An autopsy case of a ruptured pseudoaneurysm of the ascending aorta complicated by previous cardiac surgery for ventricular septal defect

A man in his thirties was found dead in bed. He had undergone repair of a ventricular septal defect in his infancy and had a 2-month history of antemortem chest pain. On autopsy, a ruptured saccular aneurysm of the ascending aorta was identified, and the right thoracic cavity was found to contain coagulated blood. The oval ostium of the aneurysm was smoothly endothelialized and a black suture was found near its edge. Histological analysis revealed a defect of the intimal and medial layers in the wall of the aneurysm and hypertensive changes in several organs. The cause of death was presumed to be the rupture of a pseudoaneurysm at the aortic cannulation site after a long postoperative period. In the present case, preexisting hypertension was suspected as the cause of the formation and rupture of the pseudoaneurysm. In case of unexpected death, it is important to examine the past medical history even after a long postoperative period.     

应用室间隔缺损封堵器封堵主动脉窦瘤破口一例

患者男,38岁。因反复心慌、心悸、乏力2年余加重10d入院,体检:血压130/70mmHg,心率90次/min,胸骨左缘第3～4肋间可及3/6级收缩期吹风样杂音。心脏彩超示:左室偏大,无冠窦扩大,突向右房,可见大小约5mm的缺口有连续血流分流入右房(图1)。因患者拒绝外科手术,拟行介入治疗。操作方法和过程:局部麻醉下,穿刺右股动、静脉,分别置入血管鞘,经动脉送入5F猪尾导管置主动脉根部,行升主动脉造影示:主动脉窦无冠窦突向右房形成一大窦瘤,瘤底有约5mm破口,血流由主动脉流入右心房(图2)。经动脉送入改造的猪尾导管置于窦瘤破口处,经猪尾导管送入泥鳅导丝,通过破口进入右房至上腔静脉,经股静脉送入圈套器至上腔静     

An adult autopsy case of acute encephalopathy associated with influenza A virus

On a cold winter morning, a 35-year-old male was unexpectedly found dead and therefore autopsied. Macro- and microscopically, the lungs were demonstrated bronchopneumonia. On the surface of brain, small blood vessels were slightly congested. Microscopically, brain edema was also observed, and proliferation of lymphocytes was observed around the capillary vessels of the hippocampus. These findings suggested a viral infection of the cerebrum. We conducted an immunohistochemical study with antibody against influenza virus. Influenza A virus antigen was detected in both the lungs and brain. Therefore, findings were compatible with influenza A encephalopathy. Even when serological inspection is not performed, it is useful to inspect localization of the virus antigen immunohistochemically. We considered that it is necessary to perform pathological examination for influenza encephalopathy in sudden death cases when influenza is epidemic.     

Ultra-low dose comprehensive cardiac CT imaging in a patient with acute myocarditis

The ability of contrast-enhanced CT to detect “late enhancement” in a fashion similar to magnetic resonance imaging has been previously reported. We report a case of acute myocarditis with coronary CT angiography as well as “late enhancement” imaging with ultra-low effective radiation dose.     

心肌梗死室壁瘤的MRI诊断

目的：总结室壁瘤的ＭＲＩ诊断要点，探讨其诊断价值和限度。材料与方法：全组２４例，由急性心肌梗死史、超声心动图和放射性核素显像或冠状动脉加左室造影及手术确立室壁瘤的诊断。结果：左心室壁显著节段性变薄，厚度为１～３ｍｍ（平均１．８±０．８ｍｍ），伴有信号强度减低及变薄节段外凸，至少一个节段室壁反向运动及无运动，且收缩期增厚率消失。左心室显著扩大，舒张末期容积达２０６±１３８．３ｍｌ，高于正常对照组１００．５±２５．９ｍｌ（Ｐ＜０．０１）。左心室收缩功能受损，平均射血分数为４０．８％±１１．７％，短轴缩短率为１７．７％±４．３％。２例患者有附壁血栓，位于邻近变薄室壁的左室腔内，呈高信号。结论：ＭＲＩ所见能反映室壁瘤的病理变化，本组阳性率达１００％。     

An autopsy case of necrotizing eosinophilic myocarditis causing left ventricular wall rupture

Acute necrotizing eosinophilic myocarditis (ANEM) is a rare entity with sudden onset and rapidly progressive course, usually leading to a fatal outcome. It is characterized by focal or widespread myocyte necrosis. The entity’s clinical presentation is quite variable, rendering the antemortem diagnosis difficult. A case of a 66-year-old woman dying suddenly, initially considered to have suffered a myocardial infarction and finally proved at autopsy to have died due to ANEM resulting in myocardial rupture, is presented. Left ventricular wall rupture is in the majority of cases, a complication of myocardial infarction and its association with acute myocarditis has been very rarely reported. The case reported herein highlights the infrequent presentation of ANEM as cardiac rupture. Myocardial rupture is associated with a high mortality rate, even if immediate surgical repair and intervention are provided.     

Peripheral cerebral aneurysm associated with a glioma

Summary This 42-year-old man with acute subarachnoid, intraventricular and parenchymal hemorrhage from an angiographically and surgically confirmed successfully clipped, right splenial artery aneurysm, subsequently manifested a grade 3 astrocytoma at the site of the aneurysm. Intracranial aneurysms are recognized in association with metastases from cardiac myxoma and choriocarcinoma, but are rarely seen with primary brain tumors. In patients with nontraumatic peripheral aneurysms it would seem prudent to biopsy the aneurysm and/or surrounding necrotic tissue at the time of surgical clipping.     

舌动脉瘤破裂出血动脉栓塞治疗一例

病例资料患者男,51岁。因吐出鲜血500 ml来急诊。曾因头面部及颈部皮疹,伴发热,双上肢肿胀、无力1个月,实验室检查肌酸激酶明显升高,肌电图提示皮肌炎。经激素冲击治疗后,持续口服激素治疗3个月,病情稳定。患者无明显诱因,突然吐出鲜血约500 ml,呈长条状血凝块,行喉镜、胃镜及胸部CT检查未发现异常。3 d后再次呕吐鲜血约1 000 ml,继之出现呼吸骤停、意识丧失,予气管插管、心肺复苏等抢救,心跳、呼吸恢复,为明确出血原因,心肺复苏后第2天行DSA检查,颈外动脉造影显示,右侧舌动脉咽段距起始部3 cm处见囊袋样对比剂充盈,约0.8 cm×1 cm,后缘见小尖刺状突起,     

Endovascular treatment of arteriovenous fistula caused by ruptured iliac aneurysm and type II endoleak

Arteriovenous fistulas (AVFs) caused by an isolated iliac aneurysm rupture and postoperative type II endoleak are rare and life threatening. We report here a case of AVF caused by a ruptured iliac aneurysm and postoperative type II endoleak. The patient was successfully treated by implanting a covered stent to treat the ruptured iliac aneurysm. However, type II endoleak with AVF persisted after the operation and was treated with transiliac vein embolization. The patient recovered uneventfully during the 2-month follow-up period.     

电解可脱式弹簧圈栓塞治疗颅内动脉瘤破裂

目的　探讨血管内电解可脱式铂金微弹簧圈 (GDC)早期栓塞治疗破裂后颅内动脉瘤的临床价值。方法　对 15例破裂后颅内动脉瘤施行血管内GDC早期栓塞治疗 ,15例患者按Hunt Hess分级 :I级 8例、II级 6例、IV级 1例 ,所有病例均经DSA造影和CT扫描诊断。结果　GDC栓塞手术成功13例 ,占 86 .7% (13/ 15 ) ;13例随访 3～ 2 5个月无再次出血和并发症 ,其中 2例 6个月后复查DSA未见复发 ,全部病例头颅正侧位片显示GDC形态、位置无改变 ;栓塞手术失败的 2例患者分别于术后第 4天和 4个月死亡。结论　早期GDC血管内栓塞治疗破裂后颅内动脉瘤为有效方法 ,可以防止再次破裂出血。     

Embolization of a ruptured middle colic artery aneurysm

Middle colic artery aneurysms are very uncommon. A few cases of occlusion of superior mesenteric artery aneurysms without bowel ischemia are reported. We describe successful uncomplicated embolization of a ruptured middle colic artery aneurysm with a Gelfoam plug.     

A ruptured mycotic aortic aneurysm in a patient with urinary retention: A case report

Symptomatic abdominal aortic aneurysm (AAA) is a diagnosis that is a true emergency. Since AAAs are typically asymptomatic prior to rupturing, they can easily be missed. When an abdominal aortic aneurysm becomes symptomatic and ruptures, the ramifications can be catastrophic for the patient. We present a case of a 55-year-old male who presented with urinary retention and suprapubic pain. Computerized tomography demonstrated a rapidly expanding AAA and signs of impending rupture. Emergent vascular surgical repair was performed successfully. There was concern for mycotic nature of the AAA with recent COVID-19 infection and possible bacteremia. This case demonstrates the need for maintaining a wider differential when examining patients and avoiding anchoring bias and serves as a point of discussion for potential complications of COVID-19 infection.     

Spinal subarachnoid hemorrhage caused by scleroderma-induced aneurysm: a case report

We introduce a 58-year-old woman who suffered from progressive systemic scleroderma (PSS) associated with trigeminal sensory neuropathy for approximately 10 years. She then had a stroke from spinal subarachnoid hemorrhage (SSAH). Spinal digital subtraction angiography (DSA) revealed two aneurysms and smaller dilations of the afferent vessel that could also be seen by MRI. Three asymptomatic brain infarctions in different vascular regions could be revealed by CCT. The SSAH, ischemic lesions and aneurysms were probably caused by vasculitic affections induced by PSS. Correspondence to: J. Müller     

Value of MRI in patients with a clinical suspicion of acute myocarditis

The diagnosis of myocarditis is difficult and is generally one of exclusion. Moreover, endomyocardial biopsy (EMB) is not a sensitive technique. Magnetic resonance imaging (MRI), however, has shown promising results in diagnosing myocarditis. We evaluated 20 patients with a clinical suspicion of acute myocarditis. Troponin I levels were elevated in 17/20 patients. Cardiac catheterization (n = 13) showed no evidence of coronary artery disease, while normal findings were reported in all five patients who underwent EMB. MRI performed 9.8 ± 7.5 days after the onset of symptoms showed an LV-EDV of 172 ± 50 ml and LV-EF of 57 ± 10%. Abnormalities on delayed contrast-enhanced MRI were found in 15/20 patients, involving 3.7 ± 2.1 segments using the 17-segment model. The lateral LV wall was most frequently involved (61% of enhanced segments). The enhancement was most frequently subepicardial, less often transmural, or midwall (respectively, 67%, 22%, and 11% of enhanced segments). Mild to moderate systolic wall motion abnormalities were invariably found in the abnormally enhancing myocardium on MRI. Associated pericardial effusion was found in six, pericardial enhancement in nine patients. In conclusion, the present study suggests an important role for MRI in evaluating patients with clinical suspicion of acute myocarditis. Not only can the myocardial damage be precisely depicted but also concomitant involvement of the pericardium and impact on regional and global ventricular function can be assessed.     

Cerebral vasospasm evaluated by computed tomography in a patient with ruptured cerebral aneurysm

Summary Low density areas on computed tomography were correlated with changes in the neurological state of a patient who had cerebral vasospasm after subarachnoid hemorrhage from a ruptured anterior communicating aneurysm. No aneurysm was revealed on repeated angiograms initially because of vasospasm, but a low density area was found in the inferior part of the left frontal lobe. Following an attack of low blood pressure on the 12th day his neurological state deteriorated and CT disclosed low density areas in the inferior part of both frontal lobes. The aneurysm was finally disclosed and operated successfully on the 49th day when cerebral vasospasm had disappeared completely.     

Rupture of an internal carotid artery aneurysm during angiography with leakage of contrast medium via an external ventricular drain

With a ruptured intracranial aneurysm producing subarachnoid haemorrhage (SAH) cerebral angiography is currently used for identification of the affected vessel. Aneurysm rerupturing is one of the more serious complications of cerebral angiography and has been frequently described. We report a 61-year-old man who presented with SAH who had rerupture of a large aneurysm of the internal carotid artery during angiography. A substantial amount of contrast medium escaped via a ventricular drain. The three main risk factors for rerupture of an aneurysm are: angiography performed within 6 h of the primary SAH, an aneurysm on the internal carotid artery and an unfavourable Glasgow coma score.     

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     

Histiocytoid cardiomyopathy and ventricular non-compaction in a case of sudden death in a female infant

A case of sudden infant death with histiocytoid cardiomyopathy and ventricular non-compaction was investigated with immunohistochemical methods. Histiocytoid cardiomyopathy is thought to be a developmental defect of the cardiomyocytes of the conduction system. In contrast to mature cardiomyocytes, the histiocytoid cells showed only weak reactions to desmin and myosin antibodies. They lacked cross-striation but reacted strongly to enolase and myoglobin antibodies. The protein Pax-7, seen only in cells undergoing differentiation, and the proliferation marker Ki-67 were not expressed in the histiocytoid cells. In areas of altered myocardium, clusters of CD4-, CD8-, and CD68-positive inflammatory cells were seen as well an abundance of mast cells. With the TUNEL method, it was found that many of the histiocytoid cells were undergoing apoptosis. Our results confirm that the histiocytoid cells are defective cardiomyocytes. The apoptotic and inflammatory changes point to a degenerative process rather than defective maturation of cardiomyocytes as has been suggested in some earlier studies. Ventricular non-compaction is a developmental defect of the subendocardial tissue with hypertrabeculation and weak development of the papillary muscles. Only one case combined with histiocytoid cardiomyopathy has been described previously. A causal connection between the two conditions cannot be established until more cases have been analyzed.     

Sudden cardiac death from parvovirus B19 myocarditis in a young man with Brugada syndrome

Cardiovascular diseases are the leading cause of sudden death all over the world. The aetiology of sudden cardiac death among young adults includes Brugada syndrome and myocarditis.Brugada syndrome is a genetic abnormality of sodium channels in the myocardium with a characteristic electrocardiographic pattern.Myocarditis has several aetiologies including infections. One of the most common cardiotropic viruses is parvovirus B19. This infection presents as a febrile illness in childhood and may result in fatal outcome, more frequently in adults. In this report we present a case of a young man who suffered from a mild upper respiratory tract infection. After recovery he had an episode of syncope and was diagnosed with Brugada syndrome. Some weeks later he died suddenly at home while sleeping. The detailed forensic pathological, histological and microbiological investigation revealed a parvovirus B19-associated myocarditis. Synergic effect of structural and functional abnormalities of the myocardium may lead to death. The cause and potential complications (eg. myocarditis) of even mild infections should be monitored carefully.     

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.