calibre of the splenic vein with a hyperechogenicity within it raised the suspicion of a thrombus, which was confirmed on a contrast-enhanced CT examination. CECT of the abdomen also showed a small peripheral splenic infarct, while CECT of the chest revealed bilateral miliary lesions in the lungs along with necrotic mediastinal lymphadenopathy. The final imaging diagnosis was disseminated tuberculosis complicated by splenic vein thrombosis. A timely institution of anti-coagulant and anti-tubercular treatment led to a complete resolution of the splenic vein thrombosis.
Contrast-enhanced CT serves as a useful imaging tool for the detection of venous thrombosis and for the estimation of a complete burden of the disease. This condition should be kept in mind by both clinicians and radiologists and looked for in order to prevent life-threatening complications.
静脉血栓栓塞是一种已知但罕见的与感染相关的并发症。报道的感染患者静脉血栓栓塞发生率为1.5% - 3.4%，其发生是由于相关炎症诱导的高凝状态。
一名患有肺结核的年轻女性在影像学检查中被发现患有播散性结核以及脾静脉内一处临床未怀疑的部分血栓。超声显示肝脾肿大伴多个肉芽肿以及腹水和左侧胸腔积液。脾静脉内径增宽且内部回声增强，引发了对血栓的怀疑，这在增强CT检查中得到证实。腹部增强CT还显示脾外周有一个小梗死灶，而胸部增强CT显示肺部有双侧粟粒样病变以及坏死性纵隔淋巴结肿大。最终影像学诊断为播散性结核并发脾静脉血栓形成。及时给予抗凝和抗结核治疗使脾静脉血栓完全消退。
增强CT是检测静脉血栓形成以及评估疾病完整负担的有用影像学工具。临床医生和放射科医生都应牢记这种情况并进行排查，以预防危及生命的并发症。
