Hepatic artery mycotic aneurysm of tubercular aetiology

Hepatic artery aneurysm caused by tuberculosis is extremely rare, the commonest being atherosclerosis and vasculitis. A 13 year boy admitted with suspected disseminated tuberculosis had a hepatic bruit. Patient died of aneurysmal rupture before antemortem etiological diagnosis could be established. Postmortem examination revealed widespread tubercular lesions in the chest and abdomen and hepatic artery aneurysm.     

Uncommon associations and catastrophic manifestation in Takayasu arteritis: an autopsy case report

Takayasu arteritis, a chronic inflammatory vasculitis affecting aorta and its major branches, is complicated by stenosis, occlusion, and aneurysm formation. The aneurysm formation and subsequent complications such as heart failure, aortic regurgitation, and aneurysm rupture can be fatal. The aortic aneurysm rupture is a rare and fatal complication with only a few cases reported in the English literature. The involvement of coronary artery in Takayasu occurs in about 10% patients, and the coronary artery aneurysm is the least common manifestation. Here, we describe a case of Takayasu arteritis with abdominal aortic aneurysm rupture and coronary artery aneurysm. This patient also had associated systemic inflammatory diseases like sarcoidosis and Hashimoto's thyroiditis.     

Imaging findings in a giant hepatic artery aneurysm

A rare case of relatively asymptomatic giant hepatic artery aneurysm of atherosclerotic aetiology is presented. The importance of imaging findings in the diagnosis of this condition and the differential diagnosis including the pertinent literature on the topic is discussed.     

Primary dissecting hepatic artery aneurysm in pregnancy.

A 32-year-old 32 weeks pregnant primigravida presented with acute abdomen and died 13 h later. She was normotensive during her antenatal period and on admission. At postmortem, a primary dissecting aneurysm of the main hepatic artery extending into its intrahepatic right branch was found. The cause of the dissection was presumably pregnancy-related.     

Congenital or berry aneurysm in the optic nerve

A case is presented of a 67-year-old woman with hypertension and arteriosclerosis who died from cerebral infarction. There was an associated arteriosclerotic aneurysm of the right vertebral artery, and incidental congenital or berry aneurysms of the anterior communicating and left internal carotid or anterior cerebral artery. The latter aneurysm was situated within the left optic nerve.     

Rare forms of renal hypertension

Summary In the present study 19 patients with rare forms of renal hypertension were investigated: 6 patients with renal artery aneurysm, 6 cases with unilateral hydronephrosis, 4 patients with unilateral simple renal cyst, 2 cases with coarctation of the abdominal aorta and associated renal artery stenosis and 1 patient with radiation nephritis.Renal venous renin activity (PRA) was determined in 17 of the 19 cases. Seven of these 17 (41%) patients showed significant PRA-ratios (PRA affected/PRA unaffected side 1.5). The percentage of positive tests was comparably high in the various subgroups except in patients with renal cyst, none of them showing lateralisation of renin secretion. Selective sampling in 2 patients with renal artery branch aneurysm revealed in both cases marked local renin oversecretion.Fifteen of the 19 patients (79%) were operated either by reconstruction surgery or nephrectomy. Four cases with a renal artery aneurysm were treated with antihypertensive drugs.Patients with unilateral hydronephrosis showed the best response to surgery in terms of cure rate (3 cured, 3 improved), whereas blood pressure normalisation could not be achieved in patients with simple renal cyst (2 improved, 1 unimproved). Patients with coarctation of the abdominal aorta and associated renal artery stenosis and the 2 operated cases with renal artery aneurysm showed a good effect of corrective surgery (2 cured, 2 improved). The patient with radiation nephritis finally was improved 2 years after nephrectomy.For the total group the prognostic validity of renal venous renin determination was limited. However, selective blood sampling from peripheral renal veins may be useful in cases with renal artery branch aneurysm to detect local oversecretion of renin.     

The importance of parent artery geometry in intra-aneurysmal hemodynamics

We show the importance of arterial geometry in intra-aneurysmal hemodynamics. Using a new geometric parameterized saccular aneurysm model including parameters for parent artery shape and the configuration of the aneurysm in the parent artery, we performed a parametric computational fluid dynamics study. We examined lateral saccular aneurysm models with different aneurysm shapes (i.e., the ratio of aneurysm height to aneurysm neck diameter) and different configurations (i.e., the torsion angle of the aneurysm to the upstream part of the parent artery). The aneurysm lateral to the curve of the parent artery had significantly higher wall shear stress than the aneurysm inside or outside the curve of the artery, even with the same shape of the aneurysm. Our findings suggest the important role played by the configuration of the aneurysm relative to the parent artery in intra-aneurysmal hemodynamics.     

Multiple focal nodular hyperplasia of the liver associated with vascular malformations of various organs and neoplasia of the brain: a new syndrome

Focal nodular hyperplasia (FNH) is a lesion of the liver in which a large anomalous artery is located within a region of hyperplastic hepatic parenchyma. Patients with FNH commonly have other lesions, often vascular in nature, in the liver or other organs. We have noted that these associated lesions almost always occur in patients with multiple FNH. We therefore studied 27 autopsied patients with FNH. All 13 with multiple FNH had other lesions such as hemangioma of liver, meningioma, astrocytoma, telangiectasis of the brain, berry aneurysm, dysplastic systemic arteries, and portal vein atresia. One patient had several of these lesions including multiple FNH, meningioma, astrocytoma, vascular malformation of the brain stem, and hemangioma of the liver. In contrast, among the 14 patients with solitary FNH there were no associated lesions, except for hepatic hemangioma in one patient. The prevalence of this syndrome was estimated by examination of 2500 serial autopsies and autopsies with various components of the syndrome. On review of 73 consecutive autopsies with meningioma, three had multiple FNH, compared with seven of 2500 consecutive adult autopsies (P less than 0.001). Multiple FNH was found in two of 83 autopsies with astrocytoma (P less than 0.05) and in one of 139 autopsies with berry aneurysm (not significant). We describe a telangiectatic subtype of FNH which occurs in this syndrome as well as in a minority of patients with solitary FNH. The existence and character of this syndrome suggest that there may be an underlying systemic abnormality in some patients having components of the syndrome. Investigation of patients with multiple FNH lesions may reveal significant treatable lesions.     

Homonymous hemianopia after embolization of an aneurysm-associated AVM supplied by the anterior choroidal artery

The primary objective for the treatment of arteriovenous malformations (AVM) of the brain is to reduce the risk of hemorrhage. The risk of hemorrhage is known to increase with the presence of an aneurysm associated with AVM. The purpose of this report is to describe the development of visual complications after the embolization of a hemorrhagic anterior choroidal artery feeding AVM with an associated aneurysm and to describe the possible causes.     

双椎动脉变异的影像学特点及临床意义-附3例报道

报道经血管造影证实的3例双椎动脉变异病例:2例为颅外段的椎动脉开窗畸形,其中1例伴有大脑中动脉分叉处动脉瘤,1例左椎动脉起于主动脉弓的变异;另1例为右侧椎动脉双起源变异,伴旁路血管内血栓形成。结合文献对这一现象的胚胎成因及临床意义进行了讨论。     

Endovascular treatment of bilateral carotid artery occlusion with concurrent basilar apex aneurysm: a case report and literature review

We report a case of successful endovascular treatment of bilateral carotid artery occlusion with concurrent basilar apex aneurysm. An elderly female patient with subarachnoid hemorrhage (SAH) onset was admitted to the hospital. Computed tomography (CT) and digital subtraction angiography (DSA) confirmed the presence of bilateral carotid artery occlusion with concurrent basilar apex aneurysm. Brain blood supply was provided by the bilateral vertebral artery through the basilar artery. We treated the aneurysm with the endovascular approach by embolizing the aneurysm with three coils. The patient recovered well after surgery and showed no recanalization of the aneurysm on a one-year follow-up DSA. We also reviewed six similar cases found with a PUBMED database search (1980-2010), including those with bilateral common carotid artery occlusion. In conclusion, by using the endovascular approach, bilateral carotid artery occlusion with concurrent basilar apex aneurysm was efficiently treated.     

Multiple intracranial aneurysms associated with branchio-oto-dysplasia

Branchio-oto-dysplasia is characterized by abnormalities of embryonic branchial arch system and deafness inherited as autosomal dominant with variable gene expression. We present a rare case of multiple intracranial aneurysms associated with branchio-oto-dysplasia. A 40-yr-old man with severe headache presented as spontaneous subarachnoid hemorrhage on brain computed tomographic scan. The patient also manifested clinical features of branchio-oto-dysplasia and right hemifacial hypoplasia. Carotid angiogram confirmed an aneurysm in the anterior communicating artery. Intraoperative findings demonstrated multiple aneurysms in the anterior communicating artery and in the left posterior communicating artery, which were clipped successfully. Postoperative course was uneventful. This condition has not been reported previously. We also reviewed literatures to discuss whether the intracranial aneurysm was as a coincidental finding or a part of this malformation.     

Gene expression profile of the intima and media of experimentally induced cerebral aneurysms in rats by laser-microdissection and microarray techniques

Cerebral aneurysm is a common disease with a high prevalence and can cause a catastrophic subarachnoid hemorrhage. To elucidate the molecular mechanism of the formation and progression of cerebral aneurysms, gene expression profiling was performed in experimentally induced rat cerebral aneurysms. The intima and media of cerebral arterial walls in rats with or without aneurysm induction were dissected respectively by a laser-microdissection technique. Changes in gene expression in the intima and media of aneurysmal walls were analyzed using Agilent Rat Oligo Microarrays, followed by a specific pathway analysis using GeneSpring software. Of the 41,012 genes examined, 633 were differentially expressed between a normal cerebral artery and a cerebral aneurysm in the intima, with 395 showing increased expression and 238 showing decreased expression. In the media, 1344 were differentially expressed, with 928 showing increased expression and 416 showing decreased expression. Specific pathway analysis revealed that increased gene expression was associated with proteinase, reactive oxygen species, growth factor, chemokine, complement, adhesion molecule and apoptosis in both the intima and the media of aneurysmal walls. Some genes showed an opposite expression pattern between the intima and the media indicating a different role between endothelial cells and vascular smooth muscle cells in cerebral aneurysm formation and progression. These data suggest that cerebral aneurysmal formation and progression are closely related to vascular inflammation, degeneration of extracellular matrix and apoptosis.     

原位肝移植供肝血管及胆道修整

目的探讨原位肝移植供肝血管及胆道系统的修整处理方法。方法回顾性分析31例原位肝移植其供肝动脉变异及胆道内异常情况的处理资料。结果肝动脉变异5例,其中2例肝左动脉来自胃左动脉,2例肝右动脉来自肠系膜上动脉,1例肝总动脉来自肠系膜上动脉。来自肠系膜上动脉的2例肝右动脉,1例吻合到脾动脉的断端;另1例将腹腔干吻合到肠系膜上动脉的近端。供肝的肝内胆管行冲洗时发现有寄生虫2例。结论避免变异的供肝动脉损伤,选择适当的肝动脉吻合方式可以保证移植肝脏的动脉血供。正确的供肝胆道处理,可以减少胆道的并发症。     

Early changes of experimentally induced cerebral aneurysms in rats. Light-microscopic study.

The changes of the anterior cerebral artery/olfactory artery junction, one of the favorite sites of aneurysm formation, in rats treated with unilateral ligation of the common carotid artery and renal hypertension were investigated by light microscopy. The initial changes of aneurysm occurred not at the apex itself, but on the distal side of the major branch adjacent to the apex, at the intimal pad and the neighboring distal portion. Here the internal elastic lamina showed various degenerative changes and disappearance. The neighboring distal portion adjacent to the intimal pad showed a shallow depression associated with a thinning of the media due to a decrease of medial smooth muscle cells in number even in some control animals. Such degenerative changes of the internal elastic lamina and medial smooth muscle cells caused by hemodynamic stress due to branching structure, including intimal pads, augmented by the experimental treatment, are supposed to be the basis for aneurysm formation.     

供肝修整过程中防止肝动脉损伤的解剖方法

目的　探讨供肝修整过程中防止肝动脉损伤的解剖方法。 方法　回顾性分析2004年8月至2010年11月202例供肝修整过程的资料,总结肝动脉变异情况及防止肝动脉损伤的解剖学方法。结果　肝动脉的变异率较高,202例中有21.8%肝动脉变异,5.0%在修整过程中发生肝动脉损伤。 结论 大多数的变异肝动脉来源于肠系膜上动脉和胃左动脉;肝动脉变异的存在增加了其损伤的危险性,经胃十二指肠动脉入路解剖肝动脉可有效防止肝动脉损伤。     

Clinical anatomy of the inferior phrenic artery

The majority of anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic artery (IPA). In the last decade, however, increased numbers of reports have appeared with reference to the arterial supply of hepatocellular carcinoma (HCC). The IPA is a major source of collateral or parasitized arterial supply to this type of carcinoma, second only to the hepatic artery. The aim of this study was to identify the origin and distribution of the IPA (right and left), in normal and pathological cases, and to apply such findings to the clinical scenario of treating hepatic cancer. We have examined 300 formalin-fixed adult cadavers lacking abdominal pathology, and 30 cadavers derived from patients with HCC. Dissections in normal cadavers showed that the right IPA originated from the: a) celiac trunk in 40% of the specimens; b) aorta in 38%; c) renal in 17%; d) left gastric in 3%; and e) hepatic artery proper in 2% of the specimens. The left IPA originated from the: a) celiac trunk in 47%; b) aorta in 45%; c) renal in 5%; d) left gastric in 2%; and e) hepatic artery proper in 1% of the specimens. The IPA gave rise to eight notable branches: ascending, descending, inferior vena cava, superior suprarenal, middle suprarenal, esophageal, diaphragmatic hiatal, and accessory splenic. The right IPA was always associated with HCC and served as the major collateral artery adjunct to the hepatic artery. These findings could have major implications in the transcatheter embolization of HCC patients.     

Retroportal proper hepatic artery with malrotated gut

Variations in celiac and hepatic vasculature are common and reported in one in five individuals. We report a rare case of a retroportal proper hepatic artery arising from a celiac trunk with quadruple branching associated with an intraperitoneal duodenum, pancreas and ascending colon. In addition, accessory left hepatic artery arose from the left gastric and the cystic artery originated abnormally from the gastroduodenal artery. Awareness of such variable arterial patterns is relevant in radiological assessment and planning for successful liver transplants, hepatobiliary surgery, portal vein resections and particularly interventional transarterial regional/focal chemoablative procedures of liver.     

Recurrent radial artery aneurysm in a five-month-old infant

Distal radial artery aneurysms are an infrequent occurrence in adults and rare in children. The rate of aneurysm formation in adults has been reported as 0.048% following catheterization. A case report of a 5-month-old girl with a recurrent left radial artery aneurysm is presented. The etiology of the aneurysm was radial artery catheterization in the neonatal intensive care unit. Recurrence occurred after resection for an end-to-end repair. Ligation of the artery was required for ultimate treatment. No deleterious sequelae were found after the final operation.     

复杂的腹部创伤性假性动脉瘤和动静脉瘘形态学分析

目的分析腹部创伤性假性动脉瘤和动静脉瘘形态学特点。方法分析1例复杂的腹部创伤性假性动脉瘤和动静脉瘘临床资料,总结腹部创伤性假性动脉瘤和动静脉瘘形态学特点。结果患者在腹部刀刺伤术后,出现顽固性腹水、低蛋白血症、门静脉高压症;彩色多普勒、螺旋CT和数字减影血管造影(DSA)提示肝总动脉、腹主动脉瘤形成,肝动脉门静脉瘘和腹主动脉门静脉瘘。采用血管内介入方法,行腹主动脉和门静脉支架植入术,动脉瘤和动脉门静脉瘘栓塞术,门静脉高压症消失,患者康复出院。结论腹部创伤性假性动脉瘤和动静脉瘘解剖结构复杂,具有独特的形态学特点;给诊断治疗带来困难。