Calcified aneurysm of the abdominal aorta 12 years after umbilical artery catheterization

We report a 12-year-old boy who presented with abdominal pain and who was found to have an aneurysm of the abdominal aorta (AAA). The patient was born from a quadruplet pregnancy induced by in vitro fertilization. Postnatal transient respiratory distress required assisted ventilation that had been monitored by two consecutive umbilical arterial catheters (UAC). AAA is a rare condition in childhood. Infection and/or trauma are known to be the most frequent causes. Most of the reported cases have occurred in children in whom a UAC had been placed during the neonatal period. In this patient the delay between UAC placement and diagnosis was considerable. At the time of this report the patient had remained well during a follow-up of 8 years after treatment.     

Complete thrombotic obliteration of the ascending aorta and the aortic arch as a cause of acute heart failure in a newborn

Thrombosis of the great vessels, and especially of the aorta, is rare in neonates. We report a case with thrombosis of the ascending aorta, aortic arch, brachiocephalic trunk and subclavian artery. Clinically, severe heart failure occurred on the 1st day of life and the diagnosis was confirmed by echocardiography and cardiac catheterization, including angiocardiography. Left ventricular function was found to be extremely depressed. An infusion with prostaglandin E₁ was initiated in order to improve the systemic circulation by dilating the arterial duct. The infant died of neurological complications prior to surgery.Research fellow from Medical Academy, Sofia, Bulgaria, supported by A. v. Humboldt Stiftung     

Gigantic aneurysm in the thoraco-abdominal aorta of an infant

We report the case of a boy with a gigantic aneurysm in the thoraco-abdominal region which was detected by a chest X-ray taken prior to surgical correction of ptosis of the eyelids at 11 months of age. At 18 months, he successfully underwent aneurysm exclusion and bypass grafting. A biopsy from the thoracic aorta revealed medial degeneration with conspicuous smooth muscle cell involvement. Laboratory examination showed altered elastase activity in the granulocytes and whole blood. The present case may represent a unique form of aneurysm in infancy.     

Congenital thrombotic occlusion of the ascending aorta and the aortic arch

Summary In a one-day-old male newborn with severe heart failure, the skin of the upper right thorax was pink, whereas the remaining areas were cyanotic. No peripheral pulses were palpable and the blood pressure could not be measured. On cardiac catheterization, systolic and diastolic pressures were elevated in the left ventricle (137/4/12 mmHg), but in the descending aorta, reached via a patent ductus arteriosus, the pressure was only 55/45 mmHg. O₂ saturation was 97% in the left ventricle and 67% in the descending aorta. Angiocardiography showed an extreme obstruction of the ascending aorta and the aortic arch. The infant died on the second day. Postmortem examination revealed a wall-adherent calcified thrombus that totally occluded the lumen. No etiologic explanation could be obtained from the histologic examination, anamnestic data, or clinical findings.     

A large unilateral renal artery aneurysm in a young child

The case of a 13-month-old boy with fibromuscular dysplasia (FMD) presenting with a large saccular aneurysm of the left renal artery and renovascular hypertension is reported. Renal and intrarenal arteries showed numerous small aneurysms alternating with stenoses. All arterial lesions were localized to the left kidney. After left nephrectomy, the patients blood pressure normalized. Histopathologic examination of the arteries disclosed changes typical of medial fibroplasias, the most frequently described form of FMD in children. This diagnosis is rewarding as it represents a surgically curable cause of severe hypertension.     

Saccular aortic aneurysm in an asymptomatic child

Summary An asymptomatic boy was found to have coarctation of the thoracic aorta. Despite no history of endocarditis or trauma, a large saccular aneurysm involving the coarctation site was identified angiographically, confirmed, resected surgically, and examined histologically.     

Clinically occult chronic dissecting aneurysm of the superior cerebellar artery in a child

An isolated chronic dissecting aneurysm of the left superior cerebellar artery was discovered incidentally in a 12-year-old girl. There was no history of any previous trauma or witnessed abnormal neurological incident at any stage during her life. She was and has since remained asymptomatic and the aneurysm has remained radiologically stable for over 3 years. A conservative approach to the management of such incidental asymptomatic lesions is thus suggested.     

Percutaneous treatment of a ruptured superior mesenteric artery aneurysm in a child

Splanchnic artery aneurysms are very rare in children. We report a 10-year-old girl with a large atraumatic ruptured superior mesenteric artery aneurysm that was considered inoperable. She was ultimately treated with two percutaneous US-guided thrombin injections, which led to complete occlusion of the aneurysm. The aetiology of the aneurysm remained unclear, but a family history was suggestive of a congenital connective tissue disease such as Ehlers-Danlos syndrome subtype IV.     

Anomalous origin of right pulmonary artery from ascending aorta with right ventricular endocardial fibroelastosis

Summary A case of aortic origin of the right pulmonary artery with right ventricular endocardial fibroelastosis is reported. Its diagnostic features, surgical aspects, and postmortem findings are discussed. This is a rare combination. The relevant literature is reviewed.     

Mycotic aneurysm following subacute bacterial endocarditis in a child with coarctation of the aorta

Conclusion Aortic aneurysm represents an unusual complication of subacute bacterial endocarditis in children with coarctation of the aorta. Poststenotic dilatation just distal to the coarcted segment is the most usual site for such an aneurysm. Transmural bleeding and progressive dilatation with compression of neighbouring structures determine the clinical profile which include haemoptysis, pneumonitis, cough, hoarseness, dysphagia or a sudden severe chest pain with shock-like picture. Radiological evidence of progressively increasing aortic shadow, adjacent pulmonary infiltrates or a rapid accumulation of pleural or pericardial fluid provide early diagnostic clues. Surgical excision with graft replacement is the only therapy of choice. From the Departments of Paediatrics and Cardiovascular and Thoracic Surgery, Safdarjang Hospital, and the Indian Registry of Pathology, New Delhi 16.     

Pseudodissection of the aorta

Motion of the aortic wall resulting in the appearance of aortic dissection on CT is a well-described artifact in the adult radiology literature. Aortic dissection is rare in the pediatric population, and literature on pediatric CT angiography has not included recognition of this pitfall in the diagnosis of children. The current case illustrates a patient at risk of aortic dissection and a false-positive CT diagnosis as a result of this artifact.     

Life‐threatening acute gastric dilatation with aorta compression in a 3‐year‐old child

We report a fatal case of acute gastric dilatation in a 3‐year old boy who presented with severe abdominal pain and massive gastric distension in the emergency room. On physical examination the patient was in shock due to acute abdomen and lower limb ischemia. Initial laboratory findings showed multi‐organ failure with acute renal failure and pancreatitis. Abdominal computed tomography (CT) showed marked dilatation of the stomach resulting in compression of the abdominal aorta. The left kidney, spleen and pancreas were not visible on CT due to the necrotic changes. The patient was quickly stabilized by initial volume resuscitation, but suddenly deteriorated immediately after gastric decompression via nasogastric tube, and died from multi‐organ failure 3 h after initial presentation.     

Wall motion velocities of ascending aorta measured by tissue Doppler imaging in obese children

Background: Obesity is associated with the development of early cardiovascular abnormalities such as atherosclerotic lesions. Arterial stiffness may be an indicator of early vascular changes signaling the development of vascular disease. The objective of the current study was to screen aortic elastic properties with tissue Doppler imaging in obese children. Methods: We examined 37 obese children and 30 age‐ and sex‐matched normal subjects. Anthropometric measurements and metabolic risk profile were assessed in a physical examination and with blood taking. The subjects were divided into two subgroups: those with and without metabolic syndrome. Internal aortic systolic and diastolic diameters by M‐mode echocardiography and aortic systolic upper‐wall tissue velocity by tissue Doppler imaging were measured 3 cm above the aortic valve. Aortic distensibility and aortic stiffness index were calculated using accepted formulae. Results: Aortic stiffness parameters and both tissue Doppler peak systolic and diastolic velocities differed significantly in obese children compared to controls. Among the subgroups, children with metabolic syndrome had a lower aortic stiffness index, aortic distensibility and tissue Doppler velocities. However, only peak diastolic velocities significantly differed between obese children without metabolic syndrome and controls. Homeostatic model scores, diastolic blood pressures and pulse pressures were the strongest to correlate with peak diastolic velocity (r=?0.88, P < 0.001, r=?0.62, P= 0.001 and, r= 0.55, P= 0.001, respectively). Conclusions: Tissue Doppler imaging is a feasible and sensitive method to identify aortic stiffness in obese children. Reduced aortic diastolic velocity is the most prominent early vascular change detected in obese children before metabolic syndrome occurs.