Endovascular Treatment of a Left Carotid Artery "Bowtie" Pseudoaneurysm with a Covered Wallgraft Stent

The authors present an unusual case of a young male patient with a large left common carotid artery pseudoaneurysm in a shape similar to that of a bowtie treated with a covered Wallgraft. The Wallgraft is a covered stent originally designed to be used in the treatment of tracheobronchial fistula and peripheral arterial applications. The favorable outcome of this case illustrates its endovascular application in nonsurgical traumatic injuries of the carotid artery.     

主动脉假性动脉瘤的影像诊断

目的：探讨主动脉假性动脉瘤的影像表现，评价MRI的诊断价值。方法：报道5例经手术证实的主动脉假性动脉瘤的影像所见，MRI检查4例，彩超检查3例，CT检查2例和主动脉造影1例。结果：胸、腹主动脉假性动脉瘤分别为3例和2例，假性动脉瘤位于主动脉轮廓外。彩超显示瘤体与主动脉有双向血流。CT和主动脉造影表现层状密度瘤体、早期强化和显影。MRI表现假性动脉瘤壁厚薄不均和信号不均质，均有破裂口。GRE显示经主动脉狭窄破裂口向瘤腔内喷射高信号血流。结论：MRI对假性动脉瘤的诊断有重要价值。     

Diagnosis and endoscopic endonasal management of nontraumatic pseudoaneurysms of the cranial base

Background

Nontraumatic pseudoaneurysms of the cranial base are rare and present unique diagnostic and treatment dilemmas compared with both true aneurysms and pseudoaneurysms outside of the cranial base. There is a dearth of knowledge regarding the management of these complicated lesions.

Methods

Nontraumatic pseudoaneurysms of the cranial base internal carotid artery (ICA) were retrospectively identified at the University of Pittsburgh Medical Center through a key word search of cranial base cases from 2010 to 2017.

Results

Three cases were identified, demonstrating pseudoaneurysms of the cavernous and petrous ICA. Each patient underwent diagnostic work‐up with computed tomography, magnetic resonance imaging, and angiography, followed by endovascular occlusion and endoscopic endonasal surgery, which resulted in relief of presenting complaints and ablation of the pseudoaneurysm.

Conclusion

Symptomatic cranial base pseudoaneurysms should undergo treatment to obliterate the aneurysm and relieve the mass effect. First, formal angiography is necessary for accurate diagnosis and treatment planning. Next, endovascular occlusion is performed, with a preference for coiling or endoluminal reconstruction with a flow diverter. Last, endoscopic intervention follows in cases where: (1) decompression of vital structures is indicated; (2) diagnosis of the pseudoaneurysm cannot be definitively confirmed with angiography; or (3) the etiology of the confirmed pseudoaneurysm requires further investigation.

     

Echocardiographic Detection of Two Distinct Left Ventricular Pseudoaneurysms After Mitral Valve Replacement

Left ventricular pseudoaneurysm after mitral valve replacement (MVR) is a rare but clinically significant complication. We report a case of two distinct left ventricular pseudoaneurysms after re-MVR, which was correctly diagnosed by two-dimensional echocardiography, and subsequently confirmed by surgery.     

Haemosuccus pancreaticus: a clinical challenge

BACKGROUND: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss.     

Missed diagnosis of unruptured,huge left ventricular pseudoaneurysm

We report a case of a huge left ventricular pseudoaneurysm following myocardial infarction. Early after myocardial infarction, the pseudoaneurysm was missed during the cardiac examination. The patient underwent coronary bypass surgery with endoaneurysmorraphy of the pseudoaneurysm, and made a satisfactory recovery.     

CT血管成像诊断蝶窦旁颈内动脉动脉瘤

目的 探析蝶窦旁颈内动脉动脉瘤应用CT血管成像诊断的临床价值.方法 入选我院蝶窦旁颈内动脉动脉瘤患者11例,进行CT血管成像检查,对其临床资料进行回顾性分析.结果 11例均表现为蝶窦内不规则软组织影与邻近海绵窦段颈内动脉均匀同步强化,并与其沟通,边缘见浅分叶,边界清晰;周围部分动脉期不强化的软组织影边缘不整.病灶大小为1 mm×2 mm×3 mm ～ 27 mm× 30 mm×33 mm; CTA最早期病变表现为海绵窦段颈内动脉管壁局部毛糙不整,瘤体小,发生于外伤后7d.11例邻近蝶窦骨壁均出现骨折,6例断端累及蝶窦外侧壁,4例累及蝶窦后外壁并错位,局部出现骨质缺损1例.结论 破入蝶窦的海绵窦段颈内动脉创伤性假性动脉瘤应用颅脑CTA检查可明确诊断,联合应用CPR、MPR、MIP、VR处理技术可清晰显示颈内动脉破口及蝶窦壁骨折位置,值得临床推广.     

Popliteal Pseudoaneurysm After Total Knee Arthroplasty : A Report of 3 Cases

Although the incidence of vascular injuries after total knee arthroplasty is quite low, clinical outcome could be significantly impaired. Quick response and accurate management are important to achieve the best possible outcome. We present 3 cases of popliteal pseudoaneurysm formation after total knee arthroplasty and their treatment by endovascular stenting together with a review of literature.