Callori, Steven

Introduction: Pulmonary vein thrombosis (PVT) is often diagnosed incidentally but data on its management and outcomes are sparse. Methods: We queried our institutional health record to identify patients ≥18 years of age diagnosed with PVT. Demographics, medications, risk factors, diagnostics, treatment, and sequelae were collected by manual chart review. Suspected tumor thrombus cases were excluded. Results: Seventy-two patients with PVT were identified (median age 62 years, 50% male). The cohort was mostly white (85%), overweight (BMI 26 kg/m), with frequent comorbidities including hypertension (44%), hyperlipidemia (38%), atrial fibrillation/flutter (29%), and history of venous thromboembolism (21%). The most common PVT risk factors were active malignancy (54%), lobectomy (21%), surgery within 30 days (19%), and extrinsic vein compression (15%). Most PVT were diagnosed by CT (86%) and affected a single vein (86%), mostly commonly the left upper PV (32%). Laboratory studies revealed median platelet count 243 х 10 9 cells/L (n=58) and D-dimer elevated in 6 patients when measured (67%, n=9). About one-third of patients were on therapeutic anticoagulation (37%) at PVT diagnosis. Most patients were started on new anticoagulation (78%, n=56), with unfractionated heparin as the most common initial therapy (68%). Of those anticoagulated, few were treated with a limited duration (20%, n=11, median 54 d, IQR 95) while most received indefinite anticoagulation (80%, n=45), primarily warfarin (45%), apixaban (24%), or enoxaparin (21%). Serial imaging was obtained in 69% (n=50, median 65 d, IQR 116) and demonstrated resolution of PVT in 32 (64%) patients. Common PVT complications noted were as follows: 4 year risk of LA thrombus (26%, 12/16 anticoagulated), mechanical ventilation (13%), pneumonia (9%), and ischemic stroke (9%, 5/6 anticoagulated). Conclusions: PVT is often associated with active malignancy, lobectomy, recent surgery, and extrinsic vein compression. Most PVT resolve on serial imaging. Clinicians should be aware of potential high-risk sequelae including LA thrombus and stroke as well as high anticoagulation failure rates when managing PVT.

Intro: Venous thromboembolism (VTE) is a common cause of death among cancer patients, second only to cancer progression. Identifying factors predicting worse outcomes among cancer patients with VTE would be useful clinically. For cancer patients with pulmonary emboli (PE), it remains unclear whether concomitant leg deep vein thrombosis (DVT) as a source for further embolization adversely impacts this risk. The aim of this project was to determine the impact of residual DVT on adverse outcomes among cancer patients suffering acute PE. Methods: Consecutive patients with confirmed acute PE (March 1, 2013 - June 30, 2021) underwent ultrasound (US) imaging and were divided into two groups depending on the presence or absence of leg DVT. PE severity was classified based on AHA criteria. Patients were followed prospectively for VTE recurrence, major and clinically relevant non-major bleeding (CRNMB) and all-cause mortality. Results: Over the study interval, 1,035 cancer patients with PE were enrolled (Table 1). Of these, 375 (36.2%) had leg DVT confirmed by US. Patients with leg DVT were older (64.2 vs 61.4 years, p = 0.01), heavier (90.2 vs 85.1 kg, p <0.001), with lower metastatic disease prevalence (49.1% vs 57.1%, p = 0.01) compared to those without leg DVT. Cancer type distribution also differed between groups. PE patients with DVT more often had prostate, genitourinary, and hematologic cancers while those without DVT more often had pancreatic and breast cancers. Patients with DVT more often had symptomatic PE (48.2% vs. 35.9%, p < 0.001), massive (2.9% vs 0.5%, p < 0.001), and submassive (22.0% vs 7.6%, p < 0.001). Patients with DVT more often received unfractionated heparin (39.5% vs 18.7%, p < 0.001) whereas those without DVT were more frequently treated with low molecular weight heparin (57.5% vs. 44.3%, p <0.001), and apixaban (16.4% vs. 11.7%, p < 0.05). Anticoagulant duration, VTE recurrence, major bleeding and CRNMB were similar between groups (Table 2). Conclusion: Among a large cohort of cancer patients with pulmonary emboli, significant clinical and cancer specific differences exist comparing those with and without leg DVT.While theoretically increasing the risk of recurrent embolization, the presence of residual DVT does not appear to adversely impact important outcomes among cancer patients adequately treated with anticoagulation.

Abstract Background For transgender women, there is often the innate assumption that surgical breast augmentation will increase perceived chest femininity beyond hormone therapy alone. Objectives This study aimed to evaluate whether lay individuals found surgically augmented breasts more feminine than breast development from hormone replacement therapy alone in transgender patients. Methods We obtained preoperative (maximal breast growth on hormone therapy) and postoperative chest (after primary augmentation) images of 22 transgender patients, and age- and BMI-matched cisgender male (n = 17) and female (n = 21) control patients. Survey respondents (n = 271) rated each image on a scale of 1 (very feminine) to 5 (very masculine). Results were compared by survey respondent gender identity and sexual orientation. Results There was a significant difference in mean femininity score between all image types. Mean score for transgender patients fell by 0.478 points after surgery (P < .0001). Subgroup analysis looking at transgender participants revealed the same significance trend postoperatively. Transgender respondents also found no difference in femininity between female controls and postoperative transgender patients (P = .132). We also compared mean femininity scores across 4 self-identified respondent subgroups: cisgender and heterosexual, cisgender and lesbian, gay, or bisexual (LGB), transgender and heterosexual, and transgender and LGB. The cisgender and heterosexual subgroup rated the postoperative transgender patients more feminine than any of the other respondent subgroups (LGB P < .001, transgender and LGB P < .001, transgender only P = .018). Conclusions This study shows that breast augmentation significantly increased the perception of femininity. Furthermore, gender identity and sexual orientation are important in how lay persons perceive transgender patients. Level of Evidence: 4