AJR AJR Integrative Imaging Dec 2008 articles
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AJR 2002; 179:1072-1073
© American Roentgen Ray Society

Mesenteric Venous Thrombosis

Ajit Singh Kashyap and Surekha Kashyap

Armed Forces Medical College, Pune 411 040 India

We read with interest the excellent article on superior mesenteric venous thrombosis by Warshauer et al. [1]. However, the authors did not mention high altitude as an important predisposing factor for mesenteric venous thrombosis. High altitude can precipitate thrombosis because of hypobaric hypoxia and its effect on the coagulation system—in particular, increased factor VIIa activity [2, 3]. Dehydration, polycythemia, and vascular spasms may also be involved in the increased tendency to mesenteric venous thrombosis at high altitude [3].

References

  1. Warshauer DM, Lee JKT, Mauro MA, White II GC. Superior mesenteric vein thrombosis with radiologically occult cause: a retrospective study of 43 cases. AJR 2001;177:837 -841[Abstract/Free Full Text]
  2. Bendz B, Rostrup M, Sevre K, Andersen TO, Sandset PM. Association between hypobaric hypoxia and activation of coagulation in human beings. (letter) Lancet 2000;356:1657 -1658[Medline]
  3. Basnyat B, Graham L, Lee S-D, Lim Y. A language barrier, abdominal pain, and double vision. Lancet 2001;357:2022[Medline]

Reply

David M. Warshauer, Joseph K. T. Lee, Matthew A. Mauro and Gilbert C. White, II

University of North Carolina, School of Medicine, Chapel Hill, NC 27599-7510

We would like to thank Drs. Kashyap and Kashyap for their kind remarks and reminder that high altitude can be a predisposing factor for venous thrombosis. However, to paraphrase an old politician, all disease is local, and in our locale, Chapel Hill, NC, (elevation, 487 ft [14.6 m]) [1] high altitude—associated disease is nonexistent. Most high altitude—associated disease occurs above 8000 ft (240 m) [2]. Although the highest mountain in the eastern United States, Mt. Mitchell, is located in North Carolina, it reaches only 6684 ft (200.5 m) [3]. In spite of our appalling lack of elevation, we agree that data regarding recent travel to high mountainous regions or even recent air travel alone would be of interest in the workup of unexplained venous thrombosis. However, this data was not generally available in our retrospective study [4] and hence was not included in our risk factor analysis.

References

  1. Rand McNally Commercial Atlas and Marketing Guide, 133rd ed, New York: Rand McNally, 2002: 450
  2. Zafren K, Honigman B. High-altitude medicine. Emer Med Clin North Am 1997;15:191 -222[Medline]
  3. World almanac and book of facts 2002, New York: World Almanac Books, 2002:592
  4. Warshauer DM, Lee JKT, Mauro MA, White II GC. Superior mesenteric vein thrombosis with radiologically occult cause: a retrospective study of 43 cases. AJR 2001;177:837 -841

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