Abdominal aortic aneurysm in association with horseshoe kidney.

The authors report 3 cases of infra-renal abdominal aortic aneurysms resected in the presence of horseshoe kidney. In all these cases the diagnosis of the renal anomaly was done before the aneurysmectomy. In the first case, the diagnosis of horseshoe kidney was done by an aortography. In the second case by a previous operation to remove an urinary calculi. Three years after this surgery the diagnosis of abdominal aortic aneurysm was done when a computed tomography, an intravenous pyelography and an aortography, confirmed the diagnosis of horseshoe kidney. The third case come to our hospital in the fourth day after an exploratory laparotomy done in another hospital, when was observed the aneurysm and the horseshoe kidney. The second case had two anomalous arteries. One of them arose from the aneurysm to the renal isthmus and the other one from the common iliac to the isthmus. The three patients had an uncomplicated postoperative course. Only in the second case we had the necessity to reattache an anomalous artery directly to the graft.     

Abdominal aortic aneurysm in association with horseshoe kidney

We report the preoperative diagnosis and surgical treatment of an abdominal aortic aneurysm (AAA) in association with a horseshoe kidney (HSK) in a 70-year-old man. Through a median laparotomy a vascular tube graft was successfully used for repair the AAA. The extensive parenchymal isthmus overlying the aneurysm remained intact.     

Abdominal aortic aneurysm and horseshoe kidney. Clinical cases

The concomitance of horseshoe kidney and abdominal aortic aneurysm is rare but represents an interesting challenge for vascular surgeons. The trouble is greater if the diagnosis is formulated intraoperatively and specially if it is an emergency operation for aortic rupture or fissuration. The surgeon's aim is to get to the aneurysm collar without damaging the kidney, the renal arteries or the urinary tract that often have an anomalous development. The authors make a review of the literature and describe three cases occurred out of 2558 prosthetic reconstructions due to abdominal aortic aneurysm.     

Abdominal aortic aneurysm associated with horseshoe kidney

The optimal approach to abdominal aortic aneurysm with horseshoe kidney is still debated. We describe a successful abdominal aortic aneurysm repair through a left retroperitoneal approach in a 77-year-old woman with a horseshoe kidney.     

Abdominal aortic aneurysm in association with a congenital pelvic horseshoe kidney: sentinel report and technical consideration

A case of an abdominal aortic aneurysm in the presence of a congenital pelvic horseshoe kidney is described and the technical approach discussed. Renal function was preserved by 'double clamping' during the proximal anastomosis and infusing cold crystalloid into cannulated renal arteries originating from the aneurysm sac.     

Congenital heart diseases and urinary malformations

The purpose of this study was to evaluate the advisability of a systematic search for uropathy in patients with malformative heart disease. Thirty-three cases of urinary tract malformation associated with congenital cardiopathy are reported. These cases represent 2.8 p. 100 of all cardiac patients seen during the same period. The congenital heart diseases were varied, with a predominance of ventricular septal defect (48 p. 100) followed by dextrocardia, single ventricle and coarctation of the aorta. UT abnormalities included vesico-ureteral reflux (36 p. 100), renal agenesis (5 cases), renal dysplasia or hypoplasia (4 cases), upper UT obstruction (4 cases), hypospadias (3 cases), renal ectopia (3 cases), lower UT obstruction (2 cases), polycystic kidney, megaloureter, horseshoe kidney and supernumerary kidney (1 case each). A study of the literature showed that the two uropathies with a risk of associated cardiopathy are renal agenesis and horseshoe kidney. The cardiopathy-uropathy association was found in isolation (11 cases) or combined with cryptorchidism (2 cases) or with multiple malformations (20 cases). The malformations were diverse, the most frequent being neurosensorial malformations (70 p. 100), followed by skeletal malformations (55 p. 100) equally divided between apine and limbs, genital malformations (35 p. 100) and digestive tract malformations (25 p. 100). A study of the cardiopathy-uropathy concordances failed to elicit any predominant association; in the literature, ventricular septal defect is usually associated with horseshoe kidney.(ABSTRACT TRUNCATED AT 250 WORDS)     

彩色多普勒超声在腹主动脉瘤破裂诊断中的应用价值

目的探讨彩色多普勒超声在腹主动脉瘤破裂诊治中的价值。方法回顾性分析14例腹主动脉瘤破裂患者的灰阶和彩色多普勒超声图像,从腹主动脉瘤发生部位、瘤体大小、瘤壁厚度、瘤体破裂部位、瘤体破裂时血管内异常回声、血管周边形成血肿、出现腹腔游离液及瘤体内彩色多普勒表现等方面进行分析,并与手术结果、CT血管成像或磁共振检查结果进行对比。结果腹主动脉瘤超声检出率100%,肾上型2例,肾下型12例,瘤体最大直径6.1～1 3.2 cm,超声诊断腹主动脉瘤壁破裂处显示率14.3%,腹主动脉瘤旁腹腔血肿显示率66.7%,腹腔积液显示率80.0%,腹膜后血肿显示率12.5%。结论超声作为可移动简便无损伤的检查方法 ,可以快速的对腹主动脉瘤破裂和其他腹腔器官肿物引起的急腹症进行鉴别,在腹主动脉瘤的发现、随访监测、腹主动脉瘤破裂急诊入院有较高的临床应用价值。     

Echocardiographic diagnosis of atrial septal aneurysm in an infant with hypoplastic right heart syndrome

Echocardiographic findings are described in a patient with hypoplastic right heart syndrome (pulmonary atresia type with intact ventricular septum and small right ventricular cavity) who had an associated atrial septal aneurysm. An unusual appearance of echoes behind the aorta bulging into the left atrium in diastole on both the M-mode and cross-sectional echo suggested this diagnosis prior to cardiac catheterization. The angiographic findings confirmed the diagnosis of right ventricular hypoplasia, pulmonary atresia and the large atrial septal aneurysm. The infant died after surgery and the atrial septal aneurysm was observed at autopsy. The importance of the diagnosis of the atrial septal aneurysm and its association with restriction of right-to-left atrial shunting prompts this report.     

Horseshoe lung and facio-auriculo-vertebral sequence: a previously unreported association

We describe a case of horseshoe lung in an infant with facio-auriculo-vertebral (FAV) sequence that included mild hemifacial microsomia, ear anomalies, a missing left rib, left hemivertebrae (T2-T4), and complex congenital heart disease. Of the approximately 40 cases of horseshoe lung described since 1962, most are reported in association with scimitar syndrome, and only four reported cases were associated with left lung hypoplasia. None of these cases included malformations consistent with a diagnosis of FAV sequence.     

Retroperitoneoscopic left nephrectomy in a horseshoe kidney with the use of the harmonic scalpel

Laparoscopy has greatly evolved over the years. More recently, retroperitoneoscopy has gained wide acceptance as the preferred approach for simple and complicated nephrectomies. We report on a 12 year-old girl who underwent a left nephrectomy on a horseshoe kidney through a retroperitoneoscopic approach using the harmonic scalpel for dissection and isthmus division. The operation was successful, recovery uneventful, and the patient was discharged 24 hrs post operatively, with excellent cosmesis. Retroperitoneoscopy can be considered if ablative surgery is contemplated in a horseshoe kidney, with adequate preoperative evaluation and solid retroperitoneoscopic surgical experience. The use the harmonic scalpel was greatly beneficial for the overall success of this complicated intervention.     

The “horseshoe” lung: Six new cases

Six cases of horseshoe lung have been found in a group of 147 scimitar syndrome cases collected in a cooperative multicenter study. These cases were associated either with the severe infantile or with the benign adult form of the scimitar syndrome. The aim of this paper is to describe the clinical and imaging signs as well as the prognosis of 6 new cases of horseshoe lung in association with scimitar syndrome. The authors conclude (1) that the diagnosis of horseshoe lung may be strongly suspected on standard chest radiographs and confirmed by thoracic CT scan; (2) that the prognosis of scimitar syndrome does not seem to be worse when associated with horseshoe lung. Pediatr Pulmonol. 1994; 17:124–130 . © 1994 Wiley-Liss, Inc.     

Fortuitous discovery of the association of true and false aneurysm of the left ventricle after cardiogenic shock]

The authors report the fortuitous diagnosis of a true and a false left ventricular aneurysm in a 77 year old man with severe ischaemic heart disease and calcific aortic stenosis, admitted for cardiogenic shock. The association of these two forms of aneurysm is very rare. Clinical and paraclinical diagnosis is difficult. Conventional left ventriculography is the investigation of reference but the diagnosis has been facilitated by Technetium 99 cardiac scintigraphy and color Doppler echocardiography. Surgery may be considered in cases of true aneurysm especially in patients with left ventricular failure, but the indication is formal in cases of false aneurysm.     

A multi-perforated man: asymptomatic ruptured sinus of Valsalva aneurysm associated with an atrial and ventricular septal defect.

We report the case of an exceptional association of a right coronary sinus of Valsalva aneurysm (SVA) ruptured into the right ventricle, a supracristal ventricular septal defect (VSD) and an atrial septal defect (ASD). Our patient was totally asymptomatic and the diagnosis was established by echocardiography. The patient underwent prompt surgery that consisted in closing the aneurysm and the VSD with a pericardium patch.     

Bilateral aneurysm of the common iliac artery and kidney pelvic ectopia: endovascular treatment

We report the case of a 65-year-old man who developed chronic ischemia of the lower limbs. The angiogram showed bilateral aneurysm of both common iliac arteries in association with a left congenital pelvic kidney. The vascular supply was made by with three arteries originating in the inferior mesenteric artery. The aneurysms were treated with percutaneous stent grafts.     

Carcinosarcoma of the renal pelvis in a horseshoe kidney: about a case

Carcinosarcoma of the renal pelvis is a rare tumor, and its development in a horseshoe kidney makes it even more special. This is the first case reported in the literature of a renal pelvis carcinosarcoma developed in a horseshoe kidney and diagnosed on macroscopic hematuria.     

Perianeurysmal retroperitoneal fibrosis: An unusual cause of renal failure

Retroperitoneal fibrosis causing ureteral obstruction in association with an abdominal aortic aneurysm has been reported infrequently. However, the clinical presentation of patients with this entity and the histopathologic findings at surgery are similar to those in patients with idiopathic retroperitoneal fibrosis. We describe a patient with perianeurysmal fibrosis and bilateral ureteral obstruction who presented with severe renal failure. The diagnosis of an abdominal aortic aneurysm with perianeurysmal fibrosis was made only at the time of surgery to repair bilateral ureteral obstruction. Previous case reports of perianeurysmal fibrosis are reviewed, and possible pathogenetic mechanisms are discussed. It is important to consider the presence of an occult abdominal aortic aneurysm in patients suspected of having retroperitoneal fibrosis because of the serious prognostic and therapeutic implications.     

Aneurysm of the subclavian artery after operatively corrected coarctation of the aorta: 20 years of follow-up and review of the current literature]

We report of long-term follow-up of a combined fusiform aneurysm of the right subclavian artery extending to the thyreocervical trunk (3.2 x 2.8 x 2.2 cm (width x height x depth)) in a 33-year old patient. As a newborn, the clinical diagnosis of an aortic isthmus stenosis was made without need for intervention at this stage. Further development of the child remained unremarkable until the age of eleven years when he experienced dizziness after sporting activities. Due to clinically proven progress, cardiac catheterization was performed and confirmed the initial diagnosis of a juxtaductale stenosis of the aortic isthmus, which was operated thereafter with an end-to-end anastomosis. Furthermore, an aneurysm of the right subclavian artery was revealed. Since then, non-invasive routine follow-up showed no significant worsening of this aneurysm, which extends to the thyreocervical trunk. The patient has been event free and completely asymptomatic. This case report illustrates the more than twenty years of follow-up of an asymptomatic combined fusiform aneurysm of the subclavian artery and thyreocervical trunk and provides a review of the literature on this topic.     

Inflammatory abdominal aortic aneurysm

A 58-years-old man, with no medical past history, was examined for abdominal pain and weight loss. An enlarged kidney could be palpated, and abdominal echography showed left hydronephrosis due to ureteral compression by abdominal aortic aneurysm. Laboratory data showed an inflammatory syndrome. CT scan suggested the diagnosis of inflammatory abdominal aortic aneurysm. The use of corticosteroids brought about the regression of the symptoms and the resolution of the ureteral obstruction, permitting aneurysmectomy and prosthesis replacement without ureterolysis. This report shows the interest of preoperative radiological diagnosis of the inflammatory character of abdominal aneurysm. For uncomplicated cases, preoperative treatment using corticosteroids could allow partial regression of the periaortic inflammation and easier surgical repair.     

A Ruptured Mycotic Aneurysm of a Branch of the Superior Mesenteric Artery and Pulmonary Tuberculosis

Superior mesenteric artery aneurysms are the third most common visceral artery aneurysm and account for 5.5% of all visceral aneurysms. Aneurysms at these sites are more susceptible to rupture and death may occur due to delayed diagnosis.A case of a ruptured mycotic aneurysm of a branch of a superior mesenteric artery in association with pulmonary tuberculosis, treated successfully with resection, is presented.     

Left ventricular aneurysm in the young African. Apropos of 23 cases]

A retrospective study allowed us to examine 23 cases with aneurysm of the left ventricle. The aneurysm was discovered incidentally in 6 patients, and as a result of cardiac symptoms in an other 14. The diagnosis made following a cerebrovascular accident and an episode of ventricular tachycardia respectively in two cases. Radiological and electrocardiographical investigation revealed the classical findings in 21 cases, while inflammatory changes were also present in 19. Tuberculosis was found to coexist in 4 patients, and was suspected in a further 4. The aetiology of these aneurysms has remained obscure until now. We feel that a debilitating conditions such as tuberculosis or late pregnancy, or perhaps a change in cardiac function, might lead to the development or enlargement of a sub-annular aneurysm in a predisposed subject. One of our patients presented with an apical aneurysm of the left ventricle in association with a complete situs inversus. A further patient had sustained a severe precordial ingiury 10 years previously, and 2 others had a past history of rheumatic joint disease many years previously. It appears to us that cases with calcification have a better prognosis.