Re: prolonged PP fever
From: D. Ashley Hill (dahmd@cfl.rr.com)
Thu Aug 24 21:23:47 2006
Agree with others it sounds like OVT/SPT. I would ask radiologist to
review CT scan (many radiologists are not used to looking for the target
lesion that suggests OVT). Sibai wrote a nice paper several years ago
suggesting it takes longer than the 48 hours we were taught to
defervesce, so I would keep with the full-dose heparin. Good luck.
Ashley
At Thu, 24 Aug 2006, Garry E. Siegel, M.D. wrote:
>
>One would think that a CT of the abdomen/pelvis might show something.
>
>I absolutely would start heparin empirically, and, as Joe said, watch
>her get better.
>
>Garry
>
>At Thu, 24 Aug 2006, Betsy Hyde wrote:
>>
>>thanks, Dan. It didn't show upon CT, though. How long should it
>>take to defervese on heparin if SPT?
>>
>>I admit I have no clue re the utility of CT/MRI re diagnosing pelvic
>>thrombophlebitis. How high do duplex ultrasounds of the venous tree go?
>>
>>--
>>Betsy Hyde CNM
>>Branford, CT
>>
>>On Aug 24, 2006, at 9:31 PM, R. Daniel Braun wrote:
>>
>>> Sounds like Ovarian Vein Septic Thrombophlebitris. It should show
>>> up on CT. Sometimes never respond to Abx, only to surgical removal
>>> of ovarian vein. I had one patient who had a 15 cm in diameter
>>> purulent ovarian vein on the right. We had to excise it all the way
>>> to the IVC.
>>>
>>> Dan
>>>
>>> On 8/24/06, Betsy Hyde <elishyde@mindspring.com> wrote:
>>>
>>> G1P1 now s/p c/s for something or other in labor. Don't remember
>>> what, and don't think it is relevant to the presentation. It wasn't
>>> sepsis.
>>>
>>> Now 10 days post c/s and still spiking to 101.5. Blood cultures while
>>> spiking are neg. EKG neg. No hx travel to tropical climates.
>>>
>>> Post op course includes normal CT scan, WBC never >11.9, courses of
>>> triples (amp/gent/clinda and also amp/gent/metronidazole).
>>>
>>> Now on amp/gent/metronidazole/heparin x 36 hours and still spiking to
>>> 101.5. No localizing signs. Patient feels fine.
>>>
>>> Today's plans include MRI.
>>>
>>> Thoughts???
>>>
>>> How long does it take for septic thrombophlebitis to defervese on
>>> heparin?
>>>
>>> Anything else we should consider? I raised the possibility of
>>> valvular disease and vegetative emboli, but cultures during spikes
>>> were neg, and EKG was neg as well.
>>>
>>> Drug fever???
>>>
>>> (MFM is involved as well as the OBs in my practice..this is not a
>>> midwifery management question...)
>>>
>>> Betsy Hyde CNM
>>> Branford, CT
>>>
>>> --
>>> R. Daniel Braun
>>>
>>> "The way to health is an aromatic bath and scented massage
>>> everyday".
>>> Hippocrates
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Medical Director, Loch Haven Ob/Gyn Group
Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
Orlando, Florida
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