Some popliteal aneurysms are congenital

Although the majority of popliteal aneurysms are of atherosclerotic origin and are discovered in patients aged more than 50, the aetiology of a small minority may be attributed to arterial trauma, septic disruption, Behcet's disease, a medial fibromuscular dysplasia, or popliteal entrapment. The aim of this study was to propose a possible congenital origin for popliteal aneurysms without evidence of any other aetiology. A retrospective review of five younger patients (aged 20-45 years) with seven non-atherosclerotic popliteal aneurysms was performed. In patient nos 1 and 2, histological examination showed that the arterial wall had been replaced by an abundant collagenic tissue. After replacement by a saphenous bypass graft, these patients did well with a follow-up ranging from 1 to 15 years. Patient no. 3 was not operated on because of a symptomless occlusion of the tibial and peroneal arteries, and remains well 10 years later. Patients nos 4 and 5 were treated with a saphenous bypass graft. The last patient also had associated bilateral congenital anomalies of the division of the popliteal arteries. In the absence of any evidence of any classical aetiology, particularly fibromuscular dysplasia and popliteal entrapment, a congenital aetiology is proposed in aneurysms diagnosed in younger patients. The complex composition of the popliteal artery, being composed by an association of three original segments, may induce a fragility of the arterial wall that may be responsible for aneurysmal deterioration as well as abnormal branching or popliteal artery entrapment. These aneurysms are associated with the same risk of thrombosis as atherosclerotic aneurysms and therefore, they should be subjected to the same therapeutic considerations.

Pulmonary artery aneurysm: is surgery always indicated?

The authors present a seventy-eight year old woman with an aneurysm of the main pulmonary artery. Although a surgical approach is generally considered life-saving by preventing rupture of the aneurysm, literature is unclear about possible rupture in the specific situation of a pulmonary artery aneurysm without a causative cardiac lesion and/or pulmonary hypertension. In fact, some reports suggest a conservative treatment for this specific entity. Therefore we did not operate on our patient and she remains stable at 18 months follow-up.

Spontaneous regression of aneurysmal nonpatent ductus arteriosus: report of a neonate case

We report a newborn baby boy with an aneurysmal ductus arteriosus, that underwent spontaneous regression in the 2 years follow-up. Plain chest films showed the clue. Echocardiography, magnetic resonance imaging and angiocardiography are helpful in the differential diagnosis of other superior mediastinal mass. Perinatal asphyxia and hypoxemia may contribute to the formation of the ductal aneurysm. Intravenous infusion of dopamine and dobutamine may precipitate the nonpatency of the ductal aneurysm.

Extrahepatic portal obstruction without hepatopetal pathway associated with congenital arterioportal fistula: a case report

Extrahepatic portal obstruction is one of the causes of portal hypertension, in which well-developed hepatopetal pathways are commonly recognized. Herein an extremely rare case of extrahepatic portal obstruction without hepatopetal pathway, probably caused by arterioportal fistula, is reported. The patient was a normally matured 16-year-old girl admitted for further evaluation of jaundice, presenting with the clinical manifestations of the portal hypertension associated with hypersplenism and portosystemic venous shunt. Celiac angiography clearly demonstrated an intrahepatic arterial aneurysm fed by the right hepatic artery shunting to the superior mesenteric vein, and portography disclosed complete obstruction of the portal trunk with conspicuous hepatofugal pathway but no hepatopetal collateral veins. The exact mechanism of this phenomenon is not known and whether the extrahepatic portal obstruction was primary or secondary is still obscure. However, this is the first case report in the world literature describing extrahepatic portal obstruction with absence of hepatopetal pathway.

A case of neonatal ductus arteriosus aneurysm

A case of successfully operated neonatal ductus arteriosus aneurysm is described. Cardiac catheterization was performed to confirm the diagnosis because of a misinterpretation of the anatomy on transthoracic echocardiography. Rupture, embolism and infection are described complications of such aneurysms. Surgery should therefore be recommended without delay.

Clinicopathologic findings in congenital aneurysms of the great vessels

We describe the clinical, histopathologic, and angiographic findings in four children with congenital abnormalities of the great vessels of unknown cause, comprising either single or multiple arterial aneurysms, aortic/arterial dilatation, vessel tortuosity, or combinations of these abnormalities. Two children had early and severe respiratory distress due to aneurysmal compression of the trachea. All children had diffuse dilatation of several arteries, and two children also had tortuosity of multiple arteries. Progression of these abnormalities was clearly evident in one child, in whom diffuse vessel irregularity and tortuosity affected intra-abdominal, and intra and extra-cranial arteries. One child died at 5 years, while the other three have undergone successful surgical repair in the first 3 months of life and are now well, between age 2.5 and 7 years. The phenotype of each child appears unique but all have in common the rare finding of aneurysms of the aorta and main pulmonary artery. Congenital aortic aneurysms did not occur as an isolated finding in any of these children.

Superior mesenteric venous aneurysm

The case of a 50-year-old woman with an extremely rare venous malformation of the portal venous system is reported. The patient presented with a true aneurysm of the superior mesenteric vein, which has thus far been reported in no more than eight cases worldwide. This malformation may be congenital or acquired. Secondary aneurysms are thought to be due to liver disease, portal hypertension, trauma, or inflammation. Aneurysms of the portomesenteric venous system may be asymptomatic or give rise to severe, often dramatic conditions such as crampy abdominal pain, jaundice, and upper gastrointestinal hemorrhage secondary to portal hypertension. The diagnosis is usually made by ultrasound (B-mode or color flow Doppler), CT scan, and MRI. Invasive procedures such as venous phase mesenteric arteriography or splenoportography may be helpful in confirming it. In our opinion aneurysms of the portal venous system, even if they are congenital and (still) asymptomatic, require early surgical control because the prognosis for patients with these aneurysms is unpredictable and potential complications (e.g., portal hypertension, fistula, contained perforation, or rupture) may be fatal. In the case presented the mesenteric venous aneurysm was resected and the confluent veins were reconstructed.

Unruptured aneurysm of the sinus of Valsalva

A 50-year-old man with 'presyncope' is presented. He was found to have an aneurysm of the right coronary sinus of Valsalva and an aneurysm of the noncoronary sinus. Neither aneurysm had ruptured. It is postulated that the patient's symptoms were related to partial obstruction of the right ventricle. Other potential complications of an unruptured aneurysm of the sinus of Valsalva are discussed.

Unusual manifestation of a vein of Galen malformation: value of CT angiography

We describe a neonate with aneurysmal dilatation of the vein of Galen with arteriovenous fistulous sites located at the superior vermian vein. Helical CT angiography was useful for evaluating the anomalous vessels.

Congenital mesenteric aneurysm and mesenteric arterioportal fistula

A unique case with superior mesenteric artery aneurysm and arterioportal fistula resulting from mesenteric arteriovenous malformation is presented, and the relevant literature is reviewed.

Repair of an aneurysm of the left main coronary artery

Coronary artery aneurysms are rare, especially in the left main coronary artery. Coronary artery aneurysms may rupture or cause myocardial infarction. There are only a few reports of coronary artery aneurysms of the left main coronary artery treated surgically. We report a case in which an arterial graft from the internal iliac (hypogastric) artery was used for the reconstruction of a congenital coronary artery aneurysm of the left main coronary artery. After a follow-up of 5 years, the patient is well and in good condition.

Congenital internal jugular venous aneurysm: diagnosis and treatment

The diagnosis, preoperative work-up, and treatment of a neck mass can be extensive and complex. We report a case of an adolescent female who presented with a soft compressible mass in her neck that became more prominent during phonation (singing). Dynamic magnetic resonance imaging (MRI) confirmed this mass to be an isolated dilation of the internal jugular vein. The patient subsequently underwent an uncomplicated cosmetic excision of a large venous aneurysm. We recommend dynamic MRI as a useful noninvasive exam in the preoperative evaluation of this rare entity.

[Indirect azygos vein continuation syndrome with segmental agenesis and saccular aneurysm of the inferior vena cava]

Indirect vena azygos continuation syndrome and aneurysm are rare variations of the inferior vena cava (IVC). In this article we describe the ultrasound, angiographic and CT appearance of a 14-year-old girl with this congenital anormaly of the IVC.

Classification of congenital arterial and venous vascular malformations

Arterial and venous vascular malformations due to congenital abnormalities rarely occur in the daily practice of vascular surgeons. These malformations represent a heterogeneous group of isolated or multiple congenital abnormalities, sometimes associated with complex congenital syndromes. Correct recognition and classification of these rare abnormalities may sometimes be difficult. No systematic classification of arterial and/or venous vascular malformations due to congenital abnormalities is currently available. On the basis of embryologic and pathophysiologic considerations, a rational and simple classification of arterial and venous vascular malformations due to congenital abnormalities can be performed. This contribution presents an appropriate classification of clinically important arterial and venous vascular malformations due to congenital abnormalities.

Congenital aneurysm of the internal jugular vein in a pregnant woman

A pregnant woman with a symptom-free congenital aneurysm of the internal jugular vein (IJV) is described. A color duplex scan revealed an aneurysm (2.4 cm in diameter) of the right IJV in the mid-neck without evidence of thrombus. To the authors' knowledge, this is the first reported case demonstrating that such a lesion in a pregnant woman can be safely managed without excision.

Rupture of congenital peripheral pulmonary aneurysm

A 58-year-old man presenting with solitary aneurysm of a peripheral pulmonary artery was treated by left lower lobectomy. Histologically, the aneurysmal wall showed medial hypertrophy with the loss of smooth muscle fibers, without evidence of a mycotic process or inflammatory exudate. The aneurysm appeared to be congenital in origin.

Anomalous splenic artery aneurysm: demonstration on CT scanning and angiography

An asymptomatic 35-year-old female was found to have a congenital aneurysm of an anomalous splenic artery arising from the superior mesenteric artery on routine investigation for infertility. Demonstration on CT and angiography is presented and the pathogenesis, natural history, management, and implications during pregnancy are discussed.

Congenital and acquired aneurysmal disease

Finding an aneurysm in a child is a rare event that should prompt careful evaluation for a secondary disease or a history of trauma or serious infection. Although congenital and idiopathic aneurysms do occur, almost all aneurysms seen in children are acquired. The majority of true aneurysms (including mycotic aneurysms) occur in the aorta, with the primary branches of the aorta (such as the renal or iliac arteries) the next most common site. Most false aneurysms are caused by trauma and usually present in the extremities. Treatment is surgical resection and vascular reconstruction except in patients with arteritis and small stable aneurysms.

Airway compromise secondary to vascular compression in a neonate

Respiratory distress in the neonate may be due to extrinsic tracheobronchial compression. We recently observed a neonate with left mainstem bronchus obstruction resulting in respiratory distress and mediastinal shift. Initial management required intubation and positive pressure ventilation. Bronchoscopic evaluation demonstrated compression of the proximal left main bronchus. The distal bronchus appeared normal. Bronchography, echocardiography and an MRI of the chest confirmed proximal compression of the bronchus and suggested that the cause was an aneurysmal left pulmonary artery and patent ductus arteriosus. With medical therapy there was resolution of the bronchial compression. Re-evaluation by bronchoscopy and echocardiography revealed a normal left main stem bronchus, a normal left pulmonary artery and a closed ductus arteriosus. This clinical scenario suggests that transient pulmonary hypertension may result in significant airway compression due to the proximity of the left main stem bronchus to the left pulmonary artery.

Congenital internal carotid artery aneurysm

Congenital carotid aneurysms are frequently found in the intracranial arteries but rarely seen in extracranial part of the internal carotid artery. A case of a congenital internal carotid artery aneurysm at the skull base was treated in a 13-year-old female child. This case is being presented for its rarity and also to highlight the ease of exposing the upper end of the aneurysm via lateral skull base approach. Infratemporal fossa approach was adopted in this case. The carotid canal was drilled off and the upper end of the aneurysm in the intrapetrous part was mobilized and vascular clip applied before dissection of the aneurysm. Relevant literatures pertaining to this case are also reviewed.

Diffuse arterial aneurysms in a case of Ehlers-Danlos syndrome--a case report

A three-year-old boy with the diagnosis of Ehlers-Danlos syndrome (EDS) with persistent ductus arteriosus and multiple diffuse arterial aneurysms is presented. The case is classified as "EDS type unknown" because the clinical features and the inheritance pattern differ from the types described previously. It is stressed that the diagnosis of the disease is important for genetic counseling and surgical intervention.