A rare case of spontaneous thrombosis in saccular cerebral aneurysm in a patient with subarachnoid hemorrhage

Cerebral aneurysm is a known cause of spontaneous subarachnoid hemorrhage (SAH). Furthermore, this condition is often asymptomatic, but the occurrence of a rupture can lead to fatal complications. The incidence of spontaneous thrombosis in saccular aneurysm is rare, with an incidence rate of 1%-2%. The most common sites include the middle cerebral artery (MCA) (41%), posterior communicating artery (PCOMM) (15%), and posterior inferior cerebellar artery (PICA) (11%). A head computed tomography angiography (CTA) with contrast is a common diagnostic tool for detecting SAH in the temporoparietal area, hippocampal gyrus, and right fissure of Sylvie. In some cases, saccular aneurysm can be found in the segment bifurcation of the right middle cerebral artery. A cerebral angiography was carried out, specifically digital subtraction angiography, which revealed the presence of visible blister remnants of aneurysm in the form of spontaneous thrombosis. After 1 year, another angiography evaluation was performed to assess the condition of the patient. Furthermore, the results showed no evidence of recanalization and there were no new neurologic deficits. Although spontaneous thrombosis led to the healing of aneurysm in some cases, secondary recanalization remained a possibility. Therefore, it was essential to monitor any incidence of this complication. Precise knowledge of the mechanism of spontaneous thrombosis could lead to the development of new therapeutic approaches. Spontaneous thrombosis in cases of saccular aneurysm is a rare occurrence, which can provide temporary or permanent benefits to the patient. Therefore, periodic evaluation is required to assess the condition of the patient.

Saccular Aneurysm of the External Jugular Vein: An Unusual Cause of a Neck Mass

Venous aneurysms are rare cause of neck masses. Among neck veins, external jugular vein aneurysms are incredibly uncommon. We, herein, report the case of a 45-year-old woman who presented with a non-tender, non-pulsatile, progressively enlarging mass in the left supraclavicular region. B-mode and Doppler ultrasound examination showed a saccular dilatation of the external jugular vein. Saccular aneurysms of the external jugular vein are uncommon, and serious complications are rarely encountered. Ultrasonography with color flow duplex imaging can allow early detection of such venous aneurysms of the neck making the other imaging methods unnecessary.

Diagnostic dilemma: Saccular aneurysm or pseudoaneurysm of the ascending aorta with dissection above level of leaflets

BACKGROUND

In true aneurysm, the wall of aneurysm is composed of the normal histological components of aorta. A false aneurysm (pseudoaneurysm) represents a rupture which does not contain the normal histological components of aorta. It is a fibrous peel that has formed from a small perforation of aorta. We describe an unusual presentation that has signs which some of them are only manifested in true aneurysm and some others only in pseudoaneurysm.

CASE REPORT

An 85-year-old man underwent elective coronary angiography for chest pain work-up. Our evaluation by invasive angiography and CT angiography showed aortic dissection. In surgery we found that dissection flap was composed of some parts of intima and media layers. These signs leaded to confusing symptoms. Localized bulging of ascending aorta had continued to brachiocephalic artery (transverse arch involvement). Dissection flap was composed of some part of intima and media layers. It was a strange case, it was not solely a perivascular hematoma and it did not have all three layers of aorta wall. Partial aorta replacement was performed. The operation and recovery was uneventful.

CONCLUSION

This unusual presentation of disease has not been mentioned in literatures. Our experience can help to manage similar cases. This case was the first unusual presentation of its type.