BackgroundThe aim of the study was to analyze characteristics of patients with bilateral internal jugular vein thrombosis in our department during a 1-year period.Internal jugular vein thrombosis refers to an intraluminal thrombus occurring anywhere from the intracranial internal jugular vein to the junction of the internal jugular vein and the subclavian vein, which form the brachiocephalic vein. It can occur spontaneously or as a complication of head and neck infections, surgery, central venous lines, local malignancy, polycytemia, hyperhomocysteinemia, neck massage, or intravenous drug abuse. Spontaneous bilateral internal jugular vein thrombosis may occur as a result of a neoplasm, a condition called Trousseau’s syndrome.MethodsThe medical records of four patients with internal jugular vein thrombosis were reviewed for patient clinical characteristics, including age, sex, and other diseases. This is a retrospective study, and we analyzed four patients who had distant malignant tumors.ResultsDuring a 1-year period, four male patients were referred to our department for bilateral internal jugular vein thrombosis. Three of them had lung neoplasm, and one had urinary tract neoplasm. Three patients had thrombosis in the upper arm at the same time, one of them in both arms. Therapy consisted of unfractioned heparin in all patients. The main clinical manifestations were pain and cervical edema. The time between the first clinical manifestation and diagnosis of internal jugular vein thrombosis was 4 days. In the current study, no patient exhibited complications due to internal jugular vein thrombosis.ConclusionsDiagnosing internal jugular vein thrombosis requires a high degree of suspicion. Our study underlines that bilateral internal jugular vein thrombosis is a risk indicator for malignancy. In our literature review of internal jugular vein thrombosis, 85% of patients exhibited unilateral thrombosis, whereas the remaining patients had bilateral thrombosis (15%). The knowledge of predictive factors of internal jugular vein thrombosis seems to be of utmost importance to improve patient management.

Wandering spleen is a very rare defect characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the upper left abdomen. Patient symptomatology is variable and ranges from mere feeling of an abdominal lump to sudden abdominal pain due to infarction. Patients may have subacute to chronic abdominal or gastrointestinal complaints. Because of nonspecific symptoms, clinical diagnosis can be difficult; hence, imaging plays an important role. A major complication is splenic torsion, which is the cause of acute abdomen. We present a case of acute abdominal pain due to torsion of wandering spleen in a patient with Marfan Syndrome, valvular heart disease, and vertebral anomalies. Preoperative diagnosis was made on the basis of ultrasonography and computed tomography, which was later confirmed on surgery, and treated successfully.

IntroductionInjuries of the diaphragm were first described in 1541 by Sennertus and the initial repair was performed by Riolfi in 1886. Posttraumatic diaphragmatic hernia in adults is usually caused by blunt trauma and may remain asymptomatic and undiagnosed for many years. Right-sided tears are significantly less likely than left-sided tears because of the protective effect of the liver. They are associated with high mortality and morbidity. The rupture of the right side of the diaphragm and the presence of an inflamed gallbladder in the thoracic cavity are uncommon.Case presentationWe present the case of a 57-year-old Albanian man with prolapses of his gallbladder and other abdominal organs into the thoracic cavity through the herniation of his right hemidiaphragm due to trauma. The diaphragmatic hernia and gallstones seen in the thorax computed tomography scan were diagnostic. The organs herniated to the thoracic cavity were placed back into the abdominal cavity, a cholecystectomy was performed and the defect in the diaphragm was repaired with a prolene mesh graft during the operation. The patient was discharged 10 days after the surgical procedure, and no complications were reported.ConclusionDiaphragmatic hernia should be considered as a possible diagnosis in patients with respiratory disorders or unusual shadows in the thoracic region after recently sustained injury or with a history of injury. The prolapse of a gallbladder is rare. The symptoms are uncharacteristic and patients with this disease may remain without symptoms for a long period. Treatment is surgical.

The most complications of the vascular access are: thrombosis, aneurysm, infection. Aneurysms can be either true, containing all layers of a venous wall, or false (pseudoaneurysm), lined by fibrous tissue and thrombosis. Aneurysm dilatation is one of the major complications of vascular access. The incidence increased with the duration of the usage, repeated puncture at the same or nearby site, and increased intraluminal pressure of the graft. We present an uncommon case in which aneurysm and pseudoaneurysm of the native fistula is caused by puncture, in both sides. Repeated punctures at the same site, may progressively weaken the venous wall resulting in dilation of the outflow vein. A 68- year-old Albanian women had been in a hemodialysis program for 4 years, using a left brachiocephalic fistula. The inflow artery, outflow vein, and the deep veins were examined in detail. During the study period the patient have had three surgeries, for aneurysm of hemodialysis access on one hand, and for pseudoanurysm of hemodialysis access on the other hand. But, even that the patient survived and everything went well. The idea of our paper was that in patients we have predisposition for the formation of aneurysm and pseudoaneursym, the medical staff have more frequent meetings, so that such cases are treated more specifically, with more frequent visits to vascular surgeon, with more frequent measurements of draining vein diameter and flow of vascular access. The K/DOQI guidelines recommend a regular program of monitoring and surveillance of the vascular access. Color Doppler ultrasound s considered a valuable tool in the preoperative evaluation and in the follow-up.