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The lumen of the rectum is distended and fluid filled (arrowhead) with no proximal obstruction.
A proximal obstruction will prevent such respiratory variation resulting in a continuous flow pattern and will also prevent venous distension normally seen when performing the Valsalva maneuver.
However, depending on the setting, the vessel observed and the patient condition, the rouleaux (or sludge sign) should sometimes induce to extend the observation to the possibility of proximal obstruction.
In advanced stages of hilar cholangiocarcinoma, retroperitoneal adenopathy, peritoneal carcinomatosis and proximal obstruction may occur[ 9 ].
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Endobronchial treatment for obstructed airways is indicated for patients with symptomatic proximal obstructions prior to specific medical treatment (recommendation).
Endobronchial techniques are useful for symptomatic proximal obstructions (option).
To assess the effect of hyoscine-N-butylbromide (HBB) as premedication on the rate of proximal tubal obstruction during hysterosalpingography (HSG).
Obstructive pneumonia with central abcedation was excluded by the visualisation of normally aerated lung parenchyma between the proximal tumoral obstruction and the subpleural consolidation.
However, when cancer cells invade to lymphatic vessels, they could cause the proximal lymphatic obstruction and spread with the retrograde lymphatic flow to iliac or inguinal areas [12 14].
To rule in or out a more proximal venous obstruction in the presence of rouleaux, the operator should look for direct visualization of a thrombus or examine compressibility of the proximal veins.
Despite rapid initial improvement, the patient required prolonged mechanical ventilation and antibiotherapy because of abscess development and several episodes of acute respiratory distress after proximal bronchi obstruction with plugs of necrotic lung tissue (Figure 2).
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