Thrombosis, a deceptive curtain!

Introduction: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It is the third most common cardiovas-cular disease, with a total annual incidence of 100-200 per 100,000 inhabitants. VTE can be fatal in the acute phase or can lead to chronic disease and disability, but can also often be prevented. Acute pulmonary embo-lism is the most serious clinical presentation of VTE. Juvenile polyposis syndrome is a genetic disease with autosomal dominant inheritance, with an incidence of 000, which is characterized by the appearance of multiple juvenile polyps in the gastrointestinal tract, the number may vary between 1 and over 100 and the size between 1 and 30 mm, sessile or peduncled, usu-ally diagnosed in the first decades of life, with a 55% risk of oncological pathologies of the gastrointestinal tract until the age of 42 years. Patients may associate extra-intestinal arterio-venous malformations, anemia, digital hippocracy, mental retardation, heart abnormalities, tricuspid stenosis, polydactyly, macrocephaly.

Case presentation: 25 years old patient, with antecedent collateral inheritance- brother with hemorrhagic stroke at the age of 16- known with hemorrhoidal di-sease, with recurrent diarrheal syndrome, recurrent rectorrhagies from 2019, neglected, presents in emer-gency unit for pain in the right lower limb and lower abdominals, edema in the right lower limb, symptoms with onset of about 2 weeks,, progressively accentua-ted, recurrent rectorrhagia, severe dry anemia with Hb 4.1 g/dl. CT examination-thrombosis bilateral femo-ral veins, external iliac vein, right common, inferior vena cava to the infrahepatic segment, intraluminal thrombus at the level of the posterior basal segmental arteries lower right lobe, normal ascending aorta, LV undilated, ejection fraction (EF) > 50%, ventricular allure (VA) 110/min, RV undilated, without PHT, 16 IVC, free pericardium. The patient is hospitalized in CICU where he receives treatment with transfusion of red cell concentrates (RCC), until Gastric evaluation. Upper digestive endoscopy with biopsy: normal esophagus, numerous polyps between 0.5-3 cm in size, disseminated from cardia to pylorus, a duodenal polyp. Conclusions: Hyperplastic gastric polyp (Histopatho-logical appearance is similar in juvenile polyposis); it is decided by mutual agreement to start the treatment with LMWH, later with VKA.

Particularity: 25 years old patient without significant personal pathological history (hemorrhoidal disease, recurrent diarrheal syndrome), but significant antecedent collateral inheritance, presents with severe ane-mia, PTE and DVT in which a rare genetic disease of the gastrointestinal area (juvenile polyposis) with specific clinical and paraclinical signs, but with an atypical presentation (DVT + PTE).

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)