Coexistence of a congenital arteriovenous fistula of the left breast with a true aneurysm of the right internal mammary artery

Arteriovenous fistulas (AVF) and true aneurysms are uncommon arterial vascular disorders of the breast. The etiology can be either acquired or congenital. Coexistence of a congenital AVF and true aneurysm of internal mammary artery (IMA) branches is a very rare condition. We present a case of congenital AVF and true aneurysm of the IMA in a woman, age 56 years. To the best of our knowledge, this is the first published case of the coexistence of a congenital AVF with a true aneurysm of the breast. The radiologic findings of these rare entities have been reviewed according to the literature.

Vertebral artery aneurysm rupture: an autopsy case

Vertebral artery aneurysm rupture is a rare cause of sudden death. The presented case was 31-year-old woman who was found dead in her bedroom. Family members stated that she had history of one year duration childhood epilepsy treatment. Autopsy investigation revealed 5 mm in diameter aneurysm, ruptured in 1 mm area, localized on the trunk of the right vertebral artery. We described an autopsy case of sudden unexpected death due to ruptured vertebral artery aneurysm.

[Aneurysm of the unpaired visceral aortal branches]

Clinical signs, data of additional methods of examination, results of surgical treatment of patients for aneurysm of unpaired visceral aortal branches were analyzed. Specific complaints and clinical signs are absent. Most informative and trustworthy method of investigation is a computer tomography. In the sizes of aneurysm more than 2 cm surgical treatment is indicated.

Marfan syndrome with spontaneous rupture of aneurysm of common iliac artery

Marfan syndrome rarely presents with peripheral artery and pulmonary artery aneurysms. We are presenting a case of a fifteen-year-old boy who presented to us with progressive lower abdominal pulsatile swelling with bruit in the right inguinal region for one month. He had typical marfanoid habitus, though there was no history of similar illness in family. CT angiogram revealed the presence having giant right common iliac aneurysm along with interlobar pulmonary artery aneurysm. He had spontaneous rupture of aneurysm in right common iliac artery.

Dysphagia lusoria: a late onset presentation

Dysphagia lusoria is a term used to describe dysphagia secondary to vascular compression of the oesophagus. The various embryologic anomalies of the arterial brachial arch system often remain unrecognised and asymptomatic, but in 30%-40% of cases can result in tracheo-oesophageal symptoms, which in the majority of cases manifest as dysphagia. Diagnosis of dysphagia lusoria is via barium swallow and chest Computed tomography scan. Manometric abnormalities are variable, but age-related manometric changes may contribute to clinically relevant dysphagia lusoria in patients who present later in life. Our report describes a case of late-onset dysphagia secondary to a right aortic arch with an aberrant left subclavian artery, which represents a rare variant of dysphagia lusoria. The patient had proven additional oesophageal dysmotility with solid bolus only and a clinical response to dietary modification.

[Lymphoma and arteries: peri- or intravascular?]

PURPOSE

Lymphoma is a polymorphous disease that does not spare arteries. Arterial involvement may be perivascular or intravascular, with different prognostic and therapeutic implications.

PATIENTS AND METHODS

We present here one case of perivascular lymphoma and another case of intravascular lymphoma in order to highlight the specific features of each type.

RESULTS

The first patient was a woman who presented a pseudo-aneurysmal anterior iliac artery due to a non-Hodgkin lymphoma with subsequent bilateral pyelocalyceal distension. The second patient was a man who developed intravascular lymphomatosis expressed by an aneurysm of the common femoral then the primitive iliac artery.

CONCLUSION

The distinction between perivascular and intravascular arterial involvement is based on a range of features and is essential for an optimal care of patients with lymphoma.

[Aortic vascular anomalies and Kommerell's diverticulum, an imagiologic diagnosis]

Aortic vascular anomalies are complex anatomic entities requiring often complex and problematic surgical approaches. The authors report the clinical case of a Kommerell's diverticulum and right-sided aortic arch. Right-sided aortic arch is an uncommon congenital defect of the aorta and it is rare in the setting of an otherwise normal heart. A right-sided aortic arch was described more than two centuries ago. Several classifications of these anomalies have been proposed on the basis of the arrangement of the arch vessels, relationships with the esophagus, or the presence of congenital heart anomalies. In the adult population, a right-sided aortic arch is often asymptomatic, unless aneurismal disease develops. This usually occurs at the level of the take-off of an aberrant left subclavian artery and is known as a Kommerell's diverticulum. In spite of its rarity, this condition is clinically relevant due to the mortality associated with rupture, morbidity caused by compression of mediastinal structures, and complexity of surgery.

Traumatic true aneurysm of the superficial temporal artery

BACKGROUND

Aneurysms of the superficial temporal artery (STA) usually are pseudoaneurysms and occur after blunt or penetrating trauma to the head or after surgery in the temporal region. However, true aneurysms of the STA are very rare. This report describes the case of a true aneurysm of the STA that appeared after trauma and discusses several relevant studies about the development and mechanism of this aneurysm.

METHODS

A 57-year-old woman was referred to the neurosurgery department due to a slowly growing mass on her left parietal scalp. She reported a history of trauma to the head 3 months before the consultation. However, examination showed the scar located far from pulsatile mass. Imaging studies showed a fusiform aneurysmal dilation of the parietal branch of the STA. The frontal branch likely was occluded due to the previous injury.

RESULTS

Surgical removal was performed, and the proximal STA was ligated. Histologic examination showed all three layers of the arterial wall to be intact and only luminal dilation. No sign of atherosclerosis or inflammation was detected.

CONCLUSION

The aneurysm in this case was a true aneurysm. The mechanism underlying the spontaneous development of this true aneurysm is not fully understood, although it is possible that insensible minor blunt trauma weakened the arterial wall or reduced the elasticity of the artery. Increased blood flow of the parietal branch due to occlusion of the frontal branch can facilitate aneurysmal dilation. It is speculated that the real incidence of traumatic true STA aneurysms has been underreported. Thus, the authors recommend histologic examination in all traumatic aneurysm cases.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

[Diagnostic value of blood myoglobin level elevation in patient in intensive care unit]

The goal of the study was assessment of clinical value of myoglobin level elevation in patients in neurointensive care unit. 15 healthy volunteers and 60 patients of neuroICU (40 postoperative patients and 20 patients with prolonged consciousness disorders of different states) were involved in the study. Myoglobin level was assessed immunologically. Episodes of arterial hypotension (< or = 50% from baseline) for 10-15 minutes were the cause of myoglobin level elevation in 11 from 40 postoperative patients. Association of myoglobin level elevation with type of pathology (tumor or aneurism), localization and surgery duration wasn't found. Severe hemodynamic disturbances with hypotension in 3-4 days before measurement were noted also in patients with hypermyoglobinemia in the group with prolonged consciousness disorders. Correlation of myoglobin level and duration of polyneuromyopathy, sepsis, MODS wasn't noted. Authors conclude that myoglobin level elevation is associate with hemodynamic instability and isn't specific marker of polyneuromyopathy or its duration.

Nontraumatic true aneurysm of the superficial palmar arch: a case report

A case of a 62 year-old woman with true aneurysm of the superficial palmar arch with no previous history of trauma is described. The aneurysm was resected without reconstruction based on intraoperative evidence of adequate finger perfusion after clumping the distal and proximal ends. Three years after the operation, there has been no recurrence of the aneurysm and the patient has neither complaints nor symptoms.

3D computerized occlusion rating of embolized experimental aneurysms using noninvasive 1.5T MR imaging

BACKGROUND AND PURPOSE

For embolized cerebral aneurysms, the initial occlusion rate is the most powerful parameter to predict aneurysm rerupture and recanalization. However, the occlusion rate is only estimated subjectively in clinical routine. To minimize subjective bias, computer occlusion-rating (COR) was successfully validated for 2D images. To minimize the remaining inaccuracy of 2D-COR, COR was applied to 1.5T 3D MR imaging.

MATERIALS AND METHODS

Twelve experimental rabbit aneurysms were subjected to stent-assisted coil embolization followed by 2D DSA and 3D MR imaging. Subjective occlusion-rate (SOR) was estimated. Linear parameters (aneurysm length, neck width, parent vessel diameter) were measured on 2D DSA and 3D MR imaging. The occlusion rate was measured by contrast medium-based identification of the nonoccluded 2D area/3D volume in relation to the total aneurysm 2D area/3D volume. 2D and 3D parameters were statistically compared.

RESULTS

There were no limiting metallic artifacts by using 3D MR imaging. Linear parameters (millimeters) were nearly identical on 2D DSA and 3D MR imaging (aneurysm length: 7.5 ± 2.6 versus 7.4 ± 2.5, P = .2334; neck width: 3.8 ± 1.0 versus 3.7 ± 1.1, P = .6377; parent vessel diameter: 2.7 ± 0.6 versus 2.7 ± 0.5, P = .8438), proving the high accuracy of 3D MR imaging. COR measured on 3D MR imaging was considerably lower (61.8% ± 26.6%) compared with the following: 1) 2D-COR (65.6% ± 27.1%, P = .0537) and 2) 2D-SOR estimations (69.2% ± 27.4%, P = .002). These findings demonstrate unacceptable bias in the current clinical standard SOR estimations.

CONCLUSIONS

3D-COR of embolized aneurysms is easily feasible. Its accuracy is superior to that of the clinical standard 2D-SOR. The difference between 3D-COR and 2D-COR approached statistical significance. 3D-COR may add objectivity to the ability to stratify the risk of rerupture in embolized cerebral aneurysms.

["Ex-vivo" surgical repair of renal artery branches aneurysms]

The authors report the clinical case of complex aneurysms of intra-hilar branches of the renal artery, managed recently through a renal auto-transplantation procedures with "ex-vivo" repair, discussing the technique, the principles and the indications for this kind of procedure.

Giant, metachronous bilateral dorsalis pedis artery true aneurysms

This report is the first to describe the clinical, radiographic, operative, and pathologic findings associated with large, bilateral dorsalis pedis artery true aneurysms in a single patient. A 61-year-old African American woman complained of difficulty in wearing shoes. She had a moderately firm, nontender, pulsatile mass on the dorsum of her right foot. Computed tomography and angiography confirmed dorsalis pedis artery aneurysm with sufficient collateralization. She underwent resection without reconstruction. Pathologic analysis revealed a true aneurysm (8 × 5.3 × 4.1 cm(3)) containing intralumenal thrombus. Treatment for small symptomatic and large dorsalis pedis artery aneurysms remains resection with or without reconstruction.

[A case of hepatic artery aneurysm that had formed asymptomatically and penetrated into the duodenum]

A 41-year-old man was admitted to our hospital with gastrointestinal bleeding. Esophagogastroduodenoscopy revealed a submucosal protrusion with erosion in the duodenal bulb which was thought to be the bleeding source. Dynamic CT scan, ultrasonography and angiography of the abdomen revealed a hepatic artery aneurysm and a dilated celiac artery that dissected from its origin. Although we considered percutaneous transcatheter arterial embolization with metallic coils, we chose surgical resection and vascular reconstruction to prevent hepatic ischemia resulting from interruption of collateral circulation. On the 8(th) day, hepatic artery aneurysmectomy and revascularization with a great saphenous vein was carried out without any severe complication. The pathological specimen demonstrated segmental arterial mediolysis.

Endovascular exclusion of aberrant splenic artery aneurysm with covered stent

The splenic artery arising from the superior mesenteric artery is an uncommon anatomical variant. This aberrant origin may rarely be associated with an aneurysm. Previous cases have been managed with surgery and combined surgical/endovascular or endovascular techniques, with the latter involving occlusion of the aneurysm with coils. We report a case of aberrant splenic artery aneurysm that was excluded with a balloon-mounted covered stent, and discuss the technical issues encountered in using this approach. A follow-up computed tomography performed six months after the covered stent placement showed persistent exclusion with marked shrinkage of the aneurysm sac.

Can aspect ratio be used to categorize intra-aneurysmal hemodynamics?--A study of elastase induced aneurysms in rabbit

Clinical studies suggest that aneurysm aspect ratio (AR) is an important indicator of rupture likelihood. The importance of AR is hypothesized to arise from its influence on intra-aneurysmal hemodynamics. It has been conjectured that slower flow in high AR sacs leads to a cascade of biological activities that weaken the aneurysm wall (Ujiie et al.,1999). However, the connection between AR, hemodynamics and wall weakening has never been proven. Animal models of saccular aneurysms provide a venue for evaluating this conjecture. The focus of this work was to evaluate whether a commonly used elastase induced aneurysm model in rabbits is suitable for a study of this kind from a hemodynamic perspective. In particular, to assess whether hemodynamic factors in low and high AR sacs are statistically different. To achieve this objective, saccular aneurysms were created in 51 rabbits and pulsatile computational fluid dynamics (CFD) studies were performed using rabbit specific inflows. Distinct hemodynamics were found in the low AR (AR<1.8, n=25), and high AR (AR>2.2, n=18) models. A single, stable recirculation zone was present in all low AR aneurysms, whereas a second, transient recirculation zone was also found in the superior aspect of the aneurysm dome for all high AR cases. Aneurysms with AR between 1.8 and 2.2 displayed transitional flow patterns. Differences in values and distributions of hemodynamic parameters were found between low and high AR cases including time averaged wall shear stress, oscillatory shear index, relative residence time and non-dimensional inflow rate. This work lays the foundation for future studies of the dependence of growth and remodeling on AR in the rabbit model and provides a motivation for further studies of the coupling between AR and hemodynamics in human aneurysms.

[Automatic detection of microaneurysms in colour fundus images]

PURPOSE

We present the development of a tool for the automatic detection of microaneurysms and its clinical evaluation. The intention of this tool is to facilitate the diagnosis of diabetic retinopathy in general screening programs.

METHOD

The designed and developed tool consists of three stages of processing: 1) Obtaining of the basic image of eye with the retinal camera, inverted image on the green channel, and a high-pass filter of the image. This phase enhances the microaneurysms. 2) Detection of the candidates for microaneurysms, by means of an adaptive prediction filter and regions growth. 3) Selection, among the candidates, of whom microaneurysms must be considered to fulfil the criteria of circular shape, high intensity in the inverted green channel and contrasts with respect to the surrounding pixels.

RESULTS

We selected to 20 retinal photographs of good quality and dimensions 600x600 pixels from patients with nonproliferative diabetic retinopathy. The ophthalmologists detected 297 microaneurysms in these images. The tool for automatic detection correctly located 252 microaneurysms, with a mean sensitivity of 89% and a false positives rate of 93%.

CONCLUSIONS

The results obtained seem to indicate that the tool developed will be very useful for its potential use in screening programs in primary care centres. On the other hand, more work is needed on the algorithm to decrease the rate of false positives.