Unilateral lung hypoplasia: report of three cases

The authors describe a unique pulmangiographic picture taken 24 years after the first angiographic examination made on account of repeated haemoptysis associated with Rendu-Osler-Weber s disease. Angiography revealed enlargement of the aneurysm in the lungs and dilatation of the afferent and efferent vessel of the aneurysm. The only treatment of pulmonary arteriovenous fistulas is surgical.     

A patient with aortic dissection and abdominal aortic aneurysm with fistula

Aneurysm of the abdominal aorta is not uncommon in later life. The frequency of aneurysm rupture varies with aneurysm diameter. In rare cases, the aneurysm may rupture intra-abdominally into surrounding structures and give rise to a fistula. When blood vessels are involved, the commonest form is aortocaval fistula, the presenting symptoms being those of severe right-ventricular heart failure. Although thoracic aorta dissection may be made manifest in acute intense chest pain, it is asymptomatic in up to 50 per cent of cases. The article consists in a case report of asymptomatic thoracic aorta dissection occurring concomitantly with a ruptured abdominal aneurysm the symptoms of which were severe right ventricular heart failure due to an aortocaval fistula causing increased pressure, and severe bilateral oedema of the legs. If the rare complication of an aortocaval fistula could be detected earlier, it might be possible to prevent progression to refractory cardiac failure. The possibility of a fistula should be borne in mind if haematuria is present in a case of abdominal aneurysm or a pulsatile abdominal mass is present in conjunction with a murmur.     

Assessment of left ventricular contractile state by preload-adjusted maximal power using echocardiographic automated border detection

The unexpected rupture of an intracranial aneurysm is a potentially catastrophic event. Strategies to control intraoperative aneurysm hemorrhage are based on sound surgical principles and take into consideration such variables as the timing, location, and severity of the rupture. Proven, successful techniques to prevent or control complications during aneurysm surgery are discussed in this article.     

Non-surgical treatment of abdominal aortic aneurysms

Percutaneous placement of an endovascular stent, with and without coils, in the treatment of large AAA in animal models is feasible, safe and effective. The covered stent sealed off AAA immediately after stent placement, however, it interrupted blood flow into arteries in the area covered by the stent. The uncovered stent prevented further expansion of the aneurysm and also significantly decreased the incidence of rupture. The long-term patency of branch arteries by the uncovered stent supported the possibility of safely using this approach in humans. Furthermore, either covered stent or uncovered stent with additional coils have the potential for treatment of acute aneurysm rupture or leaking. Most importantly, the aneurysm lumen in our model was gradually replaced by collagen after stent placement which further reduces the risk of aneurysm rupture: and this healing process was enhanced by the addition of coils. If proven safe and effective for humans as well, this technique has the potential for substantially reducing the morbidity and mortality associated with AAA.     

Haemoptysis associated with pulmonary varices: demonstration using computed tomographic angiography

A 67 yr old female with mitral stenosis presented with an acute haemoptysis caused by the rupture of pulmonary varices. Chest radiography and bronchoscopy showed nonspecific abnormalities. The diagnosis of this rare but potentially lethal complication was made using computed tomographic angiography with three-dimensional volume rendering.     

Surgery of abdominal aortic aneurysm and concomitant disease of the digestive tract

The incidence of intra-abdominal diseases associated with abdominal aortic aneurysm is increasing, and it is difficult to decide whether to operate the abdominal disease first, the aneurysm first or both simultaneously. Variables used in decision analysis include type, stage and life expectancy of the cancer, rupture rate of abdominal aortic aneurysm. Symptomatic lesion should be treated first. Absolute indication for operation initially on the aneurysm is the presence of symptoms of rupture. Aortic abdominal aneurysmectomy combined with surgical removal of an intestinal disease may present severe risks as infection of the graft and anastomotic leakage, especially during lower abdominal surgery. In this paper authors present four cases of AAA which had intra-abdominal surgical disease. They were treated by one-stage operation with no complications. Criteria to assess timing of surgical treatment of abdominal surgical diseases concomitant to AAA are discussed.     

Intrapleural fibrinolysis associated with lavage drainage in the management of encysted infectious pleurisy

This is a case report of a 4-year-old child presenting with a false aneurysm of a common digital artery. Failure to diagnose it led to incorrect treatment which was followed by rupture of the aneurysm and life-threatening haemorrhage.     

Words hard to say and hard to hear: "May I give you some feedback?"

Long-term favourable effects of a treatment with both cyclosporin A and coumarin in a 35 year old Caucasian female patient with Beh?et's disease, presenting with haemoptysis caused by pulmonary thromboemboli and a single major pulmonary artery aneurysm, are reported. All disease activity and complications were well controlled during 9 years of follow-up.     

Efficacy and safety of a hemostatic puncture closure device with early ambulation after coronary angiography. Angio-Seal Investigators

Two previously healthy patients were admitted for chest pain, haemoptysis and dyspnoea. Perfusion-ventilation lung scanning demonstrated pulmonary embolism. Lower extremity duplex imaging and contrast venography revealed a thrombosed popliteal vein aneurysm as the source of emboli. After immediate anticoagulant therapy, the thrombo-embolic source was excluded by aneurysmectomy with lateral venography in the first patient. The second patient was treated by anticoagulants and percutaneous vena cava inferior filter placement to prevent recurrent pulmonary embolism. Anatomopathological findings, possible origin, diagnostic modalities and medical and surgical treatment of popliteal vein aneurysm are discussed.     

Monitoring complication due to a pulsatile femoral vein from tricuspid regurgitation

A case of fatal hemorrhage caused by rupture of the external iliac artery aneurysm into the urinary bladder is presented. The patient, a 58-year-old Japanese female, had undergone total hysterectomy, and post-operative therapeutic radiation, for uterine cancer in 1974. A vesicocecal fistula was observed, and surgical intervention for closure was performed in May, 1992. On July, 13, 1992, she presented with pulsating hemorrhage from the urinary bladder. Angiography was consistent with rupture into the bladder of an iliac artery aneurysm. Surgical intervention for closure of the aneurysm was performed but the aneurysm could not be resected. She had relapse of the fistula which became infected with methicillin-resistant Staphylococcus aureus (MR-SA), and died 3 months postoperatively. To the best of our knowledge, there have been only 3 cases in which an iliac artery aneurysm ruptured directly into the urinary bladder. This case indicates that resection of the aneurysm for therapy is a vital requirement.     

Congenital left ventricular apical aneurysm

An aneurysm of the left ventricular apex was accidently discovered on chest X-ray in an otherwise healthy 3 1/2-year-old-girl. Pre-operatively performed heart catheterization and ciné-angiography were followed by successful surgical removal of the aneurysm. Microscopic examination showed that the three layers of the myocardium were present, although it was degenerated by fibrosis. This case belongs to the fibrous type of aneurysm, which is the most rare type, not associated with other developmental defects, usually asymptomatic until there is rupture and sudden death, or the condition is accidentally discovered on chest X-ray and treated surgically.     

Surgical treatment of coronary artery aneurysm with rupture into the right atrium

Considering the increasing number of patients with chest pain who undergo routine coronary artery arteriography, coronary artery aneurysm may be found more frequently. To know how to manage these aneurysms, we must understand their possible complications. The aneurysms can produce symptoms of angina or acute myocardial infarction by total thrombosis of the aneurysm and vessel, embolism to the distal vessel, or progressive enlargement and encroachment upon the distal vessel until it is occluded. Moreover, the aneurysm may enlarge and rupture into the free pericardium or produce a fistula by eroding into a chamber of the heart. The case described herein may represent the first reported case of a coronary artery aneurysm eroding into a cardiac chamber and causing an arteriovenous fistula. The treatment of choice is resection of the aneurysm, closure of the fistula, and re-establishment of continuity of the distal coronary artery with a saphenous vein bypass graft.     

Arterial aneurysms in geriatric age

After reviewing the literature on the subject, the authors examine all the cases of aortic aneurysm referred to their attention. From the tests performed, they note that males are most often affected and the age group with the highest incidence is the seventh decade of life, in particular between 60-66 years old. After having observed a pulsing abdominal mass leading to a suspected diagnosis, the radiological methods recommended by the authors include echotomography or CT, or if required, magnetic resonance. Arteriography is less convincing than the previous tests for diagnostic purposes because, as well as providing a false image of the vessel lumen (owing to the overlay of stratified thrombi it can show a virtually normal lumen), it may cause a risk of embolism. The surgeon therefore prefers an intraoperative finding in the case of subrenal aneurysm. In conclusion, faced with a diagnosis of aneurysm of the abdominal aorta, in the majority of cases, having prepared the patient, it is necessary to perform aorto-bisiliac or bifemoral graft surgery depending on aneurysm size as soon as possible in order to avoid the fissuration or even the rupture of the aneurysm.     

Pancreaticoduodenal artery aneurysm--a life-threatening cause of gastrointestinal hemorrhage: case report and review of the literature

Gastrointestinal bleeding caused by erosion of a pancreaticoduodenal artery aneurysm in patients with pancreatitis is a rare but potentially life threatening disease. In this case report, the successful treatment of a patient bleeding from a ruptured pancreaticoduodenal artery aneurysm is described. A review of the literature of reported cases discusses the value of early angiographic intervention in patients with unexplained gastrointestinal hemorrhage and suspected rupture of an aneurysm.     

Dental health amongst 11-15-year-old children in Sevagram, Maharashtra

Although most subdural hematomas are considered to be venous in origin, they may also be of arterial origin. When subdural bleeding is due to the rupture of an intracranial aneurysm, most commonly at the middle cerebral or internal carotid arteries, the amount of subdural blood is usually small and of no clinical importance. We describe two patients with subdural hematomas secondary to rupture of an intracranial aneurysm, who needed prompt surgical treatment. The first patient had a left internal carotid artery aneurysm at the origin of the ophthalmic artery. In the second patient the aneurysm was at the anterior communicating artery and rebled into the subdural space directly through a right intraparenchymatous frontobasal hematoma. The most probable mechanism of subdural bleeding in our two patients was the existence of adhesions between the aneurysm and the arachnoid due to previous minor hemorrhages. The indication of cerebral angiography in a patient with subdural hematoma is based mainly upon the existence of meningeal signs, the presence of blood in more than one intracranial compartment or the rapid progression of bleeding.     

Rupture of an abdominal aortic aneurysm following acute descending thoracic aortic dissection. Case report

The coexistence of an abdominal aortic aneurysm and an acute aortic dissection seems to be rare and only a few reports are to be found in the literature. We report a case of a patient with acute aortic dissection of the descending thoracic aorta that caused rupture of a pre-existing abdominal aortic aneurysm. The literature is also thoroughly reviewed.     

Comparing the severity of obstructive sleep apnea in patients referred by urban and rural physicians

The occurrence of a subdural hematoma caused by the rupture of an intracranial aneurysm is rare. In our case, the patient is a 43-year-old woman who suffered from sudden onset of severe headache. Computed tomographic (CT) scan disclosed a subdural hematoma associated with subarachnoid hemorrhage. CT angiography and digital subtraction angiography revealed an elongated aneurysm adhering to the dura in the left Sylvian fissure. The subdural hematoma was evacuated and the aneurysm clipped. The patient made a full recovery.     

Utility and feasibility of assessing myocardial mechanics after bypass

The authors present the case of a 34-year-old man struck over the left mastoid region by a hockey puck, who suffered a fatal rupture of a left vertebral artery berry aneurysm. He became apneic within seconds of the injury and had no brainstem reflex within minutes. The postmortem examination showed massive subarachnoid hemorrhage in the posterior fossa and the remnants of a berry aneurysm near the intradural origin of the left vertebral artery, 11 mm proximal to the posterior inferior cerebellar artery. Rupture of a saccular aneurysm as a result of head trauma is rare. This is the first reported case of a posterior circulation aneurysm rupture as a result of head trauma.     

Vertical transmission of hepatitis C virus infection

BACKGROUND: Cavernous carotid aneurysms are generally benign entities. Certain indications exist for their treatment, however, including transient ischemic events, subarachnoid hemorrhage or risk of subarachnoid hemorrhage, epistaxis or its risk, ophthalmoplegia, pain, and progressive visual loss. We feel certain angiographic features may indicate a greater likelihood that cavernous carotid aneurysms extend into the subarachnoid space, thus making their rupture a life-threatening event. METHODS: A case report of an intracavernous carotid aneurysm, which at surgery extended into the subarachnoid space, is described. RESULTS: In this particular case, deformation of the aneurysm (waisting) as seen at angiography was in retrospect an indication that the cavernous carotid aneurysm extended into the subarachnoid space, either through the dural ring or through the eroded dural roof of the cavernous sinus. This finding was verified at surgery when the lesion was explored and trapped. CONCLUSION: Angiographic waisting of a cavernous carotid aneurysm may indicate that the aneurysm extends into the subarachnoid space. Such extension means that rupture would be a life-threatening event. While deformation of the aneurysm may be secondary to compression against the optic nerve or anterior clinoid process with an intact layer of dura overlying the aneurysm, the neurosurgeon confronted with such findings should analyze such lesions carefully and consider surgical exploration.     

Renal artery aneurysm presenting as a chest mass

An enlarging mass in the right chest in a 25-year-old woman was found at operation to be a false aneurysm of the renal artery. Preoperative diagnosis was not made despite an extensive workup including arteriography. Successful resection was carried out via a posterolateral thoracotomy. Although vascular reconstruction was not feasible. The danger of rupture of such an aneurysm from an incisional biopsy is emphasized.