1
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Lazea C, Țaranu I, Bolboacă SD. Exploring Cardiovascular Involvement in Tuberous Sclerosis: Insights for Pediatric Clinicians. CHILDREN (BASEL, SWITZERLAND) 2024; 11:674. [PMID: 38929253 PMCID: PMC11201926 DOI: 10.3390/children11060674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Tuberous sclerosis is a rare genetic disorder involving mainly the nervous and cardiovascular systems. The early recognition of the cardiovascular manifestations by the pediatrician allows an appropriate management and therefore enhances the quality of life of the affected children. Cardiac rhabdomyomas and the associated arrhythmias are the first cardiac features and they might represent a diagnosis challenge given their wide spectrum of clinical manifestations. We aimed to provide the paediatric practitioners with current knowledge regarding the cardiovascular complications in children with tuberous sclerosis. We overviewed the antenatal and postnatal evolution of cardiovascular manifestations, the systematic screening and long-term follow-up strategy of cardiac rhabdomyomas and arrhythmias in children with tuberous sclerosis.
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Affiliation(s)
- Cecilia Lazea
- Pediatric Clinic 1, Emergency Pediatric Hospital, Calea Moților, No. 68, 400370 Cluj-Napoca, Romania;
- Department Mother and Child, Iuliu Hațieganu University of Medicine and Pharmacy, Calea Moților, No. 68, 400370 Cluj-Napoca, Romania
| | - Ioana Țaranu
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania;
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania;
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2
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Umibe T, Nishiori H, Koizumi S, Ikeuchi H, Matsumiya G. Saccular abdominal aortic aneurysm in adolescence with tuberous sclerosis. Clin Case Rep 2024; 12:e8715. [PMID: 38562571 PMCID: PMC10982115 DOI: 10.1002/ccr3.8715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/07/2024] [Indexed: 04/04/2024] Open
Abstract
Key clinical message Abdominal aortic aneurysm complicated by tuberous sclerosis is rare, particularly in patients over the age of 10. It is important to screen for abdominal aortic aneurysm in adolescents diagnosed with tuberous sclerosis regularly. Abstract A 15-year-old girl who was diagnosed with tuberculous sclerosis complicated with a saccular aortic abdominal aneurysm (AAA), measuring 19 × 18 mm in diameter. The patient underwent open repair of AAA using a 11 mm straight prosthetic graft. It is important to screen for AAA in adolescents diagnosed with tuberous sclerosis regularly.
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Affiliation(s)
| | - Hironobu Nishiori
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
| | - Shintaro Koizumi
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
| | - Hiroki Ikeuchi
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
| | - Goro Matsumiya
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
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3
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Fuson OI, Hirai K, Halleran DR, Jafri M, Muralidaran A, Azarbal A, Abraham CZ, Shalhub S. Open repair of a ruptured abdominal aorta with an aortoiliac vein fistula in a 7-month-old infant and review of the literature. J Vasc Surg Cases Innov Tech 2024; 10:101441. [PMID: 38464889 PMCID: PMC10921241 DOI: 10.1016/j.jvscit.2024.101441] [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: 10/20/2023] [Accepted: 01/19/2024] [Indexed: 03/12/2024] Open
Abstract
Ruptured abdominal aortic aneurysms are extremely rare in the pediatric population. In this video case report, we describe the successful repair of a ruptured abdominal aortic aneurysm in a 7-month-old female infant.
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Affiliation(s)
- Olivia I. Fuson
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Kelsi Hirai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Devin R. Halleran
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Mubeen Jafri
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Ashok Muralidaran
- Division of Cardiac Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Amir Azarbal
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Cherrie Z. Abraham
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Sherene Shalhub
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
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4
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Auen T, Linde E. An Autopsy Case of Abdominal Aortic Aneurysm in a Pediatric Decedent With Tuberous Sclerosis Complex. Am J Forensic Med Pathol 2024; 45:72-76. [PMID: 37486961 DOI: 10.1097/paf.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
ABSTRACT Vascular involvement in tuberous sclerosis complex (TSC) is uncommon and even more so in pediatric patients. When asymptomatic, these vascular abnormalities carry increased risk of rupture with increased morbidity and mortality. Here, we describe a case of a ruptured unrecognized abdominal aortic aneurysm in an 11-month-old patient with a history of TSC. The abdominal aortic aneurysm was discovered at autopsy and highlights the rarity of abdominal aortic aneurysm in pediatric patients diagnosed with TSC and the importance of screening for associated aneurysmal disease in the pediatric population with TSC. Furthermore, the extensive retroperitoneal hemorrhage seen in this case also highlights a rare but potential mimic of abuse in the pediatric population.
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Affiliation(s)
- Thomas Auen
- From the Department of Pathology and Microbiology, Nebraska Medical Center, University of Nebraska Medical Center
| | - Erin Linde
- Physicians Laboratory Services, Omaha, NE
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5
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Corso-Ramirez JM, López MM, Flórez PC, Barrera-Carvajal JG, Mackenzie JC. Open Emergency Repair of a Thoracoabdominal Aortic Aneurysm on a 12-Year-Old Boy With Tuberous Sclerosis. Vasc Endovascular Surg 2024; 58:85-89. [PMID: 37318445 DOI: 10.1177/15385744231184509] [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: 06/16/2023]
Abstract
Tuberous sclerosis complex is a neurocutaneous syndrome caused by an autosomal dominant genetic disorder. This condition can lead to the expression of many vascular anomalies especially, in the pediatric population. Likewise, it has been linked with aortic aneurysm development. We report a case of a 12-year-old boy who presented a 97 × 70 mm Crawford type IV thoracoabdominal aortic aneurysm. Satisfactory open surgical repair was performed with an 18-mm multibranched dacron tube graft. Clinical and imaging findings revealed a de novo tuberous sclerosis diagnosis. The patient was discharged uneventfully during a 1-month follow-up.
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Affiliation(s)
- Julian M Corso-Ramirez
- Vascular and Endovascular Surgery Research Group, Fundación CardioInfantil- La Cardio, Bogotá D.C, Colombia
| | - Mariana Molina López
- Vascular and Endovascular Surgery Research Group, Fundación CardioInfantil- La Cardio, Bogotá D.C, Colombia
| | - Paula Camila Flórez
- Vascular and Endovascular Surgery Fellowship, Fundación CardioInfantil- La Cardio, Bogotá D.C, Colombia
| | | | - Jaime Camacho Mackenzie
- Vascular and Endovascular Surgeon, Fundación CardioInfantil- La Cardio, Bogotá D.C, Colombia
- Cardiovascular Surgeon, Fundación CardioInfantil- La Cardio, Bogota D.C, Colombia
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6
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Alrazim AM, Burk JK, Wilder TJ, Park WM, Yoon WJ, Cho JS. Recurrent symptomatic aortic aneurysm in a young girl with tuberous sclerosis complex and review of the literature. J Vasc Surg Cases Innov Tech 2023; 9:101261. [PMID: 38106352 PMCID: PMC10725066 DOI: 10.1016/j.jvscit.2023.101261] [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: 03/17/2023] [Accepted: 06/06/2023] [Indexed: 12/19/2023] Open
Abstract
An abdominal aortic aneurysm is a rare occurrence in pediatric populations. When present, it is usually associated with an underlying etiology such as a connective tissue disorder, inflammatory process, or noninflammatory medial degeneration. In the present report, we describe the case of a girl with tuberous sclerosis complex who underwent successful emergency open repair of a symptomatic infrarenal abdominal aortic aneurysm and recurrent type IV thoracoabdominal aortic aneurysm.
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Affiliation(s)
- Ayman M. Alrazim
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Joshua K. Burk
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Travis J. Wilder
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Woosup Michael Park
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - William J. Yoon
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Jae S. Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
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7
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Olvera A, Besho JM, Tanaka A, Safi HJ, Estrera AL. Multiple Interventions to Thoracoabdominal Aortic Aneurysm in a Child With Tuberous Sclerosis. Ann Thorac Surg 2023; 115:e49-e51. [PMID: 35305993 DOI: 10.1016/j.athoracsur.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/06/2022] [Indexed: 02/07/2023]
Abstract
Thoracoabdominal aortic aneurysms in toddlers are extremely rare. However, we experienced an extent III thoracoabdominal aortic aneurysm in a boy with tuberous sclerosis who underwent 3 open repairs and 1 endovascular aortic repair between the ages of 4 years and 18 years. This case highlights the potential for severe recurrent vascular aneurysms in the thoracic and abdominal aorta as a complication of tuberous sclerosis in children. Although aortic aneurysms in children are rare, it is vital to recognize these cases to prevent death due to rupture.
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Affiliation(s)
- Alejandro Olvera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Texas
| | - Joseph M Besho
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Texas
| | - Akiko Tanaka
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Texas
| | - Hazim J Safi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Texas
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, Texas.
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8
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Computed tomography for aortic assessment in children. Pediatr Radiol 2022; 52:2470-2484. [PMID: 36151220 DOI: 10.1007/s00247-022-05501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Because the aorta is the major vessel of the body, basic knowledge of aortic pathology is essential to the pediatric imager. This review divides aortic pathology into anatomical (e.g., congenital abnormalities) and acquired (e.g., vasculitis, trauma) entities, providing a brief description of pathology, technical considerations in CT acquisition and processing, and some pearls and pitfalls of interpretation. The objective of this paper is to familiarize general pediatric imagers with imaging features of common as well as high-impact aortic pathology on CT and prepare them for acquisition and reporting.
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9
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Abdominal aortic aneurysm in a child with tuberous sclerosis. J Vasc Surg Cases Innov Tech 2022; 8:375-377. [PMID: 35936020 PMCID: PMC9352511 DOI: 10.1016/j.jvscit.2022.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
Abdominal aortic aneurysm is rare in the pediatric population and even more uncommon in association with tuberous sclerosis. We have presented a unique case of a 3-year, 8-month-old girl who was successfully treated. She was admitted because of breakthrough seizures. A painless pulsatile abdominal mass on examination prompted an abdominal ultrasound scan, which identified a large saccular abdominal aortic aneurysm. Urgent replacement of the abdominal aorta with a 12-mm woven Dacron graft was undertaken. A postoperative ultrasound evaluation confirmed the successful repair. She was growing well when examined 7 months after surgery.
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10
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Maeno R, Isaji T, Takayama T, Hoshina K. Popliteal artery aneurysm in a 14-year-old boy with tuberous sclerosis complex. J Vasc Surg Cases Innov Tech 2022; 9:100961. [PMID: 36794044 PMCID: PMC9922967 DOI: 10.1016/j.jvscit.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is rarely associated with aneurysms. We have described a patient with a popliteal artery aneurysm that was associated with TSC and occlusion of the right posterior tibial artery. The patient underwent aneurysm resection and vein graft replacement, with an uneventful postoperative course and no recurrence at 11 months of follow-up. Patients with TSC could have aneurysms in areas that will not be recognized on abdominal imaging. Physical examination of the lower extremities should be performed owing to the possibility of a popliteal artery aneurysm, and imaging studies should be performed if an aneurysm is suspected.
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Affiliation(s)
| | | | | | - Katsuyuki Hoshina
- Correspondence: Katsuyuki Hoshina, MD, PhD, Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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11
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Lazea C, Al-Khzouz C, Sufana C, Miclea D, Asavoaie C, Filimon I, Fufezan O. Diagnosis and Management of Genetic Causes of Middle Aortic Syndrome in Children: A Comprehensive Literature Review. Ther Clin Risk Manag 2022; 18:233-248. [PMID: 35330917 PMCID: PMC8938167 DOI: 10.2147/tcrm.s348366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cecilia Lazea
- Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Department of Pediatrics I, Emergency Pediatric Hospital, Cluj-Napoca, Romania
- Correspondence: Cecilia Lazea, Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, 68, Motilor Street, Cluj-Napoca, 400370, Romania, Tel +40 744353764, Email ;
| | - Camelia Al-Khzouz
- Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Department of Medical Genetics, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Crina Sufana
- Department of Pediatrics I, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Diana Miclea
- Department of Medical Genetics, Emergency Pediatric Hospital, Cluj-Napoca, Romania
- Department of Molecular Sciences, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Ioana Filimon
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Otilia Fufezan
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
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12
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Endovascular Repair of a Descending Thoracic Aortic Aneurysm in a Pediatric Patient with Tuberous Sclerosis: A Case Report and Review of the Literature. Pediatr Cardiol 2022; 43:238-243. [PMID: 34468774 DOI: 10.1007/s00246-021-02717-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
Aortic aneurysm in children is rare, but has been described in the tuberous sclerosis complex (TSC) population. While surgical repair has been utilized as the primary means of intervention, we present the first known case reporting exclusion of a descending thoracic aortic aneurysm with percutaneous covered stent implantation in a pediatric patient with TSC. A review of the literature is also included herein.
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13
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Wolf S, Rhoads A, Gomes W, Overby P, McGoldrick P. Aortic Thrombus Embolization in A Patient with Tuberous Sclerosis. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1739261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractTuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder affecting many organ systems. Patients commonly develop a variety of benign tumors as well as neurological disease, including seizures, autism, and cognitive delay. We report here the case of an adolescent patient with TSC and a history of mild COVID-19 who presented with a 1-day history of altered mental status. The patient was found to have ischemic cerebral infarction of the right MCA and ACA territories. Initial angiography showed an occlusion of the right internal carotid artery without a demonstrable etiology, with follow-up echocardiography and angiography revealing a large aortic thrombus. The patient was not a candidate for thrombus removal due to her cerebral infarct and received medical anticoagulation. Thrombosis progressed to involve the left ICA, with left cerebral infarction and subsequent death. Aortic thrombus embolization as a cause of cerebrovascular accident (CVA) is a novel finding in the setting of TSC and should be considered for pediatric patients with CVA of unknown etiology. It is unclear whether this was related to the prior COVID-19 infection.
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Affiliation(s)
- Steven Wolf
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, New York, United States
| | - Andrew Rhoads
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, New York, United States
| | - William Gomes
- Department of Radiology, Division of Neuroradiology, Westchester Medical Center, Valhalla, New York, United States
| | - Philip Overby
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, New York, United States
| | - Patricia McGoldrick
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, New York, United States
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14
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Kim MH, Yoo JH, Cho HJ, Ko KJ, Jun KW, Han KD, Hwang JK. Increased depression risk in patients with abdominal aortic aneurysm: a nationwide cohort study. Ann Surg Treat Res 2021; 101:291-298. [PMID: 34796145 PMCID: PMC8564076 DOI: 10.4174/astr.2021.101.5.291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/07/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Abdominal aortic aneurysm (AAA) is a critical disease. Most studies of AAA consider reoperation rate, complications, or mortality, but do not consider a patient's mental state. However, there is a possibility of interaction between AAA and depression in disease development and prognosis. We investigated the incidence and risk ratio of depression in patients with AAA using nationwide data. Methods We selected subjects from National Health Insurance System database who were diagnosed with AAA between 2009 and 2015 and survived at least 1 year after diagnosis or AAA surgery (n = 10,373). We determined the control group using propensity score matching by age and sex. The control group had about 3 times the number of subjects as the AAA cohort (n = 31,119). Results The incidence of depression was 1.4 times higher in the AAA group than the control group. We further analyzed the incidence of depression in the AAA group according to treatment modalities (nonsurgical vs. surgical or nonsurgical vs. open surgical aneurysm repair vs. endovascular aneurysm repair) but found no significant difference among them. The incidence of depression was significantly higher in patients aged <65 years than in patients aged ≥65 years (hazard ratio, 1.539 vs. 1.270; P < 0.001). Conclusion The incidence of depression was higher in the AAA group, with an especially high risk for depression in patients aged <65 years. The psychiatric status of patients with AAA should be carefully monitored for clinicians to intervene when appropriate.
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Affiliation(s)
- Mi-Hyeong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju-Hwan Yoo
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Jin Cho
- Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Jai Ko
- Department of Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Kang-Woong Jun
- Division of Vascular and Transplant Surgery, Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Kyung-do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jeong-Kye Hwang
- Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Hamza A, Arif A, Manzoor Bhatti A, Riaz B, Mughal UJ, Ahmed Y, Tanveer S. A Rare Case of Homocysteinemia Presenting With Multiple Aneurysms in an Adolescent Boy. Cureus 2021; 13:e17950. [PMID: 34660138 PMCID: PMC8514801 DOI: 10.7759/cureus.17950] [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] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Thoracoabdominal aortic aneurysm (TAAA) is primarily a disorder of the elderly; the condition, however, is rare in children, for whom the misdiagnosis is not uncommon. It is one of the leading causes of death in the older age group worldwide, with a 4:1 male to female ratio. There are no real data about the incidence of aortic aneurysms in childhood. Although rare, an aortic aneurysm can be an important cause of mortality in children and adolescents. We present a case of an adolescent boy with a left coronary artery aneurysm, left axillary artery aneurysm, and TAAA type-IV caused by the metabolic disease homocysteinemia. He was referred to our facility when the complicated picture of the disease was discovered.
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Affiliation(s)
- Ali Hamza
- Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Anum Arif
- Vascular Surgery, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Ahsin Manzoor Bhatti
- Vascular Surgery, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Bismah Riaz
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical and Dental College, Lahore, PAK
| | | | - Yashfeen Ahmed
- Internal Medicine, Combined Military Hospital, Lahore, PAK
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16
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Hedin U, Brunnström H, Dahlin M, Backman T, Perez de Sa V, Tran PK. Resolving the biological paradox of aneurysm formation in children with tuberous sclerosis complex. JVS Vasc Sci 2021; 2:72-78. [PMID: 34617060 PMCID: PMC8489212 DOI: 10.1016/j.jvssci.2021.05.003] [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: 02/15/2021] [Accepted: 05/13/2021] [Indexed: 11/02/2022] Open
Abstract
Aortic aneurysms are rare manifestations in children with tuberous sclerosis complex (TSC) with life threating implications. Although an association between TSC, aortic and other aneurysms has been recognized, mechanistic insights explaining the pathophysiology behind aneurysm development and genetic aberrations in TSC have so far been lacking. Here, we summarize existing knowledge on aneurysms in TSC and present a case of a 2-year-old boy with an infrarenal aortic aneurysm, successfully treated with open aortic reconstruction. Histologic examination of the excised aneurysm wall showed distortion of vessel wall structure with loss of elastin and a pathologic accumulation of smooth muscle cells. Until now, these pathologic features have puzzled researchers as proliferating smooth muscle cells would rather be expected to preserve vessel wall integrity. Recent reports exploring the biological consequences of the dysregulated intracellular signaling pathways in patients with TSC provide plausible explanations to this paradox, which may support the development of future therapeutic strategies.
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Affiliation(s)
- Ulf Hedin
- Department of Vascular Surgery, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden.,Molecular Medicine and Surgery, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden
| | - Hans Brunnström
- Department of Clinical Sciences, Division of Pathology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Maria Dahlin
- Department of Neuropediatrics, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden.,Women and Children's Health, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden
| | - Torbjörn Backman
- Department of Clinical Sciences, Pediatric Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Valeria Perez de Sa
- Department of Clinical Sciences, Pediatric Anesthesiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Phan-Kiet Tran
- Department of Clinical Sciences, Pediatric Cardiac Surgery, Lund University and Skåne University Hospital, Lund, Sweden
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17
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Di Napoli C, Gennaro A, Lupica C, Falsaperla R, Leonardi R, Garozzo MT, Polizzi A, Praticò AD, Zanghì A, Ruggieri M. TSC1 and TSC2: Tuberous Sclerosis Complex and Its Related Epilepsy Phenotype. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1727142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractTuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by a multisystemic involvement. In TSC, reduced function of TSC1 and TSC2 genes products (hamartin and tuberin, respectively) leads to an hyperactivation of the mechanistic target of rapamycin (mTOR) pathway and to a consequent cell growth dysregulation. In TSC patients, neurological and neuropsychiatric manifestations, especially epilepsy and neuropsychiatric comorbidities such as autism or intellectual disability, represent the most disabling features. In particular, epilepsy occurrs up to 80% of patients, is often drug resistant and is frequently associated with neurological impairment. Due to the burden of this morbidity, different treatment strategies have been proposed with the purpose to make patients epilepsy free, such as the use of different antiepileptic drugs like vigabatrin, carbamazepine, valproic acid, and levetiracetam. More recently, a mTOR inhibitor (i.e. everolimus) has showed promising results in terms of seizures reduction.
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Affiliation(s)
- Claudia Di Napoli
- Postgraduate Training Program in Genetics, Department of Biomedical and Biotechnological Sciences, Section of Genetics, University of Catania, Catania, Italy
| | - Alessia Gennaro
- Postgraduate Training Program in Genetics, Department of Biomedical and Biotechnological Sciences, Section of Genetics, University of Catania, Catania, Italy
| | - Carmelania Lupica
- Postgraduate Training Program in Genetics, Department of Biomedical and Biotechnological Sciences, Section of Genetics, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
- Unit of Neonatal Intenstive Care and Neonatology, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Roberta Leonardi
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, Catania, Italy
| | - Maria Teresa Garozzo
- Unit of Pediatrics and Pediatric Emergency, Hospital “Cannizzaro,” Catania, Italy
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Andrea D. Praticò
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, Catania, Italy
| | - Antonio Zanghì
- Department of General Surgery and Medical-Surgical Specialty, University of Catania, Catania, Italy
| | - Martino Ruggieri
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
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Pérez S, Mulero-Soto P, Schoene A, Pereira G, Santini-Domínguez R, Martínez-Trabal J. Simultaneous rupture of two renal artery aneurysms in a patient with tuberous sclerosis complex. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:364-367. [PMID: 34136727 PMCID: PMC8176208 DOI: 10.1016/j.jvscit.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/21/2021] [Indexed: 12/01/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem neurocutaneous genetic condition. It is characterized by TSC-associated neuropsychiatric disorders, epilepsy, tumors, and angiomyolipoma in multiple organs, such as the skin, lungs, and kidneys. TSC is also associated with the development of aneurysms of the medium and large arteries, including the renal arteries. This condition will usually be diagnosed early in life, and active surveillance is required of tumor and aneurysm growth to prevent life-threatening events. We have presented the case of a 41-year-old patient with TSC that had not been previously diagnosed. The patient had presented with retroperitoneal hematoma secondary to the rupture of two left renal artery branch aneurysms that had likely developed within the angiomyolipoma.
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Affiliation(s)
- Sheila Pérez
- Division of Vascular Surgery, General Surgery Resident, Ponce Health Sciences University, St. Lukes Medical Center, Ponce, Puerto Rico
| | - Patricia Mulero-Soto
- Division of Vascular Surgery, General Surgery Resident, Ponce Health Sciences University, St. Lukes Medical Center, Ponce, Puerto Rico
| | - Alexandra Schoene
- Division of Vascular Surgery, General Surgery Resident, Ponce Health Sciences University, St. Lukes Medical Center, Ponce, Puerto Rico
| | - Gabriel Pereira
- Division of Vascular Surgery, General Surgery Resident, Ponce Health Sciences University, St. Lukes Medical Center, Ponce, Puerto Rico
| | - Rafael Santini-Domínguez
- Division of Vascular Surgery, General Surgery Resident, Ponce Health Sciences University, St. Lukes Medical Center, Ponce, Puerto Rico
| | - Jorge Martínez-Trabal
- Division of Vascular Surgery, General Surgery Resident, Ponce Health Sciences University, St. Lukes Medical Center, Ponce, Puerto Rico
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Key P, Qiryaqoz Z, Prahlow J, Fisher-Hubbard A. Tuberous Sclerosis Complex Diagnosed After Fatal Aortic Dissection. Am J Forensic Med Pathol 2021; 42:e1-e4. [PMID: 33074837 DOI: 10.1097/paf.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Phillip Key
- From the Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
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20
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Tanga CF, Fakhoury E, Ham PB, Dosluoglu HH, Harris LM. Ruptured abdominal aortic aneurysm in an 11-year-old with multiple peripheral artery aneurysms. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:539-542. [PMID: 33134637 PMCID: PMC7588751 DOI: 10.1016/j.jvscit.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Pediatric abdominal aortic aneurysms (AAAs) are rarely encountered in clinical practice. The combination of a pediatric AAA in a patient with multiple peripheral artery aneurysms is even more rare. We report the management of an 11-year-old boy who presented with a ruptured AAA who also had multiple peripheral arterial aneurysms. Infectious, genetic, and inflammatory workup was negative, classifying this aneurysm as congenital.
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Affiliation(s)
| | - Elias Fakhoury
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
| | - P Benson Ham
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
| | | | - Linda M Harris
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
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21
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Zöllner JP, Franz DN, Hertzberg C, Nabbout R, Rosenow F, Sauter M, Schubert-Bast S, Wiemer-Kruel A, Strzelczyk A. A systematic review on the burden of illness in individuals with tuberous sclerosis complex (TSC). Orphanet J Rare Dis 2020; 15:23. [PMID: 31964424 PMCID: PMC6975094 DOI: 10.1186/s13023-019-1258-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/19/2019] [Indexed: 01/10/2023] Open
Abstract
Objective This review will summarize current knowledge on the burden of illness (BOI) in tuberous sclerosis complex (TSC), a multisystem genetic disorder manifesting with hamartomas throughout the body, including mainly the kidneys, brain, skin, eyes, heart, and lungs. Methods We performed a systematic analysis of the available literature on BOI in TSC according to the PRISMA guidelines. All studies irrespective of participant age that reported on individual and societal measures of disease burden (e.g. health care resource use, costs, quality of life) were included. Results We identified 33 studies reporting BOI in TSC patients. Most studies (21) reported health care resource use, while 14 studies reported quality of life and 10 studies mentioned costs associated with TSC. Only eight research papers reported caregiver BOI. Substantial BOI occurs from most manifestations of the disorder, particularly from pharmacoresistant epilepsy, neuropsychiatric, renal and skin manifestations. While less frequent, pulmonary complications also lead to a high individual BOI. The range for the mean annual direct costs varied widely between 424 and 98,008 International Dollar purchasing power parities (PPP-$). Brain surgery, end-stage renal disease with dialysis, and pulmonary complications all incur particularly high costs. There is a dearth of information regarding indirect costs in TSC. Mortality overall is increased compared to general population; and most TSC related deaths occur as a result of complications from seizures as well as renal complications. Long term studies report mortality between 4.8 and 8.3% for a follow-up of 8 to 17.4 years. Conclusions TSC patients and their caregivers have a high burden of illness, and TSC patients incur high costs in health care systems. At the same time, the provision of inadequate treatment that does not adhere to published guidelines is common and centralized TSC care is received by no more than half of individuals who need it, especially adults. Further studies focusing on the cost effectiveness and BOI outcomes of coordinated TSC care as well as of new treatment options such as mTOR inhibitors are necessary.
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Affiliation(s)
- Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - David Neal Franz
- Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christoph Hertzberg
- Zentrum für Sozialpädiatrie & Neuropädiatrie (DBZ), Vivantes Klinikum Neukölln, Berlin, Germany
| | - Rima Nabbout
- Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University, Imagine Institute UMR1136, Paris, France
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany. .,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany. .,Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany. .,Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.
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Sheu TC, Holt D, Moole V, Barth D, Nolte R, Swischuk J. Renal artery bypass including aortic graft for renovascular hypertension. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Chérrez-Ojeda I, Espinoza-Plaza J, Cottin V, Chérrez S. A Rare Case of an Abdominal Aneurysm in a Patient with Lymphangioleiomyomatosis: A Case Report. Perm J 2019; 23:18-170. [PMID: 30939284 DOI: 10.7812/tpp/18-170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Lymphangioleiomyomatosis (LAM) is a multisystemic disorder characterized by the proliferation, metastasis, and infiltration of smooth muscle cells in the lung and other tissues. Although LAM is rarely seen in men, it is usually detected in women during the third decade of life. Renal microaneurysms have been reported in patients with LAM, but abdominal aneurysms have not. We describe a patient with a diagnosis of LAM who had an unusual aneurysm in the inferior pancreaticoduodenal artery. CASE PRESENTATION A 47-year-old Ecuadorian woman self-referred for a routine visit to her family physician. She had a history of allergy to nonsteroidal anti-inflammatory drugs, pneumothorax, bilateral pleurodesis, and LAM since 2007. For her annual follow-up, an ultrasonogram was recommended. The abdominal ultrasonographic report described "a mass with blood flow in the midabdomen." An abdominal computed tomography angiogram was performed and revealed a 2.6-cm aneurysm of the inferior pancreaticoduodenal artery. After diagnosis of arterial aneurysm, she underwent transcatheter arterial embolization and stent placement. She is currently healthy and carries out her activities normally. DISCUSSION Lymphangioleiomyomatosis is a rare lung disease of unknown etiology. Extrapulmonary manifestations include abdominal aneurysm. This type of lesion should be added to a search for aneurysms in all patients with LAM.
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Affiliation(s)
- Iván Chérrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Guayas, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - José Espinoza-Plaza
- Universidad Espíritu Santo, Samborondón, Guayas, Ecuador.,Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Vincent Cottin
- Department of Pulmonology, University Hospital, Hôpital Louis Pradel, Lyon, France
| | - Sofía Chérrez
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.,School of Medicine, University of Heidelberg, Heidelberg, Germany
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24
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Geiger MA, Cantador AA, Guillaumon AT. Thoracic aortic aneurysm in a patient with tuberous sclerosis. J Vasc Bras 2019; 18:e20160017. [PMID: 31320876 PMCID: PMC6634939 DOI: 10.1590/1677-5449.160017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tuberous sclerosis is a genetic disease with autosomal dominant transmission. Its classic presentation comprises epilepsy, mental deficiencies, and sebaceous adenomas. Aneurysms of the aorta can be detected in people with tuberous sclerosis ranging from children a few months old to young adults. We report the case of a young patient diagnosed with a saccular thoracic aortic aneurysm and tuberous sclerosis who was successfully treated using an endovascular approach.
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Affiliation(s)
- Martin Andreas Geiger
- Universidade Estadual de Campinas - UNICAMP, Departamento de Cirurgia, Disciplina de Moléstias Vasculares, Campinas, SP, Brasil
| | - Alex Aparecido Cantador
- Universidade Estadual de Campinas - UNICAMP, Departamento de Cirurgia, Disciplina de Moléstias Vasculares, Campinas, SP, Brasil
| | - Ana Terezinha Guillaumon
- Universidade Estadual de Campinas - UNICAMP, Departamento de Cirurgia, Disciplina de Moléstias Vasculares, Campinas, SP, Brasil
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25
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Volpi A, Sala G, Lesma E, Labriola F, Righetti M, Alfano RM, Cozzolino M. Tuberous sclerosis complex: new insights into clinical and therapeutic approach. J Nephrol 2018; 32:355-363. [PMID: 30406604 DOI: 10.1007/s40620-018-0547-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
Abstract
Tuberous sclerosis complex (TSC) is a complex disease with many different clinical manifestations. Despite the common opinion that TSC is a rare condition, with a mean incidence of 1/6000 live births and a prevalence of 1/20,000, it is increasingly evident that in reality this is not true. Its clinical sequelae span a range of multiple organ systems, in particular the central nervous system, kidneys, skin and lungs. The management of TSC patients is heavily burdensome in terms of time and healthcare costs both for the families and for the healthcare system. Management options include conservative approaches, surgery, pharmacotherapy with mammalian target of rapamycin inhibitors and recently proposed options such as therapy with anti-EGFR antibody and ultrasound-guided percutaneous microwaves. So far, however, no systematically accepted strategy has been found that is both clinically and economically efficient. Thus, decisions are tailored to patients' characteristics, resource availability and clinical and technical expertise of each single center. This paper reviews the pathophysiology and the clinical (diagnostic-therapeutic) management of TSC.
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Affiliation(s)
- Angela Volpi
- Laboratory of Experimental Nephrology, Renal Division, Dipartimento di Scienze della Salute, San Paolo Hospital, Università di Milano, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Gabriele Sala
- Laboratory of Experimental Nephrology, Renal Division, Dipartimento di Scienze della Salute, San Paolo Hospital, Università di Milano, Via A. di Rudinì, 8, 20142, Milan, Italy
| | - Elena Lesma
- Clinical Pharmacology Unit, San Paolo Hospital, Milan, Italy
| | | | | | | | - Mario Cozzolino
- Laboratory of Experimental Nephrology, Renal Division, Dipartimento di Scienze della Salute, San Paolo Hospital, Università di Milano, Via A. di Rudinì, 8, 20142, Milan, Italy.
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26
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Morin CE, Morin NP, Franz DN, Krueger DA, Trout AT, Towbin AJ. Thoracoabdominal imaging of tuberous sclerosis. Pediatr Radiol 2018; 48:1307-1323. [PMID: 30078036 DOI: 10.1007/s00247-018-4123-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/02/2018] [Accepted: 03/19/2018] [Indexed: 12/19/2022]
Abstract
Imaging of tuberous sclerosis complex has rapidly evolved over the last decade in association with increased understanding of the disease process and new treatment modalities. Tuberous sclerosis complex is best known for the neurological symptoms and the associated neuroimaging findings, and children with tuberous sclerosis complex require active surveillance of associated abnormalities in the chest, abdomen and pelvis. Common findings that require regular imaging surveillance are angiomyolipomas in the kidneys and lymphangioleiomyomatosis in the chest. However multiple rarer associations have been attributed to tuberous sclerosis complex and should be considered by radiologists reviewing any imaging in these children. In this review the authors discuss the spectrum of imaging findings in people with tuberous sclerosis complex, focusing on MR imaging findings in the chest, abdomen and pelvis.
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Affiliation(s)
- Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
| | - Nicholas P Morin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David N Franz
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Darcy A Krueger
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
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27
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Dillman JR, Trout AT, Smith EA, Towbin AJ. Hereditary Renal Cystic Disorders: Imaging of the Kidneys and Beyond. Radiographics 2017; 37:924-946. [PMID: 28493804 DOI: 10.1148/rg.2017160148] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this article is to review the hereditary renal cystic diseases that can manifest in children and adults, with specific attention to pathogenesis and imaging features. Various common and uncommon hereditary renal cystic diseases are reviewed in terms of their underlying etiology, including the involved genetic mutations and the affected proteins and cellular structures. Focus is placed on the morphologic findings in each condition and the features that distinguish one disorder from another. The two most common categories of hereditary renal cystic disease are (a) the ciliopathic disorders, which are related to mutations affecting the primary cilia (called "ciliopathies"), and (b) the phakomatoses. Autosomal dominant polycystic kidney disease, autosomal recessive polycystic kidney disease, and the "medullary cystic disease complex" are all ciliopathies but have different phenotypes. Tuberous sclerosis complex and the associated "contiguous gene syndrome," as well as von Hippel-Lindau syndrome, are phakomatoses that can manifest with cystic renal lesions but have uniquely different extrarenal manifestations. Finally, DICER1 mutations can manifest with renal cystic lesions (typically, cystic nephromas) in patients predisposed to other malignancies in the chest, ovaries, and thyroid. Although some overlap exists in the appearance of the renal cysts associated with each of these diseases, there are clear morphologic differences (eg, cyst size, location, and complexity) that are emphasized in this review. To improve patient outcomes, it is important for the radiologist to recognize the various hereditary renal cystic diseases so that a correct diagnosis is assigned and so that the patient is adequately evaluated and followed up. ©RSNA, 2017.
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Affiliation(s)
- Jonathan R Dillman
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Andrew T Trout
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Ethan A Smith
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
| | - Alexander J Towbin
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 (J.R.D., A.T.T., A.J.T.); and the Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.S.)
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Eliason JL, Coleman DM, Criado E, Stanley JC. Surgical treatment of abdominal aortic aneurysms in infancy and early childhood. J Vasc Surg 2016; 64:1252-1261. [DOI: 10.1016/j.jvs.2016.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
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Dueppers P, Duran M, Grabitz K, Schelzig H. Open Repair for Abdominal Aortic Aneurysm in a Young Boy with Tuberous Sclerosis and Review of the Literature. Ann Vasc Surg 2016; 39:286.e1-286.e5. [PMID: 27666806 DOI: 10.1016/j.avsg.2016.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/11/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) are very rare in pediatric patients and can rarely be associated with tuberous sclerosis (TS). Open surgery is the first-line therapy. We report our experience added by a review on current literature. CASE REPORT A 9-year-old boy with TS and history of 2 earlier open repairs for AAA presented to our department with a recurrent juxtarenal aortic aneurysm. We performed a polytetraflourethylene patch plasty. Postoperative course was uneventful. After 8 months, reconstruction was stable, and no recurrent aneurysm developed. CONCLUSIONS Recurrent aneurysms may develop after open surgery for TS-associated AAA. However, open surgery is the recommended therapy but requires special techniques and experience in pediatric patients.
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Affiliation(s)
- Philip Dueppers
- Department of Vascular and Endovascular Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Mansur Duran
- Department of Vascular and Endovascular Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Klaus Grabitz
- Department of Vascular and Endovascular Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany.
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Jenkins D, McCuaig C, Drolet BA, Siegel D, Adams S, Lawson JA, Wargon O. Tuberous Sclerosis Complex Associated with Vascular Anomalies or Overgrowth. Pediatr Dermatol 2016; 33:536-42. [PMID: 27470532 DOI: 10.1111/pde.12946] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dysregulation of the mammalian target of rapamycin pathway is the underlying pathogenic mechanism in tuberous sclerosis complex (TSC). Other syndromes caused by genetic alterations in this pathway frequently manifest as vascular anomalies or asymmetric overgrowth. Rarely, these features have been documented in TSC. OBJECTIVE To collate cases of TSC with vascular anomaly or overgrowth that have been published and to assemble additional recent cases, as this finding has been underreported. METHODS TSC cases from three pediatric dermatology referral centers on two continents were reviewed to identify individuals noted to have hemihypertrophy or vascular anomalies. RESULTS We report five additional cases of TSC associated with vascular anomalies or overgrowth that contribute to our understanding of some of the pathways and treatments involved in vascular anomalies. CONCLUSION Hemihypertrophy and vascular anomalies may be more frequent in the setting of TSC than previously appreciated. A common pathogenetic mechanism may tie these manifestations together.
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Affiliation(s)
- David Jenkins
- Dermatology Department, John Hunter Hospital, New Lambton, New South Wales, Australia.
| | - Catherine McCuaig
- Department of Pediatric Dermatology, Dermatology Service, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dawn Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Adams
- Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - John A Lawson
- Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Orli Wargon
- Sydney Children's Hospital, Randwick, New South Wales, Australia.,University of New South Wales, Randwick, New South Wales, Australia
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Vascular, Gastrointestinal, and Urogenital Associations of Tuberous Sclerosis: Classic but Less Known. AJR Am J Roentgenol 2015; 205:W566. [DOI: 10.2214/ajr.15.15016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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32
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Successful Operation for Thoracoabdominal Aortic Aneurysm in a 5-Year-Old Boy With Tuberous Sclerosis. Ann Thorac Surg 2015; 100:e119-20. [DOI: 10.1016/j.athoracsur.2015.07.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 06/22/2015] [Accepted: 07/09/2015] [Indexed: 11/23/2022]
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Abstract
Tuberous sclerosis complex is an autosomal dominant disorder with variable affection of the central nervous system (CNS) and many other organ systems. Radiological features include various lesions of the brain as well as lesions of the lungs, kidneys and the heart. Imaging is important for the early detection of complications. This article provides an overview of the clinical features and therapy as well as the specific imaging of tuberous sclerosis complex.
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Affiliation(s)
- U Yilmaz
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg/Saar, Deutschland,
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Ma A, Wang L, Gao Y, Chang Z, Peng H, Zeng N, Gui YS, Tian X, Li X, Cai B, Zhang H, Xu KF. Tsc1 deficiency-mediated mTOR hyperactivation in vascular endothelial cells causes angiogenesis defects and embryonic lethality. Hum Mol Genet 2013; 23:693-705. [PMID: 24129405 DOI: 10.1093/hmg/ddt456] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This is a study on the role of tuberous sclerosis complex1 (TSC1) mutation and mTOR activation in endothelial cells during angiogenic and embryonic development. Past studies had shown that Tsc1/Tsc2 mutant genes lead to overactivation of mTOR in the regulating pathways in developing fetus. We used conditional Cre-loxp gene knockout approach to delete Tsc1 in mice's endothelial cells in our experimental models. Similarly, activation of mTOR signaling in endothelial cells of these embryos (Tie2-Cre/Tsc1(-/-)) was found. Majority of Tie2-Cre/Tsc1(-/-) embryos died at embryonic day 14.5 in utero. Cardiovascular defects, subcutaneous edema and hemorrhage were present among them. Whole-mount immunostaining in these embryos revealed a disorganized vascular network, defective sprouting of vessels in yolk sac and thickening of the labyrinth layer in the placenta. A thinner ventricular wall with disorganized trabeculae was present in the hearts of Tie2-Cre/Tsc1(-/-) embryos. Endothelial cells in Tsc1-deficient mice showed defective mitochondrial and endoplasmic reticular morphology, but no significant change was observed in cell junctions. The mutant embryos displayed significantly reduced cell proliferation, increased apoptosis and disturbed expression of angiogenic factors. A cohort of mice was treated prenatally with mTOR inhibitor rapamycin. The offspring of these mutant mice survived up to 22 days after birth. It was concluded that physiological TSC1-mTOR signaling in endothelial cells is crucial for vascular development and embryogenesis. We postulated that disruption of normal angiogenic pathways through hyperactive mTOR signaling maybe the mechanism that lead to deranged vascular pathogenesis in the tuberous sclerosis complex.
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Affiliation(s)
- Aiping Ma
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Bhavsar AS, Verma S, Lamba R, Lall CG, Koenigsknecht V, Rajesh A. Abdominal manifestations of neurologic disorders. Radiographics 2013; 33:135-53. [PMID: 23322834 DOI: 10.1148/rg.331125097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A variety of disorders-including infectious, inflammatory, hereditary, and metabolic diseases-may affect both the brain and abdominal cavity, and the findings in one region may help establish the diagnosis or limit the differential diagnosis. Establishing an accurate early diagnosis enables clinicians to adequately manage these unusual diseases and potentially avert life-threatening complications. For example, an early diagnosis of Gardner syndrome enables annual sigmoid- or colonoscopy and ultrasonography. In many conditions, abdominal manifestations precede neurologic manifestations and may have prognostic significance. Patients with celiac disease more often present with abdominal manifestations such as duodenitis, slow transit time, reversal of the jejunal-ileal fold pattern, and transient small bowel intussusception than with intracranial manifestations. In other conditions, the neurologic manifestations may be the same as the presenting symptoms. For example, patients with Gardner syndrome may initially present with multiple mandibular or sinonasal osteomas. In addition, sarcoidosis may manifest with multifocal enhancing dural masses. Abdominal and neurologic manifestations may even occur simultaneously, as in several of the phakomatoses such as neurofibromatosis type 1, tuberous sclerosis complex, and von Hippel-Lindau syndrome. Ultimately, familiarity with the appearances of these conditions allows radiologists to pinpoint a diagnosis, even when imaging findings in either location are nonspecific.
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Affiliation(s)
- Anil S Bhavsar
- Department of Radiology, University of Cincinnati Hospitals, 234 Goodman St, ML 0761, PO Box 670761, Cincinnati, OH 45267-0761, USA.
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36
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Lynch D, Hughes R. Aortic Dissection in the Young: A Case Report and Review of the Differential Diagnostic Considerations. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aortic dissection is a rare cause of death in young adults, which may be caused by acquired or congenital factors. We present the case of a 21-year-old man who died as a result of spontaneous aortic dissection and cardiac tamponade. At autopsy, signs of Marfan syndrome were evident both grossly and microscopically. Hodgkin lymphoma was also discovered, though was noncontributory to death. We review the causes of aortic dissection in young individuals, with a focus on the key differentiating features of predisposing inheritable connective tissue disorders. Given the implications for surviving family members, it is the obligation of the diligent forensic pathologist to be aware of these conditions, such that families may be alerted to the need for genetic counseling.
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Affiliation(s)
- David Lynch
- San Antonio Uniformed Services Health Education Consortium - Department of Pathology, Lackland AFB, TX
| | - Rhome Hughes
- Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX
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Bailey MA, Rashid ST, Bridge KI, Griffin KJ, Brown E, Guerrero RR, Patel JV, Scott DJA. Images in vascular medicine. Large thoraco-abdominal aneurysm in a 3-year-old boy with tuberous sclerosis. Vasc Med 2013; 18:147-8. [PMID: 23411746 DOI: 10.1177/1358863x13475690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc A Bailey
- Yorkshire Regional Paediatric Vascular Centre, The Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, UK
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Dunet V, Qanadli SD, Lazor R, Beigelman-Aubry C. Multiple pulmonary artery aneurysms in tuberous sclerosis complex. BMJ Case Rep 2013; 2013:bcr-2012-007911. [PMID: 23341583 DOI: 10.1136/bcr-2012-007911] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare genetic disorder characterised by multiple hamartomas, caused by inactivating mutations of the TSC1/TSC2 tumour suppressor genes. Classical pulmonary involvement in tuberous sclerosis complex (TSC) consists of lymphangioleiomyomatosis and/or multiple micronodular pneumocyte hyperplasia (MMPH). Association of TSC with pulmonary artery aneurysm (PAA) has been only exceptionally described. We report here the first case of TSC with multiple PAA in combination with MMPH, cardiac rhabdomyomas and bone, skin and brain involvement.
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Affiliation(s)
- Vincent Dunet
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland.
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Yi JL, Galgano MA, Tovar-Spinoza Z, Deshaies EM. Coil embolization of an intracranial aneurysm in an infant with tuberous sclerosis complex: A case report and literature review. Surg Neurol Int 2012; 3:129. [PMID: 23227434 PMCID: PMC3513845 DOI: 10.4103/2152-7806.102944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/24/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Tuberous sclerosis (TS) is a multiorgan neurocutaneous syndrome. Vascular manifestations are often extracranial. There is a paucity of cases involving TS combined with intracranial aneurysms reported in the literature. As a result, treatment has not been well described. CASE DESCRIPTION We report the case of a 13-month-old female infant with a prior diagnosis of TS that was found to have new onset of left eye ptosis, anisocoria, and papillary mydriasis indicative of left third cranial nerve palsy. A magnetic resonance angiogram (MRA) of the brain revealed a left internal carotid artery (ICA) aneurysm. Endovascular embolization was determined to be the best option for treatment. After a successful balloon test occlusion with neuromonitoring, the left internal carotid artery was sacrificed via coil embolization. CONCLUSIONS This is only the third case report of endovascular coil embolization of an intracranial aneurysm in an infant with TS. We report no complications during the procedure, and the patient was discharged with resolving left third cranial nerve palsy. Neither surgical nor endovascular outcomes have been well described in the literature. Follow-up on this patient will be useful for establishing protocols of treatment.
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Affiliation(s)
- Juneyoung L Yi
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
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Harless CA, Power AH, Burkhart HM, Gloviczki P. Mycotic abdominal aortic and iliac aneurysms in a 4-month-old treated with a cryopreserved homograft. J Vasc Surg 2012; 56:1427-8. [PMID: 23083667 DOI: 10.1016/j.jvs.2012.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 05/10/2012] [Accepted: 05/16/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Christin A Harless
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn, USA
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41
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Ye C, Yin H, Lin Y, Zhou L, Ye R, Li X, Han A, Wang S. Abdominal Aorta Aneurysms in Children: Single-Center Experience of Six Patients. Ann Thorac Surg 2012; 93:201-5. [DOI: 10.1016/j.athoracsur.2011.08.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 08/09/2011] [Accepted: 08/15/2011] [Indexed: 11/29/2022]
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Shelton JB, Ramakrishnaiah R, Glasier CM, Phillips PH. Cavernous sinus syndrome from an internal carotid artery aneurysm in an infant with tuberous sclerosis. J AAPOS 2011; 15:389-91. [PMID: 21816642 DOI: 10.1016/j.jaapos.2011.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/25/2011] [Accepted: 03/26/2011] [Indexed: 12/01/2022]
Abstract
Aneurysms are associated with tuberous sclerosis complex. We describe the first case of cavernous sinus syndrome from an intracavernous internal carotid artery aneurysm in a 9-month-old boy with tuberous sclerosis. The presence of an intracranial aneurysm should be considered in the differential diagnosis of children with tuberous sclerosis who develop cranial nerve deficits.
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Affiliation(s)
- Julie B Shelton
- Department of Ophthalmology/Visual Sciences, University of Utah, Salt Lake City, Utah, USA
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Denne C, Gerstl EM, Mayer K, Steinborn M, Hahn H, Burdach S. Présentation inhabituelle de la sclérose tubéreuse de Bourneville de chez un nourrisson : à propos d’un cas. Arch Pediatr 2011; 18:660-4. [DOI: 10.1016/j.arcped.2011.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 09/14/2010] [Accepted: 03/21/2011] [Indexed: 11/16/2022]
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Ajlan AM, Bilawich AM, Müller NL. Thoracic computed tomographic manifestations of tuberous sclerosis in adults. Can Assoc Radiol J 2010; 63:61-8. [PMID: 20696546 DOI: 10.1016/j.carj.2010.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 07/01/2010] [Accepted: 07/05/2010] [Indexed: 11/26/2022] Open
Abstract
The purpose of this article is to illustrate the various manifestations that can be encountered on thoracic computed tomography of tuberous sclerosis in adults. The pulmonary findings include lymphangioleiomyomatosis and multifocal micronodular pneumocyte hyperplasia. The extrapulmonary manifestations are divided into cardiac, vascular, mediastinal, osseous, and upper abdominal findings.
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Affiliation(s)
- Amr M Ajlan
- Department of Radiology, Vancouver General Hospital, University of British Columbia, British Columbia, Canada.
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45
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Salerno AE, Marsenic O, Meyers KEC, Kaplan BS, Hellinger JC. Vascular involvement in tuberous sclerosis. Pediatr Nephrol 2010; 25:1555-61. [PMID: 20229188 DOI: 10.1007/s00467-010-1466-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/18/2010] [Accepted: 01/18/2010] [Indexed: 12/01/2022]
Abstract
Vascular involvement in tuberous sclerosis (TS) is rare. Central and peripheral aneurysms and large and medium size arterial stenotic-occlusive disease have been reported in patients with TS. We present here three pediatric patients with TS and severe vascular abnormalities, followed by a review of the literature. The three cases include a 14-month-old girl with polycystic kidneys and cerebral tubers who had a large asymptomatic abdominal aortic aneurysm, a 2-year-old boy with multiple features of TS who had hypertension and was found to have mid-aortic syndrome with bilateral renal artery stenosis, and an 18-year-old girl with abdominal pain and TS features who had greater than 70% celiac artery stenosis. In all cases, noninvasive vascular imaging modalities were utilized for either initial diagnosis, surveillance, or both. These cases highlight the collaborative roles of the pediatric nephrologist and cardiovascular imager in the diagnosis and management of the vascular complications in TS patients. Appropriate care can only be made through a high index of suspicion.
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Affiliation(s)
- Ann E Salerno
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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46
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Cao J, Gong L, Guo DC, Mietzsch U, Kuang SQ, Kwartler CS, Safi H, Estrera A, Gambello MJ, Milewicz DM. Thoracic aortic disease in tuberous sclerosis complex: molecular pathogenesis and potential therapies in Tsc2+/- mice. Hum Mol Genet 2010; 19:1908-20. [PMID: 20159776 DOI: 10.1093/hmg/ddq066] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a genetic disorder with pleiotropic manifestations caused by heterozygous mutations in either TSC1 or TSC2. One of the less investigated complications of TSC is the formation of aneurysms of the descending aorta, which are characterized on pathologic examination by smooth muscle cell (SMC) proliferation in the aortic media. SMCs were explanted from Tsc2(+/-) mice to investigate the pathogenesis of aortic aneurysms caused by TSC2 mutations. Tsc2(+/-) SMCs demonstrated increased phosphorylation of mammalian target of rapamycin (mTOR), S6 and p70S6K and increased proliferation rates compared with wild-type (WT) SMCs. Tsc2(+/-) SMCs also had reduced expression of SMC contractile proteins compared with WT SMCs. An inhibitor of mTOR signaling, rapamycin, decreased SMC proliferation and increased contractile protein expression in the Tsc2(+/-) SMCs to levels similar to WT SMCs. Exposure to alpha-elastin fragments also decreased proliferation of Tsc2(+/-) SMCs and increased levels of p27(kip1), but failed to increase expression of contractile proteins. In response to artery injury using a carotid artery ligation model, Tsc2(+/-) mice significantly increased neointima formation compared with the control mice, and the neointima formation was inhibited by treatment with rapamycin. These results demonstrate that Tsc2 haploinsufficiency in SMCs increases proliferation and decreases contractile protein expression and suggest that the increased proliferative potential of the mutant cells may be suppressed in vivo by interaction with elastin. These findings provide insights into the molecular pathogenesis of aortic disease in TSC patients and identify a potential therapeutic target for treatment of this complication of the disease.
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Affiliation(s)
- Jiumei Cao
- Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA
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47
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Thoracoabdominal and coronary arterial aneurysms in a young man with a history of Kawasaki disease. J Vasc Surg 2009; 50:1173-6. [DOI: 10.1016/j.jvs.2009.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 05/14/2009] [Accepted: 05/14/2009] [Indexed: 11/19/2022]
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48
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Moos JM, Rowell S, Dawson DL. Symptomatic 7-cm abdominal aortic aneurysm in an otherwise healthy 31-year-old woman. Vasc Endovascular Surg 2009; 43:622-6. [PMID: 19640913 DOI: 10.1177/1538574409335920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abdominal aortic aneurysms are rare in young women. We report the case of a 31-year-old woman who underwent open surgical repair of a symptomatic 7-cm abdominal aortic aneurysm (AAA). The patient had no identifiable AAA risk factors. Laboratory and pathological analyses demonstrated a nonspecific inflammatory component.
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Affiliation(s)
- John M Moos
- Department of General Surgery, USC/LA County, Los Angeles, California, USA.
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49
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Malikov S, Delarue A, Fais PO, Keshelava G. Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn. J Vasc Surg 2009; 50:1181-4. [PMID: 19595534 DOI: 10.1016/j.jvs.2009.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
Abstract
Congenital (primary) neonatal abdominal aortic aneurysm (AAA) is an extremely rare truncular arterial abnormality among numerous congenital vascular malformations. Only seven cases have been reported as congenital origin in newborns. This report presents the case of a male infant in whom a 33-mm congenital AAA was diagnosed prenatally and was successfully treated 10 days after birth without exogenous graft material or aneurysmorrhaphy. Follow-up study at 39 months demonstrated excellent clinical, ultrasound scan, and computed tomography scan findings. Anatomic reconstruction with native vessels is the preferred surgical technique to ensure the child's potential for harmonious growth.
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Affiliation(s)
- Sergueï Malikov
- Department of Vascular Surgery, School of Medicine, Mediterranean University, La Timone Hospital, Marseille Cedex, France.
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50
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An Abdominal Aortic Aneurysm in an 8-Month-Old Girl with Tuberous Sclerosis. Eur J Vasc Endovasc Surg 2009; 37:569-71. [DOI: 10.1016/j.ejvs.2009.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 01/14/2009] [Indexed: 11/19/2022]
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