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Arafah A, Pham R, Filby SJ. Left Main Coronary Artery and Bilateral Mammary Artery Aneurysms in a Patient With Extensive Aortopathy. Tex Heart Inst J 2023; 50:e238248. [PMID: 38054351 PMCID: PMC10751475 DOI: 10.14503/thij-23-8248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Ala’ Arafah
- Division of Internal Medicine, Case Western Reserve University, and University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Richard Pham
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Steven J. Filby
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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2
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Mafra J, Pires V, Andrade C, Rodrigues ÂR. Spontaneous rupture of breast pseudoaneurysm: a rare case. BMJ Case Rep 2023; 16:e256962. [PMID: 37993146 PMCID: PMC10668168 DOI: 10.1136/bcr-2023-256962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Ehlers-Danlos syndrome (EDS) type IV is a hereditary autosomal dominant disease associated with skin and vascular fragility, hyperextensibility and joint hypermobility. Spontaneous arterial rupture is one of its higher-risk features.The authors describe a case of a woman with EDS type IV who presented with a spontaneous breast haematoma associated with a pseudoaneurysm of a branch of the left internal mammary artery. The patient underwent a minimally invasive endovascular approach that was uneventful. However, 6 months later, she presented in the emergency room with a similar episode on the contralateral breast. There were no signs of active bleeding, and she stayed under surveillance. Nine months later, she was asymptomatic.Aneurysms of branches of the internal mammary artery are rare and prone to rupture. Early diagnosis and treatment are imperative, and this case demonstrates that an endovascular approach is a safe treatment option.
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Affiliation(s)
- Joana Mafra
- Department of Gynecology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Verena Pires
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Cláudia Andrade
- Department of Gynecology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Ângela Reis Rodrigues
- Department of Gynecology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Centro Académico Clínico de Coimbra, Coimbra, Portugal
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3
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Imamura T, Omura T, Sasaki N, Arino S, Nohara H, Saito A, Ichinose M, Yamaguchi K, Kojima N, Inagawa H, Takahashi K, Unno T, Morisaki H, Ishikawa O, Yoshikawa G, Okada Y. Case Report: Spontaneous Postpartum Quadruple Cervicocephalic Arterial Dissection With a Heterozygous COL5A1 Variant of Unknown Significance. Front Neurol 2022; 13:928803. [PMID: 35911880 PMCID: PMC9327320 DOI: 10.3389/fneur.2022.928803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Pregnancy-associated cervicocephalic arterial dissection is rare, and its pathophysiology remains poorly understood. Despite the hypothesized contribution to pathogenesis, connective tissue diseases and genetic factors are rarely identified in clinical cases. We describe a case of postpartum arterial dissection involving all four cervicocephalic arteries resulting in acute cerebral infarction. The patient underwent successful endovascular thrombectomy and angioplasty and recovered fully without sequelae. Genetic screening for connective tissue diseases identified a heterozygous missense COL5A1 variant with unknown clinical significance. Two genetically related family members later developed arterial abnormalities, and one of them tested positive for the same COL5A1 gene variant as our patient, while the other was scheduled for genetic testing. The extensive clinical presentation of our patient and the prevalence of arterial abnormalities in her family warrant further assessment of the association between the identified COL5A1 gene variant and the pathogenesis of arterial dissections.
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Affiliation(s)
- Takeaki Imamura
- Department of Emergency and Critical Care Medicine, Showa General Hospital, Tokyo, Japan
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
- *Correspondence: Takeaki Imamura
| | - Takaki Omura
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Nobuo Sasaki
- Department of Emergency and Critical Care Medicine, Showa General Hospital, Tokyo, Japan
| | - Satoshi Arino
- Department of Emergency and Critical Care Medicine, Showa General Hospital, Tokyo, Japan
| | - Haruna Nohara
- Department of Emergency and Critical Care Medicine, Showa General Hospital, Tokyo, Japan
| | - Akira Saito
- Department of Neurosurgery, Saitama Medical Centre, Saitama, Japan
| | - Maki Ichinose
- Department of Anesthesiology, Showa General Hospital, Tokyo, Japan
| | | | - Naoki Kojima
- Department of Emergency and Critical Care Medicine, Showa General Hospital, Tokyo, Japan
| | - Hiroshi Inagawa
- Department of Emergency and Critical Care Medicine, Showa General Hospital, Tokyo, Japan
| | | | - Toshiyuki Unno
- Department of Radiology, Showa General Hospital, Tokyo, Japan
| | - Hiroko Morisaki
- Department of Medical Genetics, Sakakibara Heart Institute, Tokyo, Japan
| | - Osamu Ishikawa
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
- Department of Neurosurgery, Asama General Hospital, Nagano, Japan
| | - Gakushi Yoshikawa
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan
| | - Yasusei Okada
- Department of Emergency and Critical Care Medicine, Showa General Hospital, Tokyo, Japan
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4
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Ayyildiz V, Aydin Y, Ogul H. Thrombosed Aneurysm of Left Internal Mammary Artery. Arch Bronconeumol 2021; 57:653. [PMID: 35699049 DOI: 10.1016/j.arbr.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/12/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Veysel Ayyildiz
- Department of Radiology, Medical Faculty, Suleyman Demirel University, Isparta Turkey
| | - Yener Aydin
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey; Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Hayri Ogul
- Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey; Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey.
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5
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Stengl R, Ágg B, Szilveszter B, Benke K, Daradics N, Ruskó B, Vattay B, Merkely B, Pólos M, Szabolcs Z. Case Report: Morphological Characterization and Long-Term Observation of Bilateral Sequential Internal Mammary Artery Aneurysms in a Patient With Confirmed FBN1 Mutation. Front Cardiovasc Med 2021; 8:697591. [PMID: 34222386 PMCID: PMC8242161 DOI: 10.3389/fcvm.2021.697591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022] Open
Abstract
Marfan syndrome (MFS) is a genetically determined connective tissue disorder that leads to ocular, skeletal, and severe cardiovascular involvement. High mortality of MFS is associated with aortic dissection and aneurysm characteristic to the syndrome. In MFS, only a few cases of peripheral arterial involvement have been reported so far, mostly without a genetically confirmed diagnosis. We report a 41-year-old MFS patient with a saccular pearl-string-like aneurysm on the right internal mammary artery (RIMA) and a single aneurysm on the left internal mammary artery (LIMA). To our knowledge this is the first reported case on internal mammary artery aneurysms with this special morphology and with follow-up and blood pressure control as primary therapeutic approach in a patient with genetically confirmed MFS. The aneurysms with the above described morphology first appeared as small aneurysms on a CT scan 6 years after a cardiac operation. Due to the lack of guidelines, based on the asymptomatic state of the patient, the increased tortuosity of the affected vessels and the history of prior cardiac surgery, we decided to closely monitor these aneurysms with blood pressure control and without carrying out any interventions. On the CT scans done 3, 11, 12, 17, and 32 months after identifying the aneurysms, no progression of these structures was detected. Our findings confirm the possibility of the occurrence of internal mammary artery aneurysms in patients with FBN1 mutation and we believe that monitoring these aneurysms with blood pressure management can be a suitable option in selected cases.
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Affiliation(s)
- Roland Stengl
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary.,Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Noémi Daradics
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bernadett Ruskó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
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Sueyoshi E, Sakamoto I, Koide Y, Uetani M. Endovascular repair of an internal mammary artery aneurysm in a patient with Takayasu arteritis. Interact Cardiovasc Thorac Surg 2020; 31:740-742. [PMID: 32910191 DOI: 10.1093/icvts/ivaa174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/02/2020] [Accepted: 07/26/2020] [Indexed: 11/14/2022] Open
Abstract
Internal mammary artery aneurysms are rare, but serious, clinical entities. We describe a rare case in which an internal mammary artery aneurysm in a patient with Takayasu arteritis was successfully treated with coil embolization. To the best of our knowledge, this is the first report of an internal mammary artery aneurysm associated with Takayasu arteritis.
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Affiliation(s)
- Eijun Sueyoshi
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Ichiro Sakamoto
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuji Koide
- Nagasaki Medical Education Center, Medical Education and Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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7
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Aru RG, Wallace JP, Bounds MC, Sheppard MB, Guney AK, O'Connor WN, Tyagi SC. Spontaneous Rupture of Mesenteric Vasculature Associated with Fibromuscular Dysplasia in a 28-Year-Old Male. Ann Vasc Surg 2020; 71:534.e13-534.e15. [PMID: 32947002 DOI: 10.1016/j.avsg.2020.08.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/07/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
Spontaneous rupture of mesenteric vasculature associated with fibromuscular dysplasia is an unreported phenomenon. We describe a case in a 28-year-old male with a history of chronic abdominal pain who presented to our facility in hemorrhagic shock secondary to a ruptured transverse mesocolon middle colic aneurysm status postemergent transverse colectomy. He was found to have chronic vertebral, renovisceral, and iliac aneurysms as well as acute superior and inferior mesenteric artery dissection and chronic bilateral vertebral artery dissections. He subsequently developed disseminated intravascular coagulopathy, resulting in saddle pulmonary embolus as well as right renal artery and splenic artery thrombosis. Ultimately, the patient expired.
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Affiliation(s)
- Roberto G Aru
- Department of Surgery, University of Kentucky Albert B. Chandler Hospital, Lexington, KY
| | - Jerald P Wallace
- Department of Surgery, University of Kentucky Albert B. Chandler Hospital, Lexington, KY
| | - Michael C Bounds
- Department of Surgery, University of Kentucky Albert B. Chandler Hospital, Lexington, KY
| | - Mary B Sheppard
- Department of Surgery, University of Kentucky Albert B. Chandler Hospital, Lexington, KY
| | - Akif K Guney
- Department of Surgery, University of Kentucky Albert B. Chandler Hospital, Lexington, KY
| | - William N O'Connor
- Department of Surgery, University of Kentucky Albert B. Chandler Hospital, Lexington, KY
| | - Sam C Tyagi
- Department of Surgery, University of Kentucky Albert B. Chandler Hospital, Lexington, KY.
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8
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Ayyildiz V, Aydin Y, Ogul H. Thrombosed Aneurysm of Left Internal Mammary Artery. Arch Bronconeumol 2020; 57:S0300-2896(20)30121-6. [PMID: 32576393 DOI: 10.1016/j.arbres.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/01/2020] [Accepted: 04/12/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Veysel Ayyildiz
- Department of Radiology, Medical Faculty, Suleyman Demirel University, Isparta Turkey
| | - Yener Aydin
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey; Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Hayri Ogul
- Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey; Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey.
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