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Balloon-assisted, ultrasound-guided percutaneous real-time thrombin injection, for the arteriovenous fistula pseudoaneurysm treatment. Radiol Case Rep 2023; 18:524-526. [DOI: 10.1016/j.radcr.2022.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/12/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
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Fibrocartilaginous embolism of the posterior spinal artery: A case report regarding the responsible intervertebral disc on magnetic resonance imaging. Spinal Cord Ser Cases 2022; 8:10. [PMID: 35042845 PMCID: PMC8766554 DOI: 10.1038/s41394-022-00477-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Fibrocartilaginous embolism (FCE) of the spinal cord is an ischemic myelopathy caused by rupture of the intervertebral disc and subsequent entrance of the nucleus polposus material into the nearby vasculature. However, responsible disc lesions frequently cannot be determined, which may cause diagnostic difficulty. CASE PRESENTATION A 63-year-old man suddenly felt a strange sensation in the lower limbs and noticed that he could not walk. The patient was brought to our hospital, where he was hospitalized. On neurological examination, his proprioception and vibratory sense were disturbed in the lower limbs. Spine magnetic resonance imaging (MRI) revealed a hyperintense cord lesion located at the C4-5 vertebral level of the posterior spinal artery region on diffusion-weighted sequence. He was diagnosed as having spinal cord infarction and treated with antiplatelet medication. Follow-up MRI was performed 5 days later, which displayed a collapsed C3/4 disc and a defected C4 vertebral body that were not evident on earlier MRI. These findings suggested the disc lesion was active and responsible for the infarction, leading to the diagnosis of FCE. The patient gradually improved and had no gait difficulty at the time of discharge. DISCUSSION In the presented case, MRI did not reveal the responsible disc lesion when the diagnosis of spinal cord infarction was made; however, it became evident 5 days later. Although such a disc signal change within several days has not been described as a clue suggesting FCE, follow-up MRI with a relatively short interval may elucidate the responsible lesion and correct diagnosis.
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Abstract
BACKGROUND Fibrocartilaginous embolism (FCE) is a rare cause of pediatric ischemic myelopathy. The pathology is thought to result from fragmentation with embolization into the microvasculature of the radicular artery often secondary to high axial force. While most cases arise in the setting of vigorous activity, our case reveals that FCE can also occur during relative physical inactivity. Additionally, while a majority of cases are associated with neck or back pain, our case also reveals that FCE can present without concurrent pain episodes. We describe a rare case of spinal cord infarction (SCI) likely due to FCE in a 14 year old male. Our patient was sitting with his feet elevated, playing a video game, when he developed sudden difficulty moving his arms. Initially presenting with a negative MRI scan and la belle indifference, our patient was suspected to exhibit functional quadraparesis secondary to psychosomatization/adjustment disorder. Repeat MR imaging 7 days later revealed typical findings for FCE with SCI (irregular, pencil-like T2 hyperintensity in the ventral cervical/upper thoracic cord and owl's eye pattern on axial images). Six months later, the diagnosis of FCE remains predominant. Our patient continues to improve with occupational and physical therapy. Ambulatory efforts and bladder function continue to progress. To improve functional gains, the patient is being considered for a chemodenervation procedure. CONCLUSION Our case reveals that FCE can occur during physical inactivity and present without concurrent pain. Outcome regarding pediatric fibrocartilaginous embolism is highly variant; however, the two largest outcomes reported were either patient death or discharge.
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Interventional treatment options in pseudoaneurysms: different techniques in different localizations. Pol J Radiol 2019; 84:e319-e327. [PMID: 31636766 PMCID: PMC6798774 DOI: 10.5114/pjr.2019.88021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 01/17/2023] Open
Abstract
Pseudoaneurysms are commonly experienced vascular abnormalities. The increase in the number of surgical and arteriographic procedures has caused a higher prevalence of pseudoaneurysms. Conventional angiography is still the gold standard method for diagnosis, but other imaging modalities such as duplex Doppler ultrasonography, magnetic resonance angiography and computed tomographic angiography are useful in noninvasive detection. Over the past few years, interventional radiological treatment has evolved and taken the place of surgery in management. There are different kinds of percutaneous and endovascular treatment methods in pseudoaneurysm management. Treatment options depend on certain conditions. We used a case-based approach to discuss pseudoaneurysms and their appropriate treatment by interventional radiological methods in this article.
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Sheikh A, Warren D, Childs AM, Russell J, Liddington M, Guruswamy V, Chumas P. Paediatric spinal cord infarction-a review of the literature and two case reports. Childs Nerv Syst 2017; 33:671-676. [PMID: 27889817 PMCID: PMC5382181 DOI: 10.1007/s00381-016-3295-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/02/2016] [Indexed: 11/30/2022]
Abstract
Ischemic spinal cord infarction is rare in the paediatric population, and when it does occur, it is usually associated with traumatic injury. Other potential causes include congenital cardiovascular malformations, cerebellar herniation, thromboembolic disease and infection. Magnetic resonance imaging (MRI) findings can be subtle in the early evaluation of such patients. The outcome is variable and depends on the level and extent of the spinal cord infarct and subsequent rehabilitation. Here, we present two cases of ischemic spinal cord infarction in children.
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Affiliation(s)
- Asim Sheikh
- Department of Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, UK.
| | | | | | | | | | | | - Paul Chumas
- Department of Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, UK
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Østerballe L, Helgstrand F, Axelsen T, Hillingsø J, Svendsen LB. Hepatic pseudoaneurysm after traumatic liver injury; is CT follow-up warranted? J Trauma Manag Outcomes 2014; 8:18. [PMID: 25780384 PMCID: PMC4360922 DOI: 10.1186/1752-2897-8-18] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 10/28/2014] [Indexed: 01/03/2023]
Abstract
Introduction Hepatic pseudoaneurysm (HPA) is a rare complication after liver trauma, yet it is potentially fatal, as it can lead to sudden severe haemorrhage. The risk of developing posttraumatic HPA is one of the arguments for performing follow-up CT of patients with liver injuries. The aim of this study was to investigate the occurrence of HPA post liver trauma. Methods A retrospective study from 2000-2010 of conservatively treated patients with blunt liver trauma was performed to investigate the incidence and nature of HPA. After the initial CT scan patients were admitted to the department and if not clinically indicated prior a follow-up CT was performed on day 4-5. Results A total of 259 non-operatively managed patients with liver injury were reviewed. 188 had a follow-up CT or US and in 7 patients a HPA was diagnosed. All aneurysms were treated with angiographic embolization and there were no treatment failures. There was no correlation between the severity of the liver injury and development of HPA. 5 out of 7 patients were asymptomatic and would have been discharged without treatment if the protocol did not include a default follow-up CT. Conclusions In conclusion, this study shows that HPA is not correlated to the severity of liver injury and it develops in 4% of patients after traumatic liver injury. In order to avoid potentially life-threatening haemorrhage from a post trauma hepatic pseudoaneurysm, it seems appropriate to do follow-up CT as part of the conservative management of blunt and penetrating liver injuries.
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Affiliation(s)
- Lene Østerballe
- Department of Surgery and Liver Transplantation C, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Frederik Helgstrand
- Department of Surgery and Liver Transplantation C, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Axelsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jens Hillingsø
- Department of Surgery and Liver Transplantation C, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Bo Svendsen
- Department of Surgery and Liver Transplantation C, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Three unique presentations of atraumatic spinal cord infarction in the pediatric emergency department. Pediatr Emerg Care 2014; 30:354-7. [PMID: 24786993 DOI: 10.1097/pec.0000000000000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nontraumatic spinal cord infarction is especially rare in children. Although diagnosis is easily made with magnetic resonance imaging, the typical presenting signs and symptoms and etiology remain elusive. Evidence-based treatment courses are not available. We assess a series of 3 unique patients with nontraumatic spinal cord infarction who presented to our emergency department over the course of 2 years. We consider their presentation, etiology, and treatment course to provide other emergency department physicians with the ability to better identify and evaluate these patients. We also note the need for further research on nontraumatic spinal cord infarction because these patients' outcomes can be quite devastating.
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Skattum J, Gaarder C, Naess PA. Splenic artery embolisation in children and adolescents--an 8 year experience. Injury 2014; 45:160-3. [PMID: 23137799 DOI: 10.1016/j.injury.2012.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/03/2012] [Accepted: 10/12/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-operative management (NOM) is the treatment of choice in blunt splenic injuries in the paediatric population, with reported success rates exceeding 90%. Splenic artery embolisation (SAE) was added to our institutional treatment protocol for splenic injury in 2002. We wanted to review indications for SAE and the clinical outcome of splenic injury management in children admitted between August 1, 2002 and July 31, 2010. METHODS Patients aged <17 years with splenic injury were identified in the institutional trauma and medical code registries. Patient charts and computed tomographic (CT) scans were reviewed. RESULTS Of the 72 children and adolescents with splenic injury included during the 8 year study period, 66 patients (92%) were treated non-operatively and six underwent operative management. Severe splenic injury (OIS grade 3-5) was diagnosed in 67 patients (93%). SAE was performed in 22 of the NOM patients. Indications for SAE included - bleeding (n=8), pseudoaneurysms (n=2), contrast extravasation (n=2), high OIS injury grade (n=8) and prophylactic due to specific disease (n=2). NOM was successful in all but one case (98%). For the patients aged ≤ 14 years, extravasation on initial CT scan correlated to delayed bleeding (p<0.001). Two SAE procedure specific complications were registered, but resolved without significant sequelae. CONCLUSION After SAE was added to the institutional treatment protocol, 22 of 66 NOM paediatric patients underwent SAE. NOM was successful in 98% and a 90% splenic preservation rate was achieved. Contrast extravasation correlated to delayed splenic bleeding in children ≤ 14 years.
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Affiliation(s)
- Jorunn Skattum
- Department of Traumatology, Oslo University Hospital Ullevaal, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
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Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury: multi-institutional study in Osaka, Japan. J Trauma Acute Care Surg 2013; 75:417-20. [PMID: 24089111 DOI: 10.1097/ta.0b013e31829fda77] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed rupture is well-known as a severe complication after splenic injury treated with nonoperative management (NOM). The incidence and timing of splenic pseudoaneurysm (SPA) formation, which is a cause of delayed rupture following splenic injury, have not been thoroughly investigated, and the timing of follow-up computed tomography (CT) is controversial. The objective of this study was to clarify the incidence and timing of both the delayed formation and spontaneous resolution of SPA following splenic injuries treated with NOM in several trauma centers in Japan. METHODS This was a retrospective review of all patients with documented blunt splenic injury who were treated with NOM from 2003 through 2010 in five trauma and critical care centers. RESULTS The present study consisted of 104 patients, including 16 patients (15.4%) with delayed formation of SPA (7 patients with Grade II and 9 with Grade III) during their clinical course. SPA was diagnosed with enhanced CT at a mean (SD) of 4.6 (2.1) hospital days (range, 1-8 days) after admission. Delayed formation of SPA was found in 30.4% of Grade II injuries and in 18.4% of Grade III injuries. Eight patients with delayed formation of SPA were observed without transcatheter arterial embolization during their entire stay. These SPAs were spontaneously occluded on follow-up enhanced CT or angiography. Spontaneous occlusion of SPA was confirmed at 5.2 (2.6) hospital days (range, 2-10 days) after diagnosis of delayed SPA. CONCLUSION Delayed formation of SPAs was recognized with enhanced helical CT in 15% of all patients during hospital Days 1 to 8. About one half of the SPAs had occluded spontaneously without therapeutic intervention. Our results suggested that follow-up enhanced CT performed approximately 1 week after splenic injury may be useful to detect delayed SPA formation. LEVEL OF EVIDENCE Epidemiologic study, level III.
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Martin K, Vanhouwelingen L, Bütter A. The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma. J Pediatr Surg 2011; 46:933-7. [PMID: 21616255 DOI: 10.1016/j.jpedsurg.2011.02.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Nonoperative management is the standard of care for hemodynamically stable pediatric and adult blunt splenic injuries. In adults, most centers follow a well-defined protocol involving repeated imaging at 24 to 48 hours, with embolization of splenic pseudoaneurysms (SAPs). In children, the significance of radiologically detected SAP has yet to be clarified. METHODS A systematic review of the medical literature was conducted to analyze the outcomes of documented posttraumatic SAP in the pediatric population. RESULTS Sixteen articles, including 1 prospective study, 4 retrospective reviews, and 11 case reports were reviewed. Forty-five SAPs were reported. Ninety-six percent of children were reported as stable. Yet, 82% underwent splenectomy, splenorrhaphy, or embolization. The fear of delayed complications owing to SAP was often cited as the reason for intervention in otherwise stable children. Only one child with a documented pseudoaneurysm experienced a delayed splenic rupture while under observation. No deaths were reported. CONCLUSIONS There is no evidence to support or dispute the routine use of follow-up imaging and embolization of posttraumatic SAP in the pediatric population. At present, the decision to treat SAP in stable children is at the discretion of the treating physician. A prospective study is needed to clarify this issue.
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Affiliation(s)
- Kathryn Martin
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
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Kapoor BS, Haddad HL, Saddekni S, Lockhart ME. Diagnosis and management of pseudoaneurysms: an update. Curr Probl Diagn Radiol 2009; 38:170-88. [PMID: 19464587 DOI: 10.1067/j.cpradiol.2008.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
"Pseudoaneurysm" is a term that describes disruption of an artery with patent flow in a defined space beyond the confines of the vessels. A pseudoaneurysm can involve any vascular bed and is usually associated with direct arterial injury or erosion of an artery by an adjacent tumor or inflammation. In this article, we discuss different clinical settings and various imaging modalities such as ultrasound, computerized tomography, magnetic resonance imaging, as well as conventional angiography used for the diagnosis of pseudoaneurysms. We also describe the role of newer endovascular, percutaneous, and traditional surgical approaches for the treatment of visceral and peripheral pseudoaneurysms in different clinical circumstances.
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Affiliation(s)
- Baljendra S Kapoor
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249-6830, USA.
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Inoue Y, Ikegawa H, Ukai I, Yoshiya K, Sumi Y, Ogura H, Kuwagata Y, Tanaka H, Shimazu T, Sugimoto H. Spontaneous occlusion of splenic and renal pseudoaneurysm after blunt abdominal trauma: a case report and literature review. J Emerg Med 2008; 38:e17-22. [PMID: 18180131 DOI: 10.1016/j.jemermed.2007.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 03/24/2007] [Accepted: 07/12/2007] [Indexed: 11/16/2022]
Abstract
Pseudoaneurysms caused by blunt abdominal trauma are rarely observed in solid organs. The preferred therapy for pseudoaneurysm after blunt abdominal trauma is often angiography and embolization. Here, we report a case of a spontaneous occlusion of splenic pseudoaneurysm and renal pseudoaneurysm after blunt abdominal trauma. Angiography and embolization were not required, and contrast-enhanced multi-detector computed tomography was used to monitor the patient. This case shows that spontaneous occlusion can be one of the possible outcomes of intraparenchymal splenic pseudoaneurysm and renal pseudoaneurysm after blunt abdominal trauma.
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Affiliation(s)
- Yoshiaki Inoue
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Tang LJ, Zipser S, Kang YS. Temporary spontaneous thrombosis of a splenic artery pseudoaneurysm in chronic pancreatitis during intravenous octreotide administration. J Vasc Interv Radiol 2005; 16:863-6. [PMID: 15947051 DOI: 10.1097/01.rvi.0000156190.98110.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Splenic artery pseudoaneurysm is a well-known and potentially life-threatening complication of pancreatitis for which immediate endovascular or surgical treatment is indicated. An unusual case of spontaneous thrombosis of a splenic artery pseudoaneurysm with associated partial splenic infarction was encountered in the setting of chronic pancreatitis during intravenous octreotide administration, with recanalization 9 months later.
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Affiliation(s)
- Linda J Tang
- Department of Diagnostic Imaging, Interventional Radiology Section, Santa Clara Valley Medical Center, 751 Bascom Avenue, San Jose, CA 95128, USA
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