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"https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317301781?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303959?idApp=UINPBA00004N" "url" => "/23870206/0000014900000001/v1_201707230028/S2387020617303959/v1_201707230028/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Deep venous thrombosis and spontaneous retroperitoneal haemorrhage, a fatal combination" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "41" "paginaFinal" => "42" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alejandro González-Castro, Ainara Azueta Etxebarria, Francisco José Gonzalez-Sánchez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Alejandro" "apellidos" => "González-Castro" "email" => array:1 [ 0 => "e409@humv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ainara" "apellidos" => "Azueta Etxebarria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Francisco José" "apellidos" => "Gonzalez-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombosis venosa profunda y hemorragia retroperitoneal espontánea, una combinación fatal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1445 "Ancho" => 1900 "Tamanyo" => 340947 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT angiography image showing left retroperitoneal haematoma and deep venous thrombosis of the left iliac vein.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 46-year-old female patient with spontaneous retroperitoneal haemorrhage (SRH) and deep venous thrombosis (DVT) as etiological cause.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient went to the emergency department of our hospital after presenting with low back pain and syncope. The most relevant personal history included episodes of chronic low back pain. On arrival at the emergency department, the patient was hypotensive, tachycardic and slightly sleepy. On examination, the patient had poor peripheral perfusion with delayed capillary refill time and palpation of a mass in the left lumbar region. An abdominal ultrasound shows a left retroperitoneal haematoma. According to the ultrasound findings it was decided to perform a CT angiography showing a left retroperitoneal haematoma reaching a maximum size of 137<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>82<span class="elsevierStyleHsp" style=""></span>mm; with a craniocaudal extension going from the left hypochondrium to the left iliac fossa. On the other hand, it is observed that the left iliac vein shows an increase in calibre, with hypodense appearance in relation to DVT. No signs of active bleeding were identified (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient is admitted to ICU with signs of hypovolemic <span class="elsevierStyleItalic">shock</span>. After the initial resuscitation, a right retrograde femoral approach abdominal aortography was performed: no signs of active abdominopelvic bleeding were identified.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Subsequently, the state of haemorrhagic <span class="elsevierStyleItalic">shock</span> progresses and the patient dies in a time interval of 5<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A complete autopsy is performed; a left retroperitoneal haematoma was observed after opening the abdominal cavity, from the hypochondrium to the iliac fossa, extending contralaterally to the diaphragm.</p><p id="par0030" class="elsevierStylePara elsevierViewall">No arterial system abnormalities or vascular malformations were observed macroscopically. A 1<span class="elsevierStyleHsp" style=""></span>cm thrombus is found attached to the left iliac vein wall. A laceration area of about 2<span class="elsevierStyleHsp" style=""></span>mm is observed in the vein lumen at about 1.5<span class="elsevierStyleHsp" style=""></span>cm of the location of the thrombus.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Spontaneous rupture of the iliac vein (SRIV) is a rare cause of SRH and haemorrhagic <span class="elsevierStyleItalic">shock</span> that predominantly occurs in women, during the sixth decade of life.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> The aetiology of SRIV is not well defined, however, some proposed theories include mechanical, inflammatory and hormonal factors.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The initial evaluation of a patient suspected of having SRH requires a thorough evaluation of the <span class="elsevierStyleItalic">shock</span> condition. At this point, some authors recommend that CT should be ruled out in patients with a high suspicion of SRH, directly performing an angiography, provided that the patient has abnormal vital signs such as hypotension, tachycardia, decreased urine production or altered level of consciousness. If a patient is stable, then a more methodical radiological approach can be used.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">With the diagnosis of haemorrhagic <span class="elsevierStyleItalic">shock</span> secondary to SRH, the identification of the aetiology of haemorrhage constitutes the critical step for the selection of the treatment to be performed: surgical, radiological, interventional or medical. If the bleeding is of arterial origin, the next step is to determine whether it is from the aorta or from the aortic branch. If the bleeding is of venous origin, the next step is to determine if it is from the inferior vena cava or from other small veins.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González-Castro A, Azueta Etxebarria A, Gonzalez-Sánchez FJ. Trombosis venosa profunda y hemorragia retroperitoneal espontánea, una combinación fatal. Med Clin (Barc). 2017;149:41–42.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1445 "Ancho" => 1900 "Tamanyo" => 340947 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT angiography image showing left retroperitoneal haematoma and deep venous thrombosis of the left iliac vein.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rotura espontánea de la vena ilíaca" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Castellón-Pavón" 1 => "J.L. Sanguino-Peloche" 2 => "E. del Amo Olea" 3 => "A. Corchete Serviá" 4 => "S. Prado Morales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2003" "volumen" => "15" "paginaInicial" => "376" "paginaFinal" => "380" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous rupture of left external iliac vein: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.C. Lin" 1 => "R.J. Chen" 2 => "J.F. Fang" 3 => "K.E. Lin" 4 => "Y.C. 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Kalinkin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Case Rep Radiol" "fecha" => "2016" "volumen" => "2016" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014900000001/v1_201707230028/S2387020617303935/v1_201707230028/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014900000001/v1_201707230028/S2387020617303935/v1_201707230028/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303935?idApp=UINPBA00004N" ]
