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Saturday, 12 March 2011 02:08

THROMBOSE VEINE SOUS CLAVIERE GAUCHE PAR COMPRESSION EXTRINSEQUE Featured

Written by  jamel MOUHLI
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Il s’agit d’une patiente de 75ans présentant un oedeme du bras droit datant depuis la  pose d’un Pace maker en situation pectorale gauche pour bloc complet , elle présente un membre supérieur avec un oedeme , douleurs et circulation collatérale thoraco brachiale gauche L’examen echodoppler montre une thrombose ancienne de la veine axillaire  gauche avec extension à la veine sous Clavière  avec syndrome obstructif et de dévaluation huméro-axillo_sous clavière , absence d’anomalie aux niveau des cavité cardiaque  une compression au niveau sous clavière gauche sous claviculaire un TDM thoracique en mode hélicoidal en contraste spontané montrant un pace maker en situation pectorale gauche haut situé par rapport à la pose habituelle, les sondes d’entrainement sont visibles en situation axillo-sous clavière jusqu’au niveau des cavités droites . Absence de processus compressif extrinsèque (contradiction avec l’echodoppler) au niveau cave supérieur, au niveau innominé ou axillo-sous clavière gauche , il n’y a pas de ‘embolie pulmonaire . En conclusion processus compressif par une des sondes du P ace maker au niveau de l’axe axillo-sous- clavier, les sondes d’entrainement étant en place, les cavité cardiaque sont normales, syndrome obstructif et de dévaluation profonde niveau de l’axe axillo-sous clavier gauche Le traitement a consiste de mettre une anticoagulation par un HBPM , et relayé par des antivitk,durant 6 mois il y a eu amélioration nette de l’oedeme et douleurs du bras gauche, la circulation collatérale de suppléances est plus accentué, 6mois après il y a eu une aggravation de son état géneral avec dyspnée et douleurs thoracique retrouvant Un BAV 2/1 secondaire à une dysfonction de la sonde ventriculaire droite de son Pacemakeravec changement de la sonde ventriculaire droite ,sonde précédante laisse en place car non extractable
Last modified on Wednesday, 07 September 2011 07:26

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