Spontaneous Rupture of the Left Subclavian Artery in Neurofibromatosis

Spontaneous rupture of the branches of left subclavian artery: A case report and review of the literatures

RATIONALE

Spontaneous rupture of the branches of left subclavian artery (LSA) without any obvious risk factors is rare.

PATIENT CONCERNS

A 51-year-old female patient without history of trauma and hypertension complained about left chest pain.

DIAGNOSES

A chest Computed tomography (CT) scan revealed a large pleural effusion (PE) in the left thorax cavity and hemothorax was confirmed by thoracentesis.

INTERVENTIONS

The patient underwent surgery.

OUTCOMES

spontaneous rupture of the branches of LSAwas confirmed.

LESSONS

The patient recovered well and discharged after timely treatments. The unusual possibility should be paid attention in mind in acute chest pain cases.

Developing Cervical Hematoma Following Jaw Thrust Maneuver Triggered Diagnosis of Neurofibromatosis: A Case Report and Brief Literature Review

A 25-year-old man underwent an excision of a thigh mass under general anesthesia without any complication. After the operation, he developed oxygen desaturation requiring a jaw thrust maneuver. A rapidly expanding hematoma on the right side of the neck was formed shortly after the application of the maneuver. The patient was returned to the operation room for a neck exploration. Damage to the facial artery and vein was noted. Further evaluations confirmed the diagnosis of Neurofibromatosis type 1 (NF-1). It is recommended that considering the probable risk of arising hematoma in NF-1 patients, application of jaw thrust maneuver should be performed meticulously.

Complications of surgical treatment of pediatric spinal deformities

Surgery in a child with spinal deformity is challenging. Although current orthopedic practice ensures good long-term surgical results, complications occur. Idiopathic scoliosis represents the most extensively investigated deformity of the pediatric spine. Nonidiopathic deformities of the spine are at higher risk for perioperative and long-term complications, mainly because of underlying comorbidities. A multidisciplinary treatment strategy is helpful to assure optimization of medical conditions before surgery. Awareness of complications that occur during or after spine surgery is essential to avoid a poor outcome and for future surgical decision making. This article summarizes the complications of surgical treatment of the growing spine.

Endovascular Therapy for Subclavian Artery Rupture in von Recklinghausen Disease

Vascular anomalies are extremely rare in patients with von Recklinghausen disease. This report presents a case of an acute spontaneous subclavian artery rupture in a patient with von Recklinghausen disease. A 44-year-old woman with a history of neurofibromatosis type 1, multiple sclerosis, and aortic valve replacement experienced a ‘‘popping sensation’’ in her neck. An emergent angiogram via a right brachial artery approach revealed active extravasation of contrast from the proximal part of the right subclavian artery between the vertebral and axillary arteries. An 8 mm × 5 cm endoprosthesis stent graft was placed across the area of extravasation via the brachial sheath. Completion angiography revealed brisk flow through the stent graft with resolution of the area of extravasation and no residual stenosis. Arterial rupture, aneurysm formation, stenosis, and dissection can be fatal in patients with neurofibromatosis. Further research is needed to determine screening guidelines and management algorithms for this patient population.

Ruptured subclavian artery pseudo-aneurysm associated with Neurofibromatosis type 1

OBJECTIVE

A subclavian artery aneurysm associated with Neurofibromatosis type 1 (NF 1) is extremely rare. We report a ruptured pseudo-aneurysm of the subclavian artery in a patient with NF 1 treated with endovascular surgery.

CLINICAL DESCRIPTION

A 51 year old man with NF 1 presented with initially sudden left neck pain and continuous dysphagia. Radiological examination showed a pseudo-aneurysm of the left subclavian artery. Endovascular stenting and coil embolisation was performed to prevent rebleeding and the lesion was completely obliterated. Follow-up angiography at 3 months revealed good flow through the stent without flow into the pseudo-aneurysm.

CONCLUSION

Our patient is the first reported example of successful endovascular treatment for a ruptured subclavian artery pseudo-aneurysm associated with NF 1. Endovascular stenting and coil embolisation for the ruptured subclavian artery pseudo-aneurysm was very effective.

Ruptured left subclavian artery aneurysm presenting as upper airway obstruction in von Recklinghausen's disease

Aneurysms arising from the subclavian artery are very rare vascular abnormalities in von Recklinghausen's disease, which often have a silent clinical presentation and are difficult to diagnose before rupture. We report a case of von Recklinghausen's disease with life-threatening upper airway obstruction caused by spontaneous rupture of the left subclavian artery aneurysm in a 46-year-old woman. The diagnosis was eventually confirmed by a reconstructed enhanced computed tomography of aorta. We emphasise the importance of it as a differential diagnosis because life-threatening upper airway obstruction may develop in such patient.

Ruptured Aneurysm of the Subclavian Artery in a Patient With von Recklinghausen's Disease

A vascular manifestation of von Recklinghausen's disease is rare, but may be fatal if it is disrupted. A 39-year-old male with von Recklinghausen's disease presented with a large and tender bruise extending from his left neck to his left shoulder and arm. Computerized axial tomography revealed a ruptured aneurysm of the left subclavian artery. The patient underwent emergency surgery to exclude the aneurysm, and cross-over bypass grafting of both subclavian arteries was performed. We present a brief review of vascular maintestation of von Recklinghausen's disease, as well as a discussion regarding the strategy for treating this rare presentation.