Giant pseudoaneurysm in adolescent

Background Intracranial pseudoaneurysms, infrequent vascular lesion in children and adolescents, are characterized by the presence of organizing hematoma and fibrosis outside the true lumen instead of normal vascular elements. Because most pseudoaneurysms result from eminent insults such as major trauma or grave infection, development without preceding incident is extremely rare. Giant pseudoaneurysms in younger population, albeit unexceptionally unusual, are symptomatic in most instances and exhibit very high risk of rupture. Clinical manifestation as chronic headache without hemorrhage or neural compression is very unlikely. Once identified, only prompt surgical treatment guarantees favorable prognosis.Case history We report a case of a 17-year-old boy with a giant pseudoaneurysm arising at distal middle cerebral artery. He complained of headache that had become apparent 3 years ago and medically intractable 3 months ago. Brain computed tomographic scan and lumbar cerebrospinal spinal fluid study revealed no trace of recent hemorrhage. However, digital subtraction angiography revealed a huge aneurysmal dilatation along the right distal middle cerebral artery with the features of delayed filling and emptying of contrast agent. Surgical obliteration of the corresponding aneurysm with tandem clipping and aneurysmectomy made him free of headache postoperatively.Conclusions We could not uncover the actual cause of formation and precise mechanism of clinical presentation for this unique aneurysm; nevertheless, we suggest that blunt head injury of fairly long history caused such a lesion, and repeated minute bleeding elicited headache. This assumption was possible only after full consideration of the histopathology.     

真性与假性室间隔膜部瘤的诊断与外科治疗

报告手术治疗真性室间隔膜部瘤９例和假性室间隔膜部瘤３４例。结果：全部治愈，随访６月～１１年，预后均佳。结论：两者在发病机理、病理变化和手术方法等方面各不相同，而在症状、体征、心电图、Ｘ线及右心导管检查等方面均相类似。超声心动图对术前明确诊断有重要意义。     

Pseudoaneurysm of the profunda femoris artery: a rare complication of femoral intertrochanteric fracture fixation

Profunda femoris artery pseudo aneurysm is a rare occurrence following fractures of the proximal femur or their surgical fixation. They usually present late because of the deep position of the artery. Patients present with a painful expansile mass in the thigh with or without progressive anaemia. Modalities such as ultrasound scanning may aid in diagnosis but CT arteriography is used mostly for accurate diagnosis and intervention. We report a case of delayed presentation of profunda femoris pseudo aneurysm following dynamic hip screw fixation for intertrochanteric femur fracture.     

周围动脉创伤性病变血管内介入治疗的临床应用

目的探讨周围动脉创伤性病变的介入微创治疗。方法分析13例周围动脉创伤性病变,其中骨折伴动脉损伤8例,单纯血管软组织损伤5例(其中1例为医源性)。结果动脉造影显示8例确诊为动脉损伤后血栓形成,5例出血伴假性动脉瘤。经导管动脉内溶栓,动脉瘤栓塞及支架开通等处理,12例痊愈,1例转外科手术,介入治疗成功率92.3%,未发生术后截肢、感染、出血等严重并发症。结论对创伤性动脉损伤所致血栓闭塞、假性动脉瘤等,采用血管内介入治疗方法,微创有效,并发症少,临床应用价值大。     

The Jogger's aneurysm: Unusual presentation of popliteal artery trauma

In two cases, chronic, minor trauma was associated with the formation of pseudoaneurysms of the popliteal artery. Unusual clinical features of these cases included a painful popliteal fossa mass and leg pain following exercise. Initial noninvasive evaluation should include Doppler flow measurements and ultrasound. If a vascular origin is suggested, arteriography is essential.     

Embolotherapy of a mycotic pseudoaneurysm of the internal mammary artery in chronic granulomatous disease

We report a case demonstrating an unusual and previously unpublished complication of chronic granulomatous disease (CGD), that is massive hemorrhage from a mycotic pseudoaneurysm of the left internal mammary due to invasiveAspergillus fumigatus of the anterior chest wall. This brief report further illustrates the angiographic diagnosis and embolotherapeutic control of a mycotic pseudoaneurysm of the internal mammary artery.     

Endovascular management in abdominal visceral arterial aneurysms: A pictorial essay

Visceral artery aneurysms(VAAs) include aneurysms of the splanchnic circulation and those of the renal artery.Their diagnosis is clinically important because of the associated high mortality and potential complications.Splenic,superior mesenteric,gastroduodenal,hepatic and renal arteries are some of the common arteries affected by VAAs.Though surgical resection and anastomosis still remains the treatment of choice in some of the cases,especially cases involving the proximal arteries,increasingly endovascular treatment is being used for more distal vessels.We present a pictorial review of various intra-abdominal VAAs and their endovascular management.     

Endovascular Treatment Using Graft-Stent for Pseudoaneurysm of the Cavernous Internal Carotid Artery

A 57-year-old man presented with a 2-day history of left oculomotor palsy. Digital subtraction angiography revealed a pseudoaneurysm of the left cavernous internal carotid artery (ICA) measuring 37×32 mm. The pseudoaneurysm was treated with a balloon expandable graft-stent to occlude the aneurysmal neck and preserve the parent artery. A post-procedure angiogram confirmed normal patency of the ICA and complete sealing of the aneurysmal neck with no opacification of the sac. After the procedure, the oculomotor palsy improved gradually, and had completely resolved 3 months after the procedure. A graft-stent can be an effective treatment for a pseudoaneurysm of the cavernous ICA with preservation of the parent artery.     

An Unusual Presentation of Foreign Body in the Common Carotid Artery

Penetrating trauma to neck resulting in arteriovenous (AV) fistula and aneurysms involving the carotid system are uncommon injuries with life-threatening consequences. We report here a case of a young factory worker who developed a traumatic AV fistula with false aneurysm, with however, no other complications. He was successfully operated when he presented to us two months after the injury and is doing well in follow-up.     

Pseudoaneurisma gigante da via de saída do ventrículo esquerdo: uma patologia rara

Pseudoaneurysm of the left ventricular outflow tract (LVOT) is a rare disease with high morbidity and mortality, resulting from left ventricular damage due to myocardial infarction, infective endocarditis or surgical trauma. A case of giant pseudoaneurysm of the LVOT, even more rarely reported in the literature, is described. The lesion was detected 12 years after aortic valve replacement for infective endocarditis in a young patient, a former intravenous drug user. As it is an uncommon disease, little is known about its clinical presentation and treatment.