Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer: A case report

BACKGROUNDRadiation therapy (RT) for nasopharyngeal cancer can cause several complications. In rare cases, an internal carotid artery pseudoaneurysm can occur, which can be fatal. We report the experience of a nasopharyngeal cancer patient who underwent radiation therapy and subsequently developed a fatal pseudoaneurysm of the petrous internal carotid artery.CASE SUMMARYA 39-year-old man was diagnosed with nasopharyngeal cancer 2 years ago (American Joint Committee on Cancer Stage T3N2M0) and received concurrent chemoradiation therapy. He subsequently relapsed and received chemotherapy. One week after the 4th cycle of chemotherapy, he was admitted to the emergency room of our hospital because of massive epistaxis accompanied by a headache. A pseudoaneurysm of the petrous internal carotid artery was confirmed by digital subtraction angiography (DSA). Stent-assisted endovascular coil embolization was performed and complete occlusion was achieved. No pseudoaneurysm was observed on DSA after coil embolization; however, intermittent epistaxis was maintained even after coil embolization. After seven days, a diagnostic laryngoscopy was performed. Massive bleeding occurred after aspiration of the blood clot during the laryngoscopy and the patient died of hypovolemic shock. In this case, epistaxis may have been a sign of pseudoaneurysm; therefore, treatment such as embolization should be performed promptly, and careful management should be undertaken after treatment.CONCLUSIONThis case highlights a rare, serious complication of RT in nasopharyngeal cancer and how it should be recognized and treated.     

Rotarex mechanical thrombectomy in renal artery thrombosis: A case report

BACKGROUNDAcute renal artery thrombosis is a relatively rare disease. Early diagnosis and emergent treatment can prevent the loss of renal function and the development of hypertension.CASE SUMMARYWe report a patient with acute renal artery thrombosis who presented to our hospital with acute-onset right flank pain and was treated by percutaneous mechanical thrombectomy using the Rotarex device. After 2 mo, right kidney function had recovered slightly.CONCLUSIONRenal artery thrombosis may lead to loss of renal function and the development of hypertension. Rotarex mechanical thrombectomy may be a viable treatment option for rapid recanalization of the renal artery in patients with renal artery thrombosis.     

Cystic artery pseudoaneurysm: A case report

BACKGROUNDCystic artery pseudoaneurysm is a condition rarely encountered by clinicians; this, its etiology and presentation as well as appropriate treatments are not well studied. Although it is treated by removal of the diseased gallbladder and cystic artery, such surgery can be difficult and risky if acute inflammation with bleeding occurs, and not every patient can tolerate the surgery.CASE SUMMARYAn 81-year-old man complained of epigastric pain and tarry stool passage that lasted for 3 d. He had a medical history of poor cardiopulmonary function. The computed tomographic scan of abdomen showed cystic artery pseudoaneurysm and dilatation of gallbladder. Because of high adverse outcomes related to general anesthesia, the patient was successfully managed with endovascular embolization for this cystic artery pseudoaneurysm and percutaneous drainage for the distended gallbladder.CONCLUSIONA patient with cystic artery pseudoaneurysm may quickly deteriorate with the occurrence of concurrent arterial bleeding and sepsis. This report presents the case of a patient who did not undergo surgery due to multiple cardiopulmonary comorbidities and whose condition was managed successfully with embolization and biliary drainage. Endovascular embolization and biliary drainage may provide an alternative option to manage this complicated condition.     

Successful endovascular treatment of endoscopically unmanageable hemorrhage from a duodenal ulcer fed by a renal artery: A case report

A 52-year-old woman was admitted with hypovolemic shock. Emergency endoscopy revealed three hemorrhagic duodenal ulcers (all stage A1) with exposed vessels. Two ulcers were successfully treated by endoscopic clipping; however, the remaining ulcer on the posterior wall of the horizontal portion of the duodenum could not be clipped. Because her vital signs were rapidly worsening, we performed transcatheter arterial embolization (TAE) as it is less invasive than surgery. Computed tomography aortography showed that the duodenal hemorrhage was sourced from the lower branch of the right renal artery. In general, the duodenum is fed by branches from the gastroduodenal artery or superior mesenteric artery. However, this patient had three right renal arteries. The lower branch of the right renal artery at the L3 vertebral level was at the same level as the horizontal portion of the duodenum. Complete hemostasis was achieved by TAE using metallic coils and n-butyl-2-cyanoacrylate. After TAE, she recovered from the hypovolemic shock and was discharged from hospital. She has had no recurrence of the hemorrhagic duodenal ulcer for over 1 yr, and follow-up endoscopy showed no necrosis or stricture of the duodenum. Although she developed a small infarct of her right kidney, her renal function was satisfactory. In summary, the present case is the first reported case of hemorrhagic duodenal ulcer in which the culprit vessel was a renal artery that was successfully treated by TAE. Computed tomography aortography before TAE provides valuable information regarding the source of a duodenal hemorrhage.     

Spontaneous internal carotid artery pseudoaneurysm complicated with ischemic stroke in a young man: A case report and review of literature

BACKGROUNDCarotid artery pseudoaneurysm (PSA) is infrequently encountered in clinical settings. Internal carotid artery (ICA) PSA complicated with ischemic stroke is rare. PSAs are typically caused by iatrogenic injury, trauma, or infection. The underlying mechanisms of spontaneous PSA formation are not well characterized. We report a healthy young man who presented with stroke as a complication of spontaneous PSA of the left ICA.CASE SUMMARYA 30-year-old man working as a ceiling decoration worker was hospitalized due to sudden-onset speech disorder and right lower extremity weakness. Medical history was unremarkable. Brain computed tomography revealed ischemic stroke. Digital subtraction angiography showed a left ICA PSA with mild stenosis. The patient was conservatively managed with oral anticoagulation and antiplatelet therapy. He recovered well and was discharged. The patient was in good condition during follow-up.CONCLUSIONThe occupational history of patient should be taken into consideration while evaluating the etiology of spontaneous ICA PSA in young people with stroke.     

Renal artery embolization in the treatment of urinary fistula after renal duplication: A case report and review of literature

BACKGROUNDDuplicate renal malformation is a congenital disease of the urinary system, with an incidence rate of 0.8%. Surgical treatment is suitable for symptomatic patients. Urinary fistula is one of the complications of heminephrectomy. Long-term urinary fistula has a great impact on patients'' lives. CASE SUMMARYThis article mainly reports on a 47-year-old man with duplication of kidney deformity, long urinary fistula after partial nephrectomy, and no improvement after conservative treatment. We have achieved positive results in the arterial embolization treatment of the residual renal artery, indicating that selective arterial embolization is a good way to treat urinary fistula after partial nephrectomy. It is worth noting that this patient violated the Weigert-Meyer law, which also gave us more consideration. CONCLUSIONRenal artery embolization may be a simple and safe method to treat urinary fistula inefficacy with conservative treatment.     

Successful treatment of aortic dissection with pulmonary embolism: A case report

BACKGROUNDAortic dissection (AD) and pulmonary embolism (PE) are both life-threatening disorders. Because of their conflicting treatments, treatment becomes difficult when they occur together, and there is no standard treatment protocol.CASE SUMMARYA 67-year-old man fell down the stairs due to syncope and was brought to our hospital as a confused and irritable patient who was uncooperative during the physical examination. Further examination of the head, chest and abdomen by computed tomography revealed a subdural hemorrhage, multiple rib fractures, a hemopneumothorax and a renal hematoma. He was admitted to the Emergency Intensive Care Unit and given a combination of oxygen therapy, external rib fixation, analgesia and enteral nutrition. The patient regained consciousness after 2 wk but complained of abdominal pain and dyspnea with an arterial partial pressure of oxygen of 8.66 kPa. Computed tomography angiograms confirmed that he had both AD and PE. We subsequently performed only nonsurgical treatment, including nasal high-flow oxygen therapy, nonsteroidal analgesia, amlodipine for blood pressure control, beta-blockers for heart rate control. Eight weeks after admission, the patient improved and was discharged from the hospital.CONCLUSIONPatients with AD should be alerted to the possibility of a combined PE, the development of which may be associated with aortic compression. In patients with type B AD combined with low-risk PE, a nonsurgical, nonanticoagulant treatment regimen may be feasible.     

Hemorrhagic fever with renal syndrome complicated with aortic dissection: A case report

BACKGROUNDHemorrhagic fever with renal syndrome is caused by hantaviruses presenting with high fever, hemorrhage, and acute kidney injury. Microvascular injury and hemorrhage in mucus were often observed in patients with hantavirus infection. Infection with bacterial and virus related aortic aneurysm or dissection occurs sporadically. Here, we report a previously unreported case of hemorrhagic fever with concurrent aortic dissection.CASE SUMMARYA 56-year-old man complained of high fever and generalized body ache, with decreased platelet counts of 10 × 10⁹/L and acute kidney injury. The enzyme-linked immunosorbent assays test for immunoglobulin M and immunoglobulin G hantavirus-specific antibodies were both positive. During the convalescent period, he complained sudden onset acute chest pain radiating to the back, and the computed tomography angiography revealed an aortic dissection of the descending aorta extending to iliac artery. He was diagnosed with hemorrhagic fever with renal syndrome and Stanford B aortic dissection. The patient recovered completely after surgery with other support treatments. CONCLUSIONHemorrhagic fever with renal syndrome complicated with aortic dissection is rare and a difficult clinical condition. Hantavirus infection not only causes microvascular damage presenting with hemorrhage but may be risk factor for acute macrovascular detriment. A causal relationship has yet to be confirmed.     

Delayed pseudoaneurysm formation of the carotid artery following the oral cavity injury in a child: A case report

BACKGROUNDAn impalement injury of the oral cavity is a common traumatic injury in children. In most cases, it is not accompanied by sequelae, but if foreign body residues are not found due to a minor injury, they may result in inflammatory responses and delayed vascular injuries in the surrounding tissues. Without early diagnosis and appropriate initial management, residual foreign bodies can cause serious complications and even mortality in some cases. CASE SUMMARYA 9-year-old boy suffered an intra-oral injury by a wooden chopstick, and the patient was discharged from the hospital after receiving conservative treatment for the injury. However, the patient was readmitted to the hospital due to intra-oral bleeding, and since neck hematoma and right internal carotid artery pseudoaneurysm formation were detected on computed tomography, emergency surgery was performed. A remnant fragment of a wooden chopstick was found during the operation, and a delayed rupture of the internal carotid artery caused by the foreign body was also found.CONCLUSIONThe failure of early detection and diagnosis of a residual foreign body may result in delayed vascular rupture.     

Rare spontaneous extensive annular intramural esophageal dissection with endoscopic treatment: A case report

BACKGROUNDIntramural esophageal dissection (IED) is a rare disease that should be considered in patients with chest pain, dysphagia, and hematemesis. Although it occurs most frequently in older adult women with impaired coagulation or as a sequela of endoscopy, the incidence of spontaneous IED without an obvious causative agent has risen gradually. CASE SUMMARYThis report describes a case of extensive annular IED in a 75-year-old male patient who presented with dysphagia for the past month. Esophageal barium meal radiography revealed slow passage of diluted iohexol through the esophagus after swallowing, prominent luminal dilation, obstruction of the lower segment with only a small amount of contrast medium entering the gastric cavity, and no obvious extravasation. Gastroscopy revealed smooth esophageal mucosa; several esophageal mucosal bridges and webbed mucosa were observed approximately 22 cm from the incisor. The mucosal surface was occasionally rough and uneven, and the length of the esophageal mucosal defect exceeded 10 cm. The anatomy was considered to be annular because the mucosal bridge connecting the proximal and distal tube was not attached to the surrounding myotubes. The final diagnosis was spontaneous extensive annular IED. We treated the patient successfully using endoscopic esophagotomy, which completely relieved the symptoms without complications. CONCLUSIONSpontaneous annular IED can be treated successfully by endoscopic resection of the mucosal septum between the true and false lumen.     

Treatment of Stanford type A aortic dissection with triple pre-fenestration,reduced diameter,and three-dimensional-printing techniques: A case report

BACKGROUNDA 63-year-old female was diagnosed with acute Stanford type A aortic dissection. The patient had pain in the chest and back for 1 wk. The computed tomography angiography (CTA) showed Stanford type A aortic dissection (Myla type III aortic arch). The intimal tear was located at the top of the aortic arch and retrograded to the ascending aorta.CASE SUMMARYPreoperatively, a three-dimensional (3D)-printed model of the aortic arch was made according to CTA data. Then, under the guidance of the 3D-printed aortic model, a pre-fenestrated stent-graft was customized, and the diameter of the stent-graft was reduced intraoperatively by surgeons. 3D printing, triple pre-fenestration, and reduced diameter techniques were used during the surgery. The CTA examinations were performed at the 3^rd mo and 1st year after the surgery; the results showed that the aortic dissection was repaired without endoleak, and all three branches of the aortic arch remained unobstructed.CONCLUSIONApplying the triple pre-fenestration technique for aortic arch lesions was feasible and minimally invasive in our case. The technique provides a new avenue for thoracic endovascular aortic repair of Stanford type A aortic dissection.     

A surgical treatment for frank rupture of acute type a small intramural hematoma

A 71‐year‐old woman was admitted to the hospital due to cardiac tamponade. Computed tomography revealed that the diameter and wall thickness of the ascending aorta were 36 and 9 mm, respectively. An emergent ascending aortic replacement was performed uneventfully. The pathological findings indicated frank rupture of intramural hematoma.     

Fatal pancreatitis secondary to iatrogenic intramural duodenal hematoma: A case report and review of the literature

Intramural duodenal hematoma (IDH) is a rare finding in the adult, especially when related to iatrogenic complications of ulcer treatment. It can lead to biliary obstruction and pancreatitis, which proved fatal in our case. Contrastenhanced computed tomography (CT) is invaluable in detecting the abnormality and can definitely be diagnostic.