The usefulness of postmortem computed tomography angiography for subdural hematoma caused by rupture of the cortical artery: A report of two autopsy cases and a literature review

Acute subdural hematoma (SDH) occurs following severe head trauma with brain contusion or rupture of bridging veins. Conversely, SDH caused by rupture of a cortical artery without trauma or with minor trauma is also possible. Although over 180 cases of the latter SDH have been reported, they were predominantly diagnosed only during surgery, and therefore, no adequate histological evaluation has been performed. Therefore, essential etiology of this SDH type has remained unclear. In addition, the scarcity of autopsy cases may be attributed to arterial rupture being missed if the microscopic findings are too minimal to detect during autopsy. Here, we describe two autopsy cases of SDH of cortical artery origin. Extravasation on postmortem computed tomography angiography and arterial leakage on macroscopic observation during autopsy facilitated detection of the ruptured artery and allowed detailed histological evaluation of the ruptured artery and adjacent dura mater. The etiology of arterial rupture is briefly described on the basis of histopathological findings in this study and the available literature.     

Pulmonary artery dissection in long standing idiopathic pulmonary arterial hypertension: A case report

Pulmonary arterial dissection (PAD) is a rare and often lethal complication of chronic pulmonary arterial hypertension (PAH), which may occurs in patients with idiopathic pulmonary arterial hypertension (IPAH) and potentially in those with connective tissue disorders. While rare, sudden death often occurs secondary to acute cardiac tamponade, as the pulmonary artery dissects into the pericardium; this diagnosis is often made postmortem. Nevertheless, with the proliferation of multidetector computed tomography (MDCT) as a diagnostic test, patients may be identified very early after symptom onset, prompting rapid intervention with decreased morbidity and mortality. We report a case of IPAH complicated by pulmonary artery aneurysm (PAA) and PAD, diagnosed by CT pulmonary angiogram (CTPA), and treated with bilateral lung transplantation, pulmonic valve replacement, and re-anastomosis of the donor main PA to a pulmonary valve conduit.     

Fatal hemorrhage following sacroiliac joint fusion surgery: A case report

Threaded pins and wires are commonly used in orthopedic practice and their migration intra- or post-operatively may be responsible for potentially serious complications. Vascular and visceral injury from intra-pelvic pin or guide-wire migration during or following hip surgery has been reported frequently in the literature and may result in progression through soft tissues with subsequent perforation of organs and vessels. In this report, we describe an autopsy case involving a 40-year old man suffering from chronic low back pain due to sacroiliac joint disruption. The patient underwent minimally invasive sacroiliac joint arthrodesis. Some intra-operative bleeding was noticed when a drill was retrieved, though the patient died postoperatively. Postmortem investigations allowed the source of bleeding to be identified (a perforation of a branch of the right internal iliac artery) and a potentially toxic tramadol concentration in peripheral blood to be measured.     

A case report of primary pulmonary artery intimal sarcoma

Primary pulmonary artery sarcoma is a rare tumor that mimics pulmonary embolism. Patients may present with cough, dyspnea, chest pain, and weight loss. The diagnosis is challenging. Herein, we report a case of 29-year-old female patient who had presented with dyspnea, fatigue for 2 weeks. Computed tomography pulmonary angiography scan suggests pulmonary embolism. We decided to perform surgical embolectomy. The histopathological results, however demonstrated primary pulmonary artery intimal sarcoma. The patient died 1-month post-surgery because of respiratory and circulatory failure.     

Splenic artery embolization for spontaneous splenic rupture due to Babesiosis: a case report

Babesiosis incidence in the United States has been increasing with an 11% rise between 2018 and 2019 based on the latest CDC annual summary, reaching its highest ever reported incidence. This primarily tick-borne disease is particularly prevalent in New England. Despite predominantly nonspecific and at times subtle symptoms, life-threatening complications do occur. One such complication is splenic rupture which has been suggested to be more common in younger and otherwise healthy individuals. This is a report on a successful splenic artery embolization in a 65-year-old male from upstate New York who, unlike most prior studies, showed splenic rupture after he was discharged with negative parasitemia and general improvement following several days of targeted antibiotic therapy. Increased incidence and various presentations of Babesiosis call for an attempt to promote clinical awareness for radiologists among other specialties.     

Pulmonary artery involvement in aortoarteritis: An angiographic study

Angiographic findings of 47 patients with pulmonary artery involvement (PAI) in aortoarteritis are described together with the diagnostic evaluation of PAI and its clinical implications. Pulmonary arteriography was obtained by intravenous digital subtraction angiography in 133 patients with aortoarteritis; 45 (33.8%) were found to have PAI. Two patients with PAI, studied by conventional arteriography, are also included. Stenosis and/or occlusion of segmental and/or lobar pulmonary arteries, and subsegmental branches, were the basic angiographic findings in PAI. Pulmonary artery branches in the upper lobes were more commonly affected than those in the lower and middle (lingula) lobes. Bilateral lesions were more common than unilateral ones. Single lobar and segmental lesions were quite rare. Dilatation was uncommon. No main pulmonary artery involvement was detected. Pulmonary artery hypertension, a late complication of patients with PAI, was revealed in 9 of the 46 patients of the present series. If it occurs, PAI becomes a factor effecting the patient's clinical course and prognosis.     

Milk of calcium pericardial effusion confirmed with postmortem computed tomography and autopsy findings: A case report

We present the postmortem computed tomography and autopsy findings of a 60-year-old man who developed milk of calcium pericardial effusion and died of constrictive epicarditis. He experienced out-of-hospital cardiopulmonary arrest, and spontaneous circulation returned at the hospital. However, 7 h after recovery, the patient died. He had a swollen neck, had been experiencing coughing from 4 to 5 days earlier, and had no significant medical or surgical history. On computed tomography (CT), highly dense pericardial fluid (CT value: 130–150 Hounsfield units) and multiple calcifications along the epicardium and pericardium were visualized. The epicardium and pericardium were thick, hard, rough, and widely calcified with mild adhesions on autopsy. The pericardial cavity contained a pale, reddish brown, turbid, and highly viscous liquid. Bacteriological tests of pericardial fluid cultures revealed the presence of group G β-hemolytic streptococci. Hence, we diagnosed the patient’s cause of death as heart failure due to constrictive epicarditis. We believe that this case of milk of calcium pericardial effusion is the first case confirmed with postmortem CT and autopsy findings.     

Spontaneous splenic rupture during infection of cytomegalovirus. A case report

Splenic rupture is most commonly encountered after blunt abdominal trauma. Spontaneous atraumatic splenic rupture is a rare but dramatic occurrence that is most commonly attributed to infection or neoplasia. We report the case of a 27-year-old female patient without pathological history. Admitted to the emergency department for the sudden onset of left hypochondrial pain associated with vomiting, rapidly progressing to hypovolemic shock. She had reported an influenza-like illness a week earlier for which her COVID-19 PCR was negative. Emergency abdominal ultrasound and CT-scan revealed a ruptured spleen and widespread hemorrhagic fluid in the abdomen. Exploration revealed multiple ruptures in the spleen capsule. The patient underwent splenectomy with good clinical evolution. Despite the rarity of this condition, physicians should consider the diagnosis of spontaneous non traumatic splenic rupture when encountering healthy patients presenting with nonspecific left hypochondrial abdominal pain and hypovolemia. Mortality is essentially related to the delay in diagnosis and treatment and to the severity of the underlying pathology. Treatment often consists of splenectomy.     

Supradiaphragmatic origin of the right renal artery: a case report

Renal arteries are the main blood supply to the kidneys. They originate from the abdominal aorta at the level of the first and second lumbar vertebrae. However, variations in their origin are common. Therefore, studying renal arteries before any surgical intervention such as renal transplant surgery, conservative or radical renal surgeries, renal trauma, and others, is crucial to avoid undesirable avoidable complications or morbidities. Herein, we report a case of an isolated right supradiaphragmatic renal artery that was discovered incidentally in a 66-year-old female patient with normal blood pressure.     

Bioglue endovascular treatment of fusiform aneurysm rupture of the distal anterior temporal artery of the middle cerebral artery: a case report

The treatment of a ruptured fusiform distal anterior temporal artery aneurysm is a challenge for the stroke physician, however surgical closure and coil endovascular intervention are options. A total blockage can result in memory problems as well as object-related questions. We''d like to provide the clinical example of a 56-year-old woman with many underlying medical illnesses who was admitted to the hospital with a grade 7/10 headache and a Glasgow score of 15, but no focal neurological deficits, and was diagnosed with a ruptured distal temporal artery aneurysm. The aneurysm is positioned in the distal region, making endovascular intervention difficult to perform. As a result, we used an endovascular approach to repair with bioglue. When a patient develops fusiform aneurysms of the distal temporal artery, our findings provide an additional therapy option.     

先天性右冠状动脉缺如一例

患者男,64岁。间歇胸闷、憋气1年,加重半个月于2009年5月入院,既往高血压病史3年,血压最高达180/90mmHg,未规律服用降压药。入院体检：血压140/70mmHg,脉搏56次/min,呼吸19次/min。     

Acute massive subdural hematoma caused by rupture of internal carotid artery aneurysm during angiography: a case report

We present a case of acute, massive subdural hemorrhage caused by rupture of an internal carotid artery aneurysm during the procedure of cerebral angiography. To our knowledge, a case like the present one has been reported only once in the English-language literature. The incidence, mechanisms, treatment, and prognosis of (1) subdural hematoma, caused by rupture of cerebral aneurysm, and (2) re-rupture of aneurysm during the angiography procedure are discussed. Electronic Publication     

冠状动脉多发瘘一例

先天性冠状动脉瘘(coronary artery fistula)是指冠状动脉主干或其分支与某一心腔或血管之间存在的异常通道.先天性冠状动脉瘘在冠状动脉造影中的检出率为0.016%～0.020%,单一瘘管约占90%以上,3支冠状动脉同时形成瘘管者较少见,现报道1例冠脉造影示3支冠脉瘘的病例如下:     

Sudden death due to rupture of the right internal carotid artery in neurofibromatosis type 1: A case report

Vascular involvement is a well-recognized manifestation of neurofibromatosis type 1 (NF1) which has the potential to be fatal when disrupted. We here present a case of sudden death due to the fatal arterial rupture resulted from infiltration of the neurofibromas. A 42-year-old man who suffered from NF1 presented a 1-h history of sudden onset of pain in his right cervical region. His condition worsened and became unconscious on his way to the emergency room. Despite resuscitation efforts, he died 30 min later without regaining consciousness. Autopsy examination showed that a neurofibroma located around the right internal carotid artery, confirmed immunohistochemically with S-100, vimentin and CD34. Furthermore, proliferation of spindle cells positive for S-100 was seen in the wall of right internal carotid artery, which was disrupted and resulted in a hemorrhage. These findings suggest that the artery was disrupted by neurofibromas in the vascular wall, which led to fragility of the vessel. On the basis of these findings, we concluded that the cause of death was asphyxia resulting from airway obstruction compressed by the hematoma due to the arterial rupture. As the locality of the neurofibroma and hemorrhage were closed to the carotid baroreflex, we considered another possible mechanism of his sudden death, which could be cardiac inhibition induced by vagal stimulation. We hope this case will increase recognition of NF-1 vasculopathy when encountering any sudden death in NF1 patients.     

Situs inversus with congenital absence of left circumflex artery and a superdominant left-sided right coronary artery: A case report

Situs inversus with a coronary artery defect is an extremely rare congenital anomaly, which is often only incidentally detected during cardiac imaging studies, particularly when the patient is complaining of chest pain. We present a case study of a 37-year-old man who presented with a 3-month history of chest pain. A chest X-ray revealed dextrocardia with stomach gas in the lower right diaphragm. A CT examination showed that the right lung had 2 lobes, and the left lung had 3 lobes. This confirmed that the patient had dextrocardia with situs inversus, where the heart, organs and coronary arteries are inverted to the opposite side of the body. It is also known as a mirroring image, as the arrangement of the anatomy is unaffected. The patient''s right coronary artery was prominently inversed to the left side, while the left main coronary artery was inversed to the right side and continued toward the anterior interventricular sulcus, eventually becoming the left anterior descending (LAD) artery. The left circumflex artery was absent in the atrioventricular groove. There was also a plaque in the right-sided LAD with no significant stenosis. The patient received conservative medical therapy and had frequent follow-ups to check for potential complications.     

Persistent sciatic artery: A case report

Persistence of the embryonic sciatic artery is a rare vascular anomaly with only 52 documented cases, of which only 19 had angiographic studies. We describe a patient with angiographic demonstration of persistence of a left sciatic artery associated with arterial anomalies of the opposite limb. The embryology radiological findings and clinical significance are discussed.     

Bronchial artery embolization to control hemoptysis: A review

Bronchial artery embolization has become an established technique in the management of massive or recurrent hemoptysis. The clinical background, methods, and results of this procedure are discussed, as are the potential complications and their prevention.     

Delayed diagnosis of isolated alar ligament rupture: A case report

Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.     

Early spontaneous occlusion of a vertebral artery dissecting aneurysm caused by subarachnoid hemorrhage: A case report

We report a case of vertebral artery dissecting aneurysm (VADA) that developed with subarachnoid hemorrhage and was found to be occluded based on subsequent digital subtraction angiography. Few reports have been published on ruptured VADA in which ipsilateral vertebral arteries are occluded. The proper management of this type of aneurysm is controversial. A 44-year-old woman developed a sudden onset headache. Computed tomography and three-dimensional computed tomography were immediately performed and showed subarachnoid hemorrhage and VADA distal to the right posterior inferior cerebellar artery bifurcation. We decided to treat the VADA immediately and performed digital subtraction angiography but found the VADA had spontaneously occluded. We performed coil embolization, including the aneurysm and the parent artery, with reference to the findings of three-dimensional computed tomography. On Day 16, recurrence was considered due to the finding of dilation of the distal end where the coil was embolized. An additional embolization was performed via the posterior communicating artery. No cases of endovascular treatment have been reported in VADA cases in which the rupture site is spontaneously occluded. In such cases, the treatment may be incomplete, so strict follow-up is required.     

Double right coronary artery diagnosed by computed tomographic angiography: A case report and systematic review of the literature

Double right coronary artery (RCA) is an extremely uncommon anomaly that is mostly detected incidentally in patients undergoing coronary angiography. It can be a benign and isolated anomaly or associated with other congenital abnormalities, mostly other coronary anomalies. Although atherosclerosis and myocardial ischemia have been frequently reported in patients with double RCA, this likely reflects that the patients were evaluated for chest pain rather than the predisposition to atherosclerosis in double RCA. Paralleling the increased awareness of this entity and the availability of non-invasive and cost-effective imaging of the coronary arteries, the diagnosis of double RCA has increased recently. Here, we present a case of double RCA diagnosed by coronary computed tomographic angiography, and provide a mini-review on the demography, anatomic variants, and clinical significance of double RCA.