801
|
Abstract
Hemosuccus pancreaticus (bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of Vater) is a rare, potentially life-threatening and obscure cause of upper gastrointestinal bleeding. It is caused by rupture of the psuedoaneurysm of a peripancreatic vessel into pancreatic duct or pancreatic psuedocyst in the context of pancreatitis or pancreatic tumors. It can pose a significant diagnostic and therapeutic dilemma due to its anatomical location and that bleeding into the duodenum is intermittent and cannot be easily diagnosed by endoscopy. A 61-year-old female with HIV and alcoholism presented with 3 weeks of intermittent abdominal pain and melena. Examination revealed hypotension with pallor and mild epigastric tenderness. She was found to have severe anemia and a high serum lipase. It was decided to perform a contrast-enhanced computed tomography (CT) scan that demonstrated a hemorrhagic pancreatic pseudocyst with possible active bleeding into the cyst. An emergent angiogram showed a large pseudoaneurysm of the pancreaticoduodenal artery that was successfully embolized. Subsequent endoscopy showed blood near ampulla of Vater confirming the diagnosis of hemosuccus pancreaticus. Thus the bleeding pseudocyst was communicating with pancreatic duct. The patient had no further episodes of gastrointestinal bleeding. Hemosuccus pancreaticus should be considered in patients with intermittent crescendo-decrescendo abdominal pain, gastrointestinal bleeding and a high serum lipase. Contrast-enhanced CT scan can be an excellent initial diagnostic modality and can lead to prompt angiography for embolization of the bleeding pseudoaneurysm and can eliminate the need for surgery.
Collapse
Affiliation(s)
- Rohan Mandaliya
- Department of Internal Medicine, Abington Memorial Hospital, Abington, PA, USA
| | - Benjamin Krevsky
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Abhinav Sankineni
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Kiley Walp
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Oliver Chen
- Department of Radiology, Temple University School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
802
|
Sapkota R, Koirala B. Traumatic pseudoaneurysm of the heart. Gen Thorac Cardiovasc Surg 2014; 64:101-4. [PMID: 24623117 DOI: 10.1007/s11748-014-0391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 03/04/2014] [Indexed: 11/25/2022]
Abstract
Missile injuries to heart are one of the most severe penetrating chest injuries, and mostly fatal. The presentation in those who survive may be unusual and insidious. Pseudoaneurysms of the heart, usually sequel to myocardial infarction, may rarely present after penetrating cardiac wounds. Their management is a challenging one, and requires the provision of cardiopulmonary bypass. We report a case of ventricular pseudoaneurysm as a consequence of bullet injury, successfully managed in our center.
Collapse
Affiliation(s)
- Ranjan Sapkota
- Department of Cardio-Thoracic and Vascular Surgery, Manmohan Cardio-Thoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Bhagawan Koirala
- Department of Cardio-Thoracic and Vascular Surgery, Manmohan Cardio-Thoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| |
Collapse
|
803
|
Stapleton CJ, Fusco MR, Thomas AJ, Levy EI, Ogilvy CS. Traumatic pseudoaneurysms of the superficial temporal artery: case series, anatomy, and multidisciplinary treatment considerations. J Clin Neurosci 2014; 21:1529-32. [PMID: 24631326 DOI: 10.1016/j.jocn.2014.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/08/2014] [Indexed: 11/27/2022]
Abstract
Pseudoaneurysms of the superficial temporal artery (STA) are rare vascular lesions of the external carotid artery system and are most often incurred after blunt head trauma. Diagnosis can be made on clinical grounds, and is confirmed by ultrasonography (US) or CT angiography. Surgical ligation and excision of the aneurysm remains a definitive treatment modality. Patients with STA pseudoaneurysms are often referred to a neurovascular specialist given the neurovascular origin and gross anatomic location of these lesions. Three patients presented to our neurovascular service several weeks following blunt head injury to the anterolateral skull surface with progressive, palpable, pulsatile masses. Each patient underwent CT angiography, which demonstrated a pseudoaneurysm of the frontal branch of the STA, followed by operative ligation and en bloc excision. The present series highlights the anatomical considerations relevant to STA injury and pseudoaneurysm formation following blunt head trauma and reviews the necessary diagnostic and treatment considerations.
Collapse
Affiliation(s)
- Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, ACC-745, Boston, MA 02114, USA.
| | - Matthew R Fusco
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ajith J Thomas
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Elad I Levy
- Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Neurosurgery, University at Buffalo, State University of New York and Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, NY, USA; Department of Radiology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
804
|
Mohan B, Mohan G, Tandon R, Kumbkarni S, Chhabra ST, Aslam N, Sood NK, Wander GS. A cost effective endovascular approach for management of post-catheterization profunda femoris artery pseudoaneurysm using thrombin. Indian Heart J 2014; 66:83-6. [PMID: 24581101 PMCID: PMC3946472 DOI: 10.1016/j.ihj.2013.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 08/07/2013] [Accepted: 12/04/2013] [Indexed: 12/03/2022] Open
Abstract
Post-catheterization PSA is one of the most commonly encountered vascular complications of cardiac and peripheral angiographic procedures. We report the case of patient who developed deep-seated profunda femoris artery pseudoaneurysm (PSA) following cardiac catheterization. Despite, repeated ultrasound guided compressions the PSA failed to close and instead produced local site pressure ulcers. The secondary infection followed which precluded use of percutaneous thrombin injection. The PSA was finally closed via a total endovascular technique combining intravascular thrombin injection and coil embolization, thus obviating the need for expensive measures like cover stents or invasive surgical repairs.
Collapse
Affiliation(s)
- Bishav Mohan
- Professor of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India.
| | - Gaurav Mohan
- DM Student, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Rohit Tandon
- Consultant, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Shalinder Kumbkarni
- Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Shibba Takkar Chhabra
- Assistant Professor of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Naved Aslam
- Associate Professor of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Naresh Kumar Sood
- Professor of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| | - Gurpreet Singh Wander
- Professor & HOD of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana 141001, India
| |
Collapse
|
805
|
Patel AV, Gupta S, Laffin LJ, Retzer EM, Dill KE, Shah AP. One size does not fit all: case report of two percutaneous closures of aortic pseudoaneurysm and review of the literature. Cardiovasc Revasc Med 2014; 15:160-4. [PMID: 24630705 DOI: 10.1016/j.carrev.2014.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Abstract
Aortic pseudoaneurysms (PSAs) are common complications following cardiac surgery, and carry significant morbidity and mortality. Surgical management of aortic PSAs is associated with high mortality, however there are emerging reports of transcatheter techniques for closure of aortic PSAs. We present two cases of ascending aorta PSA which developed following cardiac surgery and were treated percutaneously with novel closure devices. We also describe a comprehensive review of the literature of all published cases of ascending aorta PSA which have been closed percutaneously, and report on the success rate and available devices for percutaneous closure.
Collapse
Affiliation(s)
- Amit Vipin Patel
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center
| | - Sameer Gupta
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center
| | - Luke Joseph Laffin
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center
| | | | - Karin Evelyn Dill
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center
| | - Atman Prabodh Shah
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center.
| |
Collapse
|
806
|
Tejero-Garcia S, Lirola Criado JF, Ast MP, Fernandez de Bobadilla GD. Popliteal pseudoaneurysm after unicompartmental knee replacement: a case report. Knee 2014; 21:597-9. [PMID: 24703686 DOI: 10.1016/j.knee.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 02/07/2013] [Accepted: 03/01/2013] [Indexed: 02/02/2023]
Abstract
UNLABELLED Popliteal pseudoaneurysm is a rare but important complication of knee arthroplasties. To our knowledge, this complication has not been reported previously in the literature after unicompartmental knee arthroplasty. Apart from intraoperatively caused arterial injuries, obese patients and other previous cardiovascular diseases may be potential factors of risks for pseudoaneurysm in knee surgeries. As it is an uncommon complication and it has inconspicuous symptoms, both diagnosis and treatment can be delayed. This means that a high level of suspicion is necessary to prevent serious complications derived from pseudoaneurysms. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Sergio Tejero-Garcia
- Department of Orthopaedic Surgery, Hospitales Universitarios Virgen del Rocío, Manuel Siurot s/n 41013, Sevilla, Spain.
| | - Jose F Lirola Criado
- Department of Orthopaedic Surgery, Hospitales Universitarios Virgen del Rocío, Manuel Siurot s/n 41013, Sevilla, Spain.
| | - Michael P Ast
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
| | | |
Collapse
|
807
|
Rohit MK, Vadivelu R, Khandelwal N, Krishna S. Post Blalock-Taussig shunt mediastinal mass - a single shadow with two different destinies. Indian Heart J 2014; 66:227-30. [PMID: 24814123 DOI: 10.1016/j.ihj.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/10/2013] [Accepted: 02/05/2014] [Indexed: 11/19/2022] Open
Abstract
The modified Blalock-Taussig shunt is a synthetic shunt between the subclavian and pulmonary artery, used in the treatment of congenital cyanotic heart diseases with pulmonary hypoperfusion. Delayed complications include progressive failure of the shunt, serous fluid leak, and pseudoaneurysm formation. We report two different and rare mediastinal vascular complications following modified BT shunt surgery in this case report. The first one is a seroma, due to serous fluid leakage through the shunt graft, which is a relatively benign complication. The second one is a pseudoaneurysm, arising from the shunt, a frequently fatal complication. Generally, X-ray chest is used for screening in these patients. CT angiography plays a vital role in the diagnosis of both these conditions. Management in pseudoaneurysm should be aggressive, as timely intervention may be life saving, while in seroma the management is most often conservative occasionally requiring surgical intervention.
Collapse
MESH Headings
- Abnormalities, Multiple/diagnostic imaging
- Abnormalities, Multiple/surgery
- Anastomotic Leak/diagnostic imaging
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/surgery
- Angiography/methods
- Blalock-Taussig Procedure/adverse effects
- Blalock-Taussig Procedure/methods
- Child, Preschool
- Double Outlet Right Ventricle/diagnostic imaging
- Double Outlet Right Ventricle/surgery
- Fatal Outcome
- Female
- Heart Aneurysm/diagnostic imaging
- Heart Aneurysm/surgery
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Ventricular/diagnostic imaging
- Heart Septal Defects, Ventricular/surgery
- Humans
- Male
- Postoperative Complications/diagnostic imaging
- Risk Assessment
- Seroma/diagnostic imaging
- Seroma/etiology
- Tetralogy of Fallot/diagnostic imaging
- Tetralogy of Fallot/surgery
- Tomography, X-Ray Computed/methods
Collapse
Affiliation(s)
- Manoj Kumar Rohit
- Associate Professor, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India.
| | - Ramalingam Vadivelu
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Niranjan Khandelwal
- Department of Radiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Satheesh Krishna
- Department of Radiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| |
Collapse
|
808
|
Rekik S, Jacq L, Bourlon F, Bernasconi F, Quaegebeur JM, Dreyfus G. Large compressive proximal pseudoaneurysm after ascending-to-descending aortic bypass in a 62 year-old patient with severe aortic coarctation: first reported case. Int J Cardiol 2014; 172:e453-7. [PMID: 24491869 DOI: 10.1016/j.ijcard.2014.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 12/30/2013] [Accepted: 01/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Sofiene Rekik
- Cardiology Department, Antibes Hospital Center, France.
| | - Laurent Jacq
- Cardiology Department, Antibes Hospital Center, France
| | | | | | - Jan M Quaegebeur
- Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, NY, USA
| | | |
Collapse
|
809
|
Abstract
Over the past decade, emergency and critical care physicians have been empowered with the ability to use bedside ultrasonography to assist in the evaluation and management of a variety of emergent conditions. Today a single health care provider at the bedside with Duplex ultrasound technology can evaluate peripheral vascular calamities that once required significant time and a variety of health care personnel for the diagnosis. This article highlights peripheral thromboembolic disease, aneurysm, pseudoaneurysm, and arterial occlusion in the acute care setting.
Collapse
Affiliation(s)
- Thomas Cook
- Department of Emergency Medicine, Palmetto Health Richland, 14 Medical Park, Suite 350, Columbia, SC 29203, USA
| | - Laura Nolting
- Department of Emergency Medicine, Palmetto Health Richland, 14 Medical Park, Suite 350, Columbia, SC 29203, USA.
| | - Caleb Barr
- Department of Emergency Medicine, Palmetto Health Richland, 14 Medical Park, Suite 350, Columbia, SC 29203, USA
| | - Patrick Hunt
- Department of Emergency Medicine, Palmetto Health Richland, 14 Medical Park, Suite 350, Columbia, SC 29203, USA
| |
Collapse
|
810
|
Rencuzogullari A, Okoh AK, Akcam TA, Roach EC, Dalci K, Ulku A. Hemobilia as a result of right hepatic artery pseudoaneurysm rupture: An unusual complication of laparoscopic cholecystectomy. Int J Surg Case Rep 2014; 5:142-4. [PMID: 24531018 DOI: 10.1016/j.ijscr.2014.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/03/2014] [Accepted: 01/09/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy has many complications which may be seen due to anatomical variations, lack of experience of the surgeon or three dimensional visualization, or insufficient exposure of the surgical field; including vascular injuries. Here we present a case of pseudoaneurysm of the right hepatic artery leading to hemobilia after rupturing into the biliary system. PRESENTATION OF CASE A 43-year-old male patient presented to our clinic 3 weeks post laparoscopic cholecystectomy with right upper quadrant pain, melena and hematemesis. After stabilizing the patient, Doppler ultrasonography, abdominal computer tomography and selective right hepatic artery angiography were performed and a pseudoaneurysm was established on the anterior posterior bifurcation of right hepatic artery. Right hepatic artery ligation and a T-tube placement after choledocotomy were performed. The patient recovered completely. DISCUSSION Pseudoaneurysms of the hepatic artery may arise as a complication of laparoscopic cholecystectomy. Clip encroachments, mechanical or thermal injury during the procedure are likely to be precipitating factors. Today, transarterial embolization (TAE) is the gold standard for the management of hemobilia, and if it fails, the next step in management is surgical. Surgery is limited to extra-hepatic or gallbladder bleeding, and for TAE failure. CONCLUSION In cases of GI bleeding the awareness of the surgeon should be drawn to a clinical suspicion of hemobilia and an underlying hepatic artery pseudoaneurysm that can arise as a complication. CT angiography should be performed for early diagnosis and management in such patients.
Collapse
Affiliation(s)
| | - Alexis K Okoh
- Ankara University School of Medicine, Department of Surgery, Turkey
| | - Tolga A Akcam
- Cukurova University School of Medicine, Department of Surgery, Turkey
| | | | - Kubilay Dalci
- Cukurova University School of Medicine, Department of Surgery, Turkey
| | - Abdullah Ulku
- Cukurova University School of Medicine, Department of Surgery, Turkey
| |
Collapse
|
811
|
Hussain M, Roche-Nagle G. Infected pseudoaneurysm of the superficial femoral artery in a patient with Salmonella enteritidis bacteremia. Can J Infect Dis Med Microbiol. 2013;24:e24-e25. [PMID: 24421797 DOI: 10.1155/2013/715609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mycotic aneurysms, defined as irreversible dilation of an artery due to destruction of the vessel wall by infection, are rare but are associated with a high risk of rupture if not treated promptly. The case of a healthy 52-year-old smoker who presented with pyrexia, rigors, night sweats and severe right leg pain with swelling is presented. He was diagnosed with a superficial femoral artery mycotic aneurysm, with Salmonella enteritidis as the causative agent. He was treated with high-dose antibiotics, local debridement and autologous reconstruction. A high index of suspicion is needed to make the correct diagnosis in these cases. Prompt surgical intervention and antimicrobial therapy are the cornerstones of treatment to reduce the associated high morbidity and mortality.
Collapse
|
812
|
Sharifkazemi MB, Moarref AR, Rezaian S, Rezaian GR. Brucella endocarditis of pseudoaneurysm of an aortic composite graft. J Cardiovasc Ultrasound 2013; 21:183-5. [PMID: 24459566 PMCID: PMC3894370 DOI: 10.4250/jcu.2013.21.4.183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 10/07/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022] Open
Abstract
The occurrence of Brucella endocarditis following Bentall operation is a rare and life threatening condition, particularly when it is complicated by development of a pseudoaneurysm. Here we present a 40-year-old veterinarian with bicuspid aortic valve, who developed type A aortic root dissection and required Bentall operation. His past medical history was positive for an episode of treated brucellosis. Four months after the operation, he developed signs, symptoms and serological findings of brucellosis for the second time and was treated with antibiotics. Then after he was well untill about 14 days prior to his recent admission, when he again developed hip pain, fever, shortness of breath, profound fatigue and weakness. His transthoracic echocardiography was suggestive of endocarditis. A transesophageal echocardiogram revealed detachment of valve-conduit from the annulus and the mitral-aortic intervalvular fibrosa and the presence of a large aortic pseudoaneurysm with multiple vegetations attached to its Dacron walls. A huge pseudoaneurysm was detected at surgery and the whole valve-conduit was replaced with a 25 mm homograft. Blood and vegetation cultures turned to be positive for Brucella melitensis. Early echocardiographic diagnosis and prompt surgical intervention were helpful for survival of our patient who had aortic pseudoaneurysm complicated by Brucella endocarditis.
Collapse
Affiliation(s)
| | - Ali Reza Moarref
- Department of Medicine (Cardiology), Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahed Rezaian
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Reza Rezaian
- Department of Medicine (Cardiology), Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
813
|
Sumiyoshi T, Shima Y, Noda Y, Hosoki S, Hata Y, Okabayashi T, Kozuki A, Nakamura T. Endovascular pseudoaneurysm repair after distal pancreatectomy with celiac axis resection. World J Gastroenterol 2013; 19:8435-8439. [PMID: 24363537 PMCID: PMC3857469 DOI: 10.3748/wjg.v19.i45.8435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/19/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
Erosive hemorrhage due to pseudoaneurysm is one of the most life-threatening complications after pancreatectomy. Here, we report an extremely rare case of rupture of a pseudoaneurysm of the common hepatic artery (CHA) stump that developed after distal pancreatectomy with en block celiac axis resection (DP-CAR), and was successfully treated through covered stent placement. The patient is a 66-year-old woman who underwent DP-CAR after adjuvant chemoradiotherapy for locally advanced pancreatic body cancer. She developed an intra-abdominal abscess around the remnant pancreas head 31 d after the surgery, and computed tomography (CT) showed an occluded portal vein due to the spreading inflammation around the abscess. Her general condition improved after CT-guided drainage of the abscess. However, 19 d later, she presented with melena, and CT showed a pseudoaneurysm arising from the CHA stump. Because the CHA had been resected during the DP-CAR, this artery could not be used as the access route for endovascular treatment, and instead, we placed a covered stent via the inferior pancreaticoduodenal artery originating from the superior mesenteric artery. After stent placement, cessation of bleeding and anterograde hepatic artery flow were confirmed, and the patient recovered well without any further complications. CT angiography at the 6-mo follow-up indicated the patency of the covered stent with sustained hepatic artery flow. To our knowledge, this is the first reported case of endovascular repair of a pseudoaneurysm that developed after DP-CAR.
Collapse
MESH Headings
- Aged
- Aneurysm, False/diagnosis
- Aneurysm, False/etiology
- Aneurysm, False/therapy
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/etiology
- Aneurysm, Ruptured/therapy
- Celiac Artery/diagnostic imaging
- Celiac Artery/pathology
- Celiac Artery/surgery
- Chemoradiotherapy, Adjuvant
- Endovascular Procedures/instrumentation
- Female
- Hepatic Artery/diagnostic imaging
- Hepatic Artery/pathology
- Hepatic Artery/surgery
- Humans
- Melena/diagnosis
- Melena/etiology
- Mesenteric Artery, Superior/pathology
- Mesenteric Artery, Superior/surgery
- Neoplasm Invasiveness
- Pancreatectomy/adverse effects
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Postoperative Hemorrhage/diagnosis
- Postoperative Hemorrhage/etiology
- Postoperative Hemorrhage/therapy
- Splenic Artery/pathology
- Splenic Artery/surgery
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Surgical Procedures/adverse effects
Collapse
|
814
|
Mittal R, Stephen E, Keshava SN, Moses V, Agarwal S. Percutaneous cyanoacrylate glue embolization for peripheral pseudoaneurysms: an alternative treatment. Indian J Surg 2013; 74:483-5. [PMID: 24293904 DOI: 10.1007/s12262-012-0456-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 03/05/2012] [Indexed: 11/29/2022] Open
Abstract
Post-traumatic pseudoaneurysms are rare in the peripheral arteries and usually occur as a late sequel of trauma. Surgery has traditionally been considered as the gold standard of therapy for traumatic peripheral pseudoaneurysms. We report 2 cases of post traumatic pseudoaneurysms successfully treated by percutaneous cyanoacrylate glue (N-Butyl 2 cyanoacrylate) embolization. This method offers complete exclusion of the pseudoaneurysm, at the same time avoiding the morbidity of open surgery.
Collapse
Affiliation(s)
- Rohin Mittal
- Division of Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | | | | | | |
Collapse
|
815
|
Glaysher MA, Cruttenden-Wood D, Szentpali K. A rare cause of upper gastrointestinal haemorrhage: Ruptured cystic artery pseudoaneurysm with concurrent cholecystojejunal fistula. Int J Surg Case Rep 2014; 5:1-4. [PMID: 24394852 DOI: 10.1016/j.ijscr.2013.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Cystic artery pseudoaneurysms and cholecystoenteric fistulae represent two rare complications of gallstone disease. PRESENTATION OF CASE An 86 year old male presented to the emergency department with obstructive jaundice, RUQ pain and subsequent upper gastrointestinal bleeding. Upper GI endoscopy revealed bleeding from the medial wall of the second part of the duodenum and a contrast-enhanced computed tomography scan revealed a cystic artery pseudoaneurysm, concurrent cholecystojejunal fistula and gallstone ileus. This patient was successfully managed surgically with open subtotal cholecystectomy, pseudoaneurysm resection and fistula repair. DISCUSSION To date there are very few cases describing haemobilia resulting from a bleeding cystic artery pseudoaneurysm. This report is the first to describe upper gastrointestinal bleeding as a consequence of two synchronous rare pathologies: a ruptured cystic artery pseudoaneurysm causing haemobilia and bleeding through a concurrent cholecystojejunal fistula. CONCLUSION Through this case, we stress the importance of accurate and early diagnosis through ultra- sonography, endoscopy, and contrast-enhanced CT imaging and emphasise that haemobilia should be included in the differential diagnosis of anyone presenting with upper gastrointestinal bleeding. We have demonstrated the success of surgical management alone in the treatment of such a case, but accept that consideration of combined therapeutic approach with angiography be given in the first instance, when available and clinically indicated.
Collapse
|
816
|
Dogan KH, Demirci S, Tavli L, Buken B. Pseudoaneurysm originating from left ventricle aneurysm: an autopsy case and review of literature. J Forensic Leg Med 2013; 20:941-3. [PMID: 24237794 DOI: 10.1016/j.jflm.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/02/2013] [Accepted: 09/07/2013] [Indexed: 01/25/2023]
Abstract
Rupture of the free wall of the left ventricle is a catastrophic complication of acute myocardial infarction. Rarely, free wall rupture is contained by overlying adherent pericardium, producing a pseudoaneurysm of the left ventricle. In this report, a case of a left ventricular pseudoaneurysm due to a previous myocardial infarction is described. A 55-year-old woman had a severe chest pain 11 months prior to death. No cardiac investigation was performed. Three days prior to death, she suffered from fatigue and weakness, and had a witnessed sudden cardiac death. At autopsy, a 8.5 × 10 × 8 cm pseudoaneurysm of the left ventricle was found. There was severe coronary artery atherosclerosis. There were extensive adhesions between pericardium and pseudoaneurysm wall. The cause of death was attributed to heart failure and resulting arrhythmia. The case illustrates the rare event of left ventricular pseudoaneurysm first diagnosed at forensic autopsy.
Collapse
Affiliation(s)
- Kamil Hakan Dogan
- Department of Forensic Medicine, Faculty of Medicine, Selcuk University, Aleaddin Keykubat Campus, Selcuklu, 42075 Konya, Turkey.
| | | | | | | |
Collapse
|
817
|
Boretto JG, Gallucci GL, De Carli P. Low motor ulnar nerve palsy caused by a traumatic pseudoaneurysm of the ulnar artery. J Hand Microsurg 2014; 6:96-9. [PMID: 25414559 DOI: 10.1007/s12593-013-0110-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022] Open
|
818
|
Hammami R, Bosmans J, Voormolen M, Vermeulen T, Salgado R, Vrints C. [Acquired coronary-cameral fistula complicated by a ventricular pseudoaneurysm]. Ann Cardiol Angeiol (Paris) 2013; 62:442-5. [PMID: 24119773 DOI: 10.1016/j.ancard.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 08/12/2013] [Indexed: 11/20/2022]
Abstract
Coronary-cameral fistulas are usually congenital, rarely acquired; the complication of this anomaly with ventricular pseudoaneurysm is exceptional. We report a new case of acquired coronary-cameral fistula, occurred in a patient who had received a bypass graft and who had suffered from angina 1 year after the surgery. On computed tomography coronary angiography, the fistula seems to communicate the first diagonal to a left ventricle pseudoaneurysm. Embolization of the fistula and filling of the pseudoaneurysm by neurocoil were successfully performed. The clinical and angiographic control after 3 months showed symptoms improvement and absence of recanalization of the fistula.
Collapse
|
819
|
Abstract
Late left ventricular pseudoaneurysm is a rare complication after mitral valve replacement. Most investigators have recommended surgical repair to treat left ventricular pseudoaneurysm, since untreated left ventricular pseudoaneurysm have a high risk of rupture. Here, we report a case of a 57-year old man with left ventricular pseudoaneurysm. He had two prior mitral valve replacements 16 and 19 years ago, as well as mitral and aortic valve endocarditis causing mitral valve perivalvular leak and perforation of the aortic valve. The mitral and aortic valves were replaced with bovine pericardial valves. Left ventricular pseudoaneurysm was successfully repaired internally in our case because the internal wall at the level of the left ventricle was very fibrotic and matured.
Collapse
Affiliation(s)
- Hirohisa Ikegami
- Division of Cardiac Surgery, The Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | | |
Collapse
|
820
|
Kocovski L, Butany J, Nair V. Femoral artery pseudoaneurysm due to Candida albicans in an injection drug user. Cardiovasc Pathol 2013; 23:50-3. [PMID: 24012013 DOI: 10.1016/j.carpath.2013.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/26/2013] [Indexed: 12/18/2022] Open
Abstract
Candida arteritis is an uncommon condition but important to recognize due to the risk of significant morbidity and the difficulty in management of the enduring fungal infection. The authors report a rare case of a man with a femoral artery pseudoaneurysm with persistent Candida albicans infection, as a complication of infective endocarditis. The 23-year-old man, with a history of chronic intravenous drug use and Type I diabetes mellitus, presented with left groin pain, paresthesia of his left foot, and a pulsatile mass in the inguinal region. On imaging, he was found to have a pseudoaneurysm of the left common femoral artery, which later ruptured. Further investigation revealed vegetations on the mitral and aortic valves as well. Initial blood cultures were negative. He underwent multiple surgical interventions including replacement of the mitral and aortic valves and resection of the left common femoral artery with autogenous revascularization. In addition, he was commenced on intravenous antifungal therapy. Postoperatively, he continued to experience significant pain in the left groin and had two episodes of rerupture of the femoral artery that was consequently surgically repaired. Histological examination of the resected valves revealed vegetations with a mixture of fungal elements and bacterial cocci. The femoral artery resection specimens revealed evidence of infectious arteritis and the presence and persistence of C. albicans organisms in subsequent specimens. This case highlights the importance of an accurate diagnosis and aggressive management of fungal mycotic aneurysms in at-risk populations.
Collapse
Affiliation(s)
- Linda Kocovski
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.
| | | | | |
Collapse
|
821
|
Valli F, Teli MGA, Innocenti M, Vercelli R, Prestamburgo D. Profunda femoris artery pseudoaneurysm following revision for femoral shaft fracture nonunion. World J Orthop 2013; 4:154-156. [PMID: 23878785 PMCID: PMC3717250 DOI: 10.5312/wjo.v4.i3.154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/15/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
Femoral artery pseudoaneurysms (FAPs) have been described following internal fixation of intertrocantheric, subtrocantheric and intracapsular femoral neck fractures as well as core decompression of the femoral head. The diagnosis of FAP is usually delayed because of non-specific clinical features like pain, haematoma, swelling, occasional fever and unexplained anaemia. Because of the insidious onset and of the possible delayed presentation of pseudoaneurysms, orthopaedic and trauma surgeons should be aware of this complication. We report a case of Profunda Femoris arterial branch pseudoaneurysm, diagnosed in a 40-year-old male 4 wk after revision with Kuntscher intramedullary nail of a femoral shaft nonunion. The diagnosis was achieved by computed tomography angiography and the lesion was effectively managed by endovascular repair. The specific literature and suggestions for treatment are discussed in the paper.
Collapse
|
822
|
Nana GR, Gibson M, Speirs A, Ramus JR. Upper gastrointestinal bleeding: A rare complication of acute cholecystitis. Int J Surg Case Rep 2013; 4:761-4. [PMID: 23856254 DOI: 10.1016/j.ijscr.2013.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Haemobilia is a rare complication of acute cholecystitis and may present as upper gastrointestinal bleeding. PRESENTATION OF CASE We describe two patients with acute cholecystitis presenting with upper gastrointestinal bleeding due to haemobilia. Bleeding from the duodenal papilla was seen at endoscopy in one case but none in the other. CT demonstrated acute cholecystitis with a pseudoaneurysm of the cystic artery in both cases. Definitive control of intracholecystic bleeding was achieved in both cases by embolisation of the cystic artery. Both patients remain symptom free. One had subsequent laparoscopic cholecystostomy and the other no surgery. DISCUSSION Pseudoaneurysms of the cystic artery are uncommon in the setting of acute cholecystitis. OGD and CT angiography play a key role in diagnosis. Transarterial embolisation (TAE) is effective in controlling bleeding. TAE followed by interval cholecystectomy remains the treatment of choice in surgically fit patients. CONCLUSION We highlight an unusual cause of upper GI haemorrhage. Surgeons need to be aware of this rare complication of acute cholecystitis. Immediate non-surgical management in these cases proved to be safe and effective.
Collapse
Affiliation(s)
- Gael R Nana
- Department of Surgery, Royal Berkshire Hospital, Reading, Berkshire RG1 5AN, UK.
| | | | | | | |
Collapse
|
823
|
McCarthy E, O'Mahony N, Ryan M, Guiney M. Combined thrombin-collagen injection for the management of an iatrogenic pseudoanuerysm in the popliteal region. Indian J Radiol Imaging 2013; 22:257-9. [PMID: 23833415 PMCID: PMC3698886 DOI: 10.4103/0971-3026.111474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudoaneurysm formation is a rare but recognized complication of total knee arthroplasty (TKR), with fewer than 20 cases described in the literature. Multiple management techniques have been described for such pseudoaneurysms. As thrombin injection is an established technique, we report a case of a post-TKR tibioperoneal pseudoaneurysm successfully occluded via percutaneous injection of a dual thrombin-collagen preparation.
Collapse
Affiliation(s)
- Eoghan McCarthy
- Department of Radiology, St. James's Hospital, James's Street, Dublin-8, Ireland
| | | | | | | |
Collapse
|
824
|
Luther A, Kumar A, Negi KN. Peripheral Arterial Pseudoaneurysms-a 10-Year Clinical Study. Indian J Surg 2015; 77:603-7. [PMID: 26730072 DOI: 10.1007/s12262-013-0939-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 06/17/2013] [Indexed: 10/26/2022] Open
Abstract
Peripheral arterial pseudoaneurysms are quite common in Northern India (Punjab Province) and thus a common presenting complaint of varied etiology. The objective of this study was to evaluate the clinical outcome of patients presenting with peripheral arterial pseudoaneurysms of varied etiology. Retrospective analysis of medical records of patients with diagnosis of peripheral arterial pseudoaneurysm from 1 May 2001 to 30 October 2009 was done. In the prospective period from 1 November 2009 to 30 April 2011, the patients were personally examined by the authors and followed up till discharge from the hospital and subsequently at 2 weeks, 1 month, 3 months, and 6 months postdischarge from the hospital. We studied 50 patients (13 in the prospective group and 37 in the retrospective study group). Intravenous drug abuse (26 cases) followed by trauma (nine cases) was the commonest etiology. Femoral artery was the commonest artery involved (37 cases). A pulsatile mass with localized tenderness was the commonest presentation. All patients underwent surgical treatment with 36 (72 %) patients undergoing ligation and excision of the pseudoaneurysm. Six (12 %) patients underwent revascularization with reverse saphenous vein graft. Five (10 %) patients underwent primary repair, and three (6 %) patients were managed by putting a synthetic ePTFE graft. Postoperative wound infection was seen in 18 (36 %) patients, and 33 (66 %) patients had an uneventful recovery. In pseudoaneurysms, surgical repair at the early instance carries a favorable prognosis. If feasible, reverse saphenous vein grafting is the best conduit for repair. Synthetic vascular graft (ePTFE) can be used in case autologous saphenous vein is not available. Excision and ligation is safe, and we recommend it as the treatment of choice for infected arterial pseudoaneurysms.
Collapse
|
825
|
Samara O, Saleh AI, Alomari A, Al Ryalat N, Hadidy A, Alsmady M. Giant Spontaneous Femoral Artery Pseudoaneurysm Treated with Covered Stents: Report of a rare presentation and review of literature. Sultan Qaboos Univ Med J 2013; 13:E472-5. [PMID: 23984040 DOI: 10.12816/0003277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 12/02/2012] [Accepted: 12/19/2012] [Indexed: 01/06/2023] Open
Abstract
We report the case of a 62-year-old woman who presented with a one-month history of a pulsatile mass, with no antecedent trauma or intervention. Imaging showed a large pseudoaneurysm (PSA) of the distal portion of the left superficial femoral artery. The PSA was treated successfully with endovascular placement of covered stents.
Collapse
Affiliation(s)
- Osama Samara
- Department of Radiology & Nuclear Medicine, University of Jordan Hospital, Amman, Jordan
| | | | | | | | | | | |
Collapse
|
826
|
Gopal A, Aranson N, Woo K, Clavijo L, Shavelle DM. Recalcitrant peroneal artery pseudoaneurysm in a patient with Hemophilia B. Cardiovasc Revasc Med 2013; 14:359-62. [PMID: 23773548 DOI: 10.1016/j.carrev.2013.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/20/2022]
Abstract
Pseudoaneurysms (PAs) of arteries in the lower extremities are uncommon. In most cases, a PA of the common femoral artery develops following percutaneous access and treatment with ultrasound guided thrombin injection achieves success rates approaching 98%. In contrast, the management of a PA of the distal leg vessels is more complex and may require additional endovascular and/or surgical treatments. We present a case of a recalcitrant PA involving the distal peroneal artery that developed following blunt trauma in a patient with Hemophilia B who failed ultrasound guided thrombin injection, para-aneurysmal saline injection and required two coil embolization procedures. Our observations suggest that Factor IX supplementation combined with aggressive coil embolization is the most effective treatment approach.
Collapse
|
827
|
Acioli Pereira L, Fontes Gontijo P, Alcântara Farran J, Palandri Chagas AC, Romano ER, Bento de Souza LC. Giant pseudoaneurysm of the left ventricular outflow tract: a rare disease. Rev Port Cardiol 2013; 32:541-4. [PMID: 23746395 DOI: 10.1016/j.repc.2012.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 11/06/2012] [Indexed: 10/26/2022] Open
Abstract
Pseudoaneurysm of the left ventricular outflow tract (LVOT) is a rare disease with high morbidity and mortality, resulting from left ventricular damage due to myocardial infarction, infective endocarditis or surgical trauma. A case of giant pseudoaneurysm of the LVOT, even more rarely reported in the literature, is described. The lesion was detected 12 years after aortic valve replacement for infective endocarditis in a young patient, a former intravenous drug user. As it is an uncommon disease, little is known about its clinical presentation and treatment.
Collapse
Affiliation(s)
- Larissa Acioli Pereira
- Unidade de Terapia Intensiva, Hospital do Coração de São Paulo - Associação Sanatório Sírio, São Paulo, Brasil.
| | | | | | | | | | | |
Collapse
|
828
|
Kwon HS, Cho YK, Sohn IS, Hwang HS, Seo KJ, Park WI, Seo YS. Rupture of a pseudoaneurysm as a rare cause of severe postpartum hemorrhage: analysis of 11 cases and a review of the literature. Eur J Obstet Gynecol Reprod Biol 2013; 170:56-61. [PMID: 23746797 DOI: 10.1016/j.ejogrb.2013.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/29/2013] [Accepted: 04/22/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To clarify the clinical features of severe postpartum hemorrhage (PPH) resulting from a ruptured pseudoaneurysm and to determine the efficacy of selective arterial embolization as a method of management. STUDY DESIGN Eleven women who underwent selective arterial embolization for treatment of severe hemorrhage due to a ruptured pseudoaneurysm were identified from 2 hospitals within the past 5 years. A retrospective analysis was performed to identify the clinical characteristics of the hemorrhage and to evaluate the efficacy of arterial embolization. RESULTS Nine women delivered by cesarean delivery. Eight of the 11 women had late PPH with onset of bleeding occurring 6-100 days (median, 11.5) after delivery. The average volume of transfusion was 3196 ml of packed red blood cells (range, 1600-8980 ml). Uterine atony occurred in only one patient and was accompanied by an intrauterine abscess. Administration of uterotonic agents did not diminish the bleeding. Only one patient out of 11 underwent re-embolization. CONCLUSION If late PPH without uterine infection or retained placenta occurs after cesarean delivery, one should suspect the possibility of a ruptured pseudoaneurysm. Selective arterial embolization may be considered as a primary means of treatment.
Collapse
Affiliation(s)
- Han-Sung Kwon
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
829
|
Yun GY, Kim SK, Park SK, Moon SJ, Lee JE, Song SW, Lee KH, Park HC, Ha SK, Choi HY. Asymptomatic renal pseudoaneurysm after percutaneous renal biopsy. Kidney Res Clin Pract 2013; 32:87-9. [PMID: 26877921 DOI: 10.1016/j.krcp.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/15/2012] [Accepted: 10/22/2012] [Indexed: 01/20/2023] Open
Abstract
A 37-year-old man was referred to Division of Nephrology for a new renal cystic lesion that was found on ultrasonography. Four years prior to presentation, a percutaneous renal biopsy had been performed. Computed tomography scan showed a 4.4-cm-sized renal artery pseudoaneurysm in the left kidney. Selective renal angiography revealed a pseudoaneurysm in the left lower pole of the kidney. The renal pseudoaneurysm was successfully embolized with coil. Follow-up Doppler ultrasonography showed no internal blood flow into the aneurysmal sac. His renal function remained stable after coil embolization.
Collapse
|
830
|
Affiliation(s)
- Hidetake Kawajiri
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | |
Collapse
|
831
|
Garg A, Chandrasekaran K, Jadhav S, Chandok G, Ringe A, Sankhe A. Intra-aneurysmal glue embolisation of a giant pulmonary artery pseudoaneurysm after left upper lobe lobectomy: case report. Korean J Radiol 2013; 14:455-9. [PMID: 23690713 PMCID: PMC3655300 DOI: 10.3348/kjr.2013.14.3.455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/07/2012] [Indexed: 11/15/2022] Open
Abstract
We report a case of pseudoaneurysm of the anterior ascending branch of the left pulmonary artery, following a left upper lobectomy for pulmonary aspergillosis, for which we have done an endovascular treatment. This is the first case where complete pseudoaneurysm occlusion was accomplished after a transcatheter intra-aneurysmal N-butyl 2-cyanoacrylate (glue) injection.
Collapse
Affiliation(s)
- Ashwin Garg
- Department of Radiology, Lokmanya Tilak Medical College and Municipal General Hospital, Sion, Mumbai-400022, India.
| | | | | | | | | | | |
Collapse
|
832
|
Joseph V, Sambhaji C, Prakashini K. Radial artery pseudoaneurysm managed by prolonged ultrasound-guided compression repair and aided by interval application of compression device. Australas Med J 2013; 6:192-5. [PMID: 23671465 DOI: 10.4066/amj.2013.1677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report a case of a right radial pseudoaneurysm due to assault. The pseudoaneurysm was treated successfully with prolonged ultrasound-guided compression for more than 300 minutes over multiple sittings coupled with the use of a compression device. We believe that if initial compression fails, a prolonged ultrasound-guided compression repair coupled with a compression device can greatly improve the success rates and can negate the use of more invasive procedures to treat pseudoaneurysms.
Collapse
Affiliation(s)
- Vivek Joseph
- Medical Student, Kasturba Medical College, Manipal
| | | | | |
Collapse
|
833
|
Moustafa S, Patton DJ, Ross DB, Balon Y, Alvarez N. Unexpected sequel of chronic Q-fever endocarditis. Heart Lung Circ 2013; 22:1054-5. [PMID: 23628330 DOI: 10.1016/j.hlc.2013.03.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/27/2013] [Accepted: 03/31/2013] [Indexed: 10/26/2022]
Abstract
We report a patient with chronic Q-fever endocarditis who was treated with Bentall procedure on two occasions due to persistent endocarditis. A chronic pseudoaneurysm of the aortic root was discovered incidentally by cardiac magnetic resonance and computed tomography eight years post-operatively. Due to chronicity of the pseudoaneurysm and great risk of re-intervention, conservative management was recommended.
Collapse
Affiliation(s)
- Sherif Moustafa
- Adult Congenital Heart Disease Clinic, Peter Lougheed Hospital, Division of Cardiovascular Diseases, University of Calgary, Canada; Division of Cardiovascular Diseases, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | | | | |
Collapse
|
834
|
Judd E, Lockhart ME, Rizk DV. Renovascular hypertension associated with pseudoaneurysm following blunt trauma. Am J Kidney Dis 2013; 62:839-43. [PMID: 23518197 DOI: 10.1053/j.ajkd.2012.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 12/18/2012] [Indexed: 11/11/2022]
Abstract
We present the case of a 21-year-old man who developed a renal artery pseudoaneurysm following a 7-foot fall onto his back. He initially presented with gross hematuria, left flank pain, and back pain. He was observed in the hospital for 3 days and discharged. One week later, he was readmitted with headache, nausea, vomiting, seizure activity, and hypertension. Contrast-enhanced computed tomography of the abdomen showed a left renal artery pseudoaneurysm with associated arterial narrowing and delayed ipsilateral renal enhancement. He underwent percutaneous stent-graft placement with resolution of the pseudoaneurysm. He was free of complications and normotensive off antihypertensive medications after 36 months of follow-up. Renal artery pseudoaneurysms are rare and under-recognized complications of blunt abdominal or back trauma that can cause hypertension. Imaging modalities in renovascular hypertension have focused on detecting renal artery stenosis from atherosclerotic disease or fibromuscular dysplasia, with little attention given to renal artery pseudoaneurysms. In addition, first-line treatment for renal artery pseudoaneurysms historically has consisted of angioembolization, yet percutaneous stent-graft placement has emerged as an attractive alternative to preserve vessel patency. We discuss the role of imaging in renovascular hypertension with a focus on renal artery pseudoaneurysms and their prevalence, diagnosis, and treatment.
Collapse
Affiliation(s)
- Eric Judd
- University of Alabama at Birmingham, Birmingham, AL.
| | | | | |
Collapse
|
835
|
Fukuda H, Munoz D, Macdonald RL. Spontaneous thalamic hemorrhage from a lateral posterior choroidal artery aneurysm. World Neurosurg 2013; 80:900.e1-6. [PMID: 23396071 DOI: 10.1016/j.wneu.2013.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 02/01/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The authors report a case of lateral posterior choroidal artery pseudoaneurysm that caused a spontaneous thalamic hemorrhage. The case supports obtaining computed tomographic angiography (CTA) even in seemingly routine cases of hypertensive hemorrhage and demonstrates a possibly unreported type of aneurysm causing thalamic hemorrhage. CASE DESCRIPTION A 60-year-old man with a history of hypertension presented with a spontaneous right thalamic hemorrhage, and CTA showed a focus of contrast inside the hematoma. One month later, the patient was well but a CTA showed that the hematoma had resolved but that there was enlargement of the contrast-enhancing lesion in the thalamus. Catheter angiography showed an aneurysm of the lateral posterior choroidal artery. This was excised via an occipital interhemispheric supratentorial subcallosal approach. The patient recovered fully and returned to work 3 months later. CONCLUSION The case shows the need to carefully review CTA after ICH, even in cases of seemingly typical hypertensive ICH.
Collapse
Affiliation(s)
- Hitoshi Fukuda
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada; Labatt Family Centre of Excellence in Brain Injury and Trauma Research Toronto, Ontario, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
836
|
Marschner-Preuth N, Warnecke T, Niederstadt TU, Dittrich R, Schäbitz WR. Juvenile stroke: cervical artery dissection in a patient after a polytrauma. Case Rep Neurol 2013; 5:21-5. [PMID: 23466599 PMCID: PMC3573792 DOI: 10.1159/000347001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (poly)trauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms. We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm. To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary.
Collapse
Affiliation(s)
- Nicole Marschner-Preuth
- Department of Neurology, University Hospital of Münster, Münster, Bielefeld, Germany ; Department of Department of Neurology, Bethel Evangelisches Krankenhaus of Bielefeld, Bielefeld, Germany
| | | | | | | | | |
Collapse
|
837
|
Chen Z, Zhang J, Miao H, Niu Y, Feng H, Zhu G. Delayed rupture of iatrogenic cerebral pseudoaneurysms after neurosurgical procedures: report of two cases. Clin Neurol Neurosurg 2013; 115:1552-4. [PMID: 23369400 DOI: 10.1016/j.clineuro.2012.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/18/2012] [Accepted: 12/28/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | | | | | | | | | | |
Collapse
|
838
|
Affiliation(s)
- Jer-Shen Chen
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, Banqiao, New Taipei City, Taiwan.
| | | | | | | |
Collapse
|
839
|
Shah KJ, Halaharvi DR, Franz RW, Jenkins Ii J. Treatment of Iatrogenic Pseudoaneurysms Using Ultrasound-Guided Thrombin Injection over a 5-Year Period. Int J Angiol 2012. [PMID: 23204825 DOI: 10.1055/s-0031-1295521] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
In this study we demonstrate that ultrasound (US)-guided injection of thrombin is a safe and effective way to treat iatrogenic pseudoaneurysms as a new treatment modality at a 650-bed urban community hospital. We included retrospective chart review of patients who were treated for iatrogenic pseudoaneurysms from January 2004 to June 2010 at a single institution. All patients' pseudoaneurysms were treated using US-guided thrombin injection. This study demonstrated an overall success rate of 97.1% in treating iatrogenic pseudoaneurysms in 33 of 34 patients. One patient underwent open surgical repair. No mortality or complications were noted. The study was successful in demonstrating that the US-guided injection of thrombin is an efficacious way to treat iatrogenic pseudoaneurysms and can be safely implemented as a new treatment modality by appropriately trained vascular surgeons. A review of different techniques is included. An algorithm for the treatment of iatrogenic pseudoaneurysms is proposed from this study.
Collapse
Affiliation(s)
- Kaushal J Shah
- Department of Vascular Surgery, Grant Vascular and Vein Center, Grant Medical Center, Columbus, Ohio
| | | | | | | |
Collapse
|
840
|
Abstract
Pseudoaneurysms are rare complications of chronic pancreatitis and are associated with a high mortality. In this article we demonstrate a novel utilization of endoscopic ultrasound (EUS) technology to embolize a large pancreatic pseudoaneurysm when gold standard therapies had proven futile.
Collapse
Affiliation(s)
- Paul M Robb
- Virginia Tech-Carilion School of Medicine, Department of Internal Medicine, Roanoke, USA
| | - Paul Yeaton
- Virginia Tech-Carilion School of Medicine, Department of Gastroenterology, Roanoke, USA
| | - Thomas Bishop
- Virginia Tech-Carilion School of Medicine, Department of Interventional Radiology, Roanoke, USA
| | - John Wessinger
- Virginia Tech-Carilion School of Medicine, Department of Interventional Radiology, Roanoke, USA
| |
Collapse
|
841
|
Chakrabarty S, Majumdar SK, Ghatak A, Bansal A. Management of pseudoaneurysm of internal maxillary artery resulting from trauma. J Maxillofac Oral Surg 2015; 14:203-8. [PMID: 25838698 DOI: 10.1007/s12663-012-0427-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/15/2012] [Indexed: 10/27/2022] Open
Abstract
Pseudoaneurysm of internal maxillary artery following trauma is a rare clinical entity. A rapidly growing swelling in the facial region following fracture of the mandibular subcondylar region is an indication of a developing aneurysm. A case of pseudoaneurysm of the internal maxillary artery following condylar fracture of mandible is reported. The case was treated successfully by surgery.
Collapse
|
842
|
Park CY, Ju JK, Kim JC. Damage control surgery in patient with delayed rupture of pseudoaneurysm after blunt abdominal trauma. J Korean Surg Soc 2012; 83:119-22. [PMID: 22880189 PMCID: PMC3412185 DOI: 10.4174/jkss.2012.83.2.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/28/2012] [Accepted: 04/22/2012] [Indexed: 11/30/2022]
Abstract
Delayed rupture of post-traumatic pseudoaneurysms of the visceral arteries, especially the pancreaticoduodenal artery, is uncommon. Here, we describe a 55-year-old man hemorrhaging from a pseudoaneurysm of the inferior pancreaticoduodenal artery (IPDA). Computed tomography of the abdomen showed active bleeding in the IPDA and large amounts of hemoperitoneum and hemoretroperitoneum. Selective mesenteric angiography showed that the pseudoaneurysm arose from the IPDA, and treatment by angioembolization failed because the involved artery was too tortuous to fit with a catheter. Damage control surgery with surgical ligation and pad packing was successfully performed. The patient had an uncomplicated postoperative course and was discharged 19 days after the operation. To our knowledge, this is the first report of ruptured pseudoaneurysm of an IPDA after blunt abdominal trauma from Korea.
Collapse
Affiliation(s)
- Chan Yong Park
- Division of Trauma Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | | | | |
Collapse
|
843
|
Khoshnevis J, Sobhiyeh MR, Fallah Zavareh M. Deep femoral artery branch pseudoaneurysm after orthopedic procedure requiring surgical treatment: a case report. Trauma Mon 2012; 17:305-8. [PMID: 24350112 PMCID: PMC3860639 DOI: 10.5812/traumamon.5181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 05/08/2012] [Accepted: 06/09/2012] [Indexed: 11/16/2022] Open
Abstract
Pseudoaneurysms (PSA) of deep femoral artery (DFA) have been reported following penetrating and blunt trauma to the thigh and orthopedic procedures of the proximal femur. We describe a case of pseudoaneurysm of DFA as a late complication of limb trauma which was confirmed by exploration in an urgent surgery. After two operations successful surgical repair was performed.
Collapse
Affiliation(s)
- Jalalludin Khoshnevis
- Department of General and Vascular Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Shohada Tajrish Hospital, Tehran, IR Iran
| | - Mohammad Reza Sobhiyeh
- Department of General and Vascular Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Shohada Tajrish Hospital, Tehran, IR Iran
- Corresponding author: Mohammad Reza Sobhiyeh, Department of General and Vascular Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Shohada Tajrish Hospital, Tehran, IR Iran. Tel/Fax: +98-2122721144,
| | - Mahtab Fallah Zavareh
- Department of General and Vascular Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Shohada Tajrish Hospital, Tehran, IR Iran
| |
Collapse
|
844
|
Fukatsu K, Ueda K, Maeda H, Yamashita Y, Itonaga M, Mori Y, Moribata K, Shingaki N, Deguchi H, Enomoto S, Inoue I, Maekita T, Iguchi M, Tamai H, Kato J, Ichinose M. A case of chronic pancreatitis in which endoscopic ultrasonography was effective in the diagnosis of a pseudoaneurysm. World J Gastrointest Endosc 2012; 4:335-8. [PMID: 22816016 PMCID: PMC3399014 DOI: 10.4253/wjge.v4.i7.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 04/26/2012] [Accepted: 05/27/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasonography (EUS) was performed on a patient being treated for chronic pancreatitis because a submucosal tumor was observed in the stomach during gastrointestinal endoscopy. As internal pulsatile blood flow on Doppler was present, the diagnosis of an aneurysm was made. The pseudoaneurysm of the left gastric artery was embolized with histoacryl and lipiodol and the splenic artery was embolized with coils at the location of the pseudoaneurysm to prevent hemorrhage. Follow up EUS confirmed the cessation of blood flow from the pseudoaneurysm. Clinicians encountering a gastric submucosal tumor-like protrusion in a patient with chronic pancreatitis should use EUS to investigate the possibility of a pseudoaneurysm, which must be treated as quickly as possible once identified.
Collapse
Affiliation(s)
- Kazuhiro Fukatsu
- Kazuhiro Fukatsu, Kazuki Ueda, Hiroki Maeda, Yasunobu Yamashita, Masahiro Itonaga, Yoshiyuki Mori, Kosaku Moribata, Naoki Shingaki, Hisanobu Deguchi, Shotaro Enomoto, Izumi Inoue, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Jun Kato, Masao Ichinose, Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-0012, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
845
|
Ahmadi F, Zabihiyeganeh M, Abdollahi M. Coil embolization of persistent sciatic artery pseudoaneurysm presenting as blue toe syndrome, a rare case. Indian J Surg 2012; 75:316-8. [PMID: 24426603 DOI: 10.1007/s12262-012-0665-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 06/21/2012] [Indexed: 10/28/2022] Open
Abstract
In this report, a case of blue toe syndrome related to persistent sciatic artery pseudoaneurysm in a 63-year-old woman, which was diagnosed by selective angiography, is presented. The pseudoaneurysm was successfully treated with coil embolization with good clinical results. A persistent sciatic artery is a rare embryological anomaly that occurs when the sciatic artery fails to regress during fetal development. Therefore, thromboembolisms from persistent sciatic artery aneurysm are rare.
Collapse
Affiliation(s)
- Farideh Ahmadi
- Department of Rheumatology, Firouzgar General Hospital, Tehran University of Medical Sciences (TUMS), Karimkhan Zand Street, Tehran, Iran
| | - Mozhdeh Zabihiyeganeh
- Department of Rheumatology, Firouzgar General Hospital, Tehran University of Medical Sciences (TUMS), Karimkhan Zand Street, Tehran, Iran
| | - Mahsa Abdollahi
- Department of Rheumatology, Firouzgar General Hospital, Tehran University of Medical Sciences (TUMS), Karimkhan Zand Street, Tehran, Iran
| |
Collapse
|
846
|
Maeba H, Miyasaka Y, Kotaka A, Tsujimoto S, Yuasa F, Iwasaka T. Pseudoaneurysm with left-to-right shunt in a patient with myocardial infarction: evaluation by three-dimensional echocardiography. J Med Ultrason (2001) 2012; 39:169-72. [PMID: 27278977 DOI: 10.1007/s10396-012-0355-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 01/17/2012] [Indexed: 11/28/2022]
Abstract
It is often difficult to noninvasively differentiate a post-infarction left ventricular (LV) pseudoaneurysm from a post-infarction true aneurysm. A 66-year-old woman with a past history of inferior acute myocardial infarction was admitted to our hospital because of acute decompensated heart failure. Two-dimensional transthoracic echocardiography showed an aneurysm with a narrow orifice in the inferoposterior basal area. The pulmonary to systemic flow ratio (Q p/Q s) was 2.2:1, which corresponded to moderate left-right shunting. Three-dimensional transesophageal echocardiography (3D-TEE) showed the orifice in the perforated right ventricular basal area with a color jet through the orifice from the LV to the right ventricle. Collectively, based on the 3D-TEE findings, we diagnosed the case as inferoposterior pseudoaneurysm with a left-to-right shunt caused by myocardial infarction.
Collapse
Affiliation(s)
- Hirofumi Maeba
- Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
| | - Yoko Miyasaka
- Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Ayako Kotaka
- Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Satoshi Tsujimoto
- Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Fumio Yuasa
- Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Toshiji Iwasaka
- Division of Cardiovascular Disease, Department of Medicine II, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| |
Collapse
|
847
|
Yu YH, Sohn JH, Kim TY, Jeong JY, Han DS, Jeon YC, Kim MY. Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis. World J Gastroenterol 2012; 18:2291-4. [PMID: 22611325 PMCID: PMC3351782 DOI: 10.3748/wjg.v18.i18.2291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/28/2011] [Accepted: 03/10/2012] [Indexed: 02/06/2023] Open
Abstract
Hepatic artery pseudoaneurysm (HAP) is a very rare disease but in cases of complication, there is a very high mortality. The most common cause of HAP is iatrogenic trauma such as liver biopsy, transhepatic biliary drainage, cholecystectomy and hepatectomy. HAP may also occur with complications such as infections or inflammation associated with septic emboli. HAP has been reported rarely in patients with acute pancreatitis. As far as we are aware, there is no report of a case caused by acute idiopathic pancreatitis, particularly. We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman. The woman initially presented with acute pancreatitis due to unknown cause. After conservative management, her symptoms seemed to have improved. But eight days after admission, abdominal pain abruptly became worse again. Abdominal computed tomography (CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT. Endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain. ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram. Without any particular treatment such as embolization or surgical ligation, HAP thrombosed spontaneously. Three months after discharge, abdominal CT demonstrated that HAP in the left lateral segment had disappeared.
Collapse
|
848
|
Chu KE, Sun CK, Wu CC, Yang KC. Complete remission of pancreatic pseudoaneurysm rupture with arterial embolization in a patient with poor risk for surgery: a case report. Case Rep Gastroenterol 2012; 6:254-9. [PMID: 22679414 PMCID: PMC3369412 DOI: 10.1159/000338845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis resulting from erosion of the pancreatic or peripancreatic artery into a pseudocyst that is identified as a pulsating vascular malformation which may lead to lethal complications if left untreated. Many publications in the literature consider angiography as the first step in the management of pancreatic pseudoaneurysm to stabilize the patient's critical condition; it should be followed by surgical intervention as the definite treatment. We report a rare case of pancreatic pseudoaneurysm rupture with hemodynamic embarrassment in a critical patient with multiple comorbid conditions and poor risk for surgery who responded dramatically to angiographic management as a single therapeutic modality without further surgical intervention. The results observed in our patient suggest that pancreatic pseudoaneurysm may be successfully managed with angiography only and that not all cases require surgical intervention. This is particularly relevant in critically ill patients in whom surgical intervention would be unfeasible.
Collapse
Affiliation(s)
- Kuang-En Chu
- Division of Gastroenterology, Department of Internal Medicine, Taipei, Taiwan
| | | | | | | |
Collapse
|
849
|
Abstract
Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.
Collapse
Affiliation(s)
- Jaideep U Barge
- Diagnostic and Interventional Radiology at University of Texas Health Science Center at San Antonio, San Antonio, TX 78249, USA.
| | | |
Collapse
|
850
|
Watanabe M, Shiozawa K, Mimura T, Ito K, Kamata I, Kishimoto Y, Momiyama K, Igarashi Y, Sumino Y. Hepatic artery pseudoaneurysm after endoscopic biliary stenting for bile duct cancer. World J Radiol 2012; 4:115-20. [PMID: 22468193 PMCID: PMC3314928 DOI: 10.4329/wjr.v4.i3.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 11/14/2011] [Accepted: 11/21/2011] [Indexed: 02/06/2023] Open
Abstract
We report a case of a pseudoaneurysm of the right hepatic artery observed 9 mo after the endoscopic placement of a Wallstent, for bile duct stenosis, which was treated with transcatheter arterial embolization. The patient presented with obstructive jaundice and was diagnosed with inoperable common bile duct cancer. A plastic stent was inserted endoscopically to drain the bile, and chemotherapy was initiated. Abdominal pain and jaundice appeared approximately 6 mo after the beginning of chemotherapy. A diagnosis of stent occlusion and cholangitis was made, and the plastic stent was removed and substituted with a self-expandable metallic stent (SEMS) endoscopically. Nine months after SEMS insertion, contrast-enhanced computed tomography showed a pseudoaneurysm of the right hepatic artery protruding into the common bile duct lumen and in contact with the SEMS. The shape and size of the pseudoaneurysm and diameter of its neck was determined by contrast-enhanced ultrasonography using Sonazoid. A micro-catheter was led into the pseudoaneurysm in the right hepatic artery, GDC™ Detachable Coils were placed, and IDC™ Detachable Coils were then placed in the right hepatic artery on the distal and proximal sides of the pseudoaneurysm using the isolation method. There have been a few reports on pseudoaneurysm associated with stent placement in the biliary tract employing percutaneous transhepatic procedures, however, reports of pseudoaneurysms associated with endoscopic SEMS placement are very rare.
Collapse
|