Rupture of left sinus of Valsalva aneurysm into the pulmonary artery

Congenital sinus of Valsalva aneurysm is an uncommon lesion that frequently presents after rupture in adult life. This report describes a patient with a left sinus of Valsalva aneurysm that ruptured into the main pulmonary artery, a previously unreported anatomic variant. Anatomic and clinical features of previously reported cases of ruptured sinus of Valsalva aneurysm are reviewed.     

Neurofibromatosis type 1 with basilar artery fusiform aneurysm manifesting Wallenberg's syndrome

A case of neurofibromatosis type 1 (NF1) manifesting Wallenberg's syndrome and fusiform aneurysm of the basilar artery is reported. The patient suddenly developed dysarthria, walking difficulty and sensory disturbance. Neurological examination suggested Wallenberg's syndrome and MR imaging confirmed an ischemic lesion at the left lateral medulla oblongata. Cerebral angiography revealed a fusiform aneurysm at the middle portion of the basilar artery. However, there was no occlusive change in either the posterior inferior cerebellar artery or the vertebral artery. The clinical and radiological features are discussed together with a review of NF1 cases with intracranial aneurysms in the literature.     

Giant aneurysm of renal artery: surgical management

Giant aneurysm of the renal artery is rare even though renal artery aneurysms are diagnosed more often since the introduction of abdominal ultrasonography and selective renal arteriography. A 52-year-old man with an aneurysm of the left renal artery measuring 16 x 13 x 10 cm presented with features of an expanding aneurysm. He underwent resection of the aneurysm and a left nephrectomy.     

Radiological evaluation of hepatic artery aneurysms

The authors report 4 cases of hepatic artery aneurysm confirmed by computed tomography, sonography, angiography, and/or surgery. Three aneurysms involved the right hepatic artery and 1 involved the common hepatic artery. Two cases were treated with surgery, and the other 2 cases with transcatheter embolization. The clinical and radiological features of this entity are described together with a review of the pertinent literature.     

Initial report of a mycotic aneurysm of the common iliac artery with compression of the ipsilateral ureter and femoral vein: a literature review and case report

Iliac artery aneurysms are rare and the usual symptoms, pelvic pain and urological complaints, are nonspecific. We describe a patient with pelvic pain, intermittent urinary retention, and lower extremity edema. A right common iliac artery aneurysm was discovered during surgery after rupture had occurred. Pathologic examination revealed a mycotic process. This case demonstrates the obscure and unreported clinical features of iliac artery aneurysms. When this lesion is suspected, an angiogram should be performed promptly in an effort to prevent the predictable catastrophic consequences.     

Coronary artery lesions in Takayasu arteritis: Pathological considerations

This communication reviews the clinical and pathological features of coronary artery lesions in Takayasu arteritis. The incidence of coronary artery involvement has been reported to be 9% to 10%, and is observed mainly in autopsy cases because coronary artery disease is usually not evident until the occurrence of angina pectoris or myocardial infarction, or after the onset of congestive heart failure. On the basis of pathological features, the following three types of coronary artery lesions can be distinguished: type 1, stenosis or occlusion of the coronary ostia and the proximal segments of the coronary arteries; type 2, diffuse or focal coronary arteritis, which may extend diffusely to all epicardial branches or may involve focal segments, so-called skip lesions; and type 3, coronary aneurysm. Most of the coronary artery lesions in Takayasu arteritis are of type 1. Narrowing of the coronary arteries is mainly due to the extension of the inflammatory processes of proliferation of the intima and contraction of the fibrotic media and adventitia from the ascending aorta. In some cases, coronary stenosis may be caused by coronary arteritis as skip lesions in Takayasu arteritis, but even in these cases the lesions have been reported to affect mainly the proximal segments of the coronary arteries. Diffuse lesions of the coronary artery and coronary artery aneurysm seem to be very rare in Takayasu arteritis. Other causes of coronary ostial stenosis, coronary arteritis and coronary artery aneurysm are also discussed.     

Hepatic artery aneurysm. Report of a case and review of the literature

One hundred and nineteen cases, including the one reported here, of hepatic artery aneurysm were reviewed. The clinical features and surgical management in four etiologic groups, consisting of arteriosclerosis, cholecystolithiasis, trauma and, specific diseases, were investigated. Interruption of the hepatic artery, entailing ligation of the hepatic artery, excision of the aneurysm without vascular reconstruction, and obliterative aneurysmorrhaphy, was done in 50 patients. Its high mortality rate (26%) was principally ascribed to delayed diagnosis or inappropriate site of interruption. If conditions such as shock, anoxia and portal thrombosis are avoided, interruption of the hepatic artery seems to be a safe and useful operative method for hepatic artery aneurysms, especially accompanied by severe local infection.     

冠状动脉瘤及其临床分析

目的利用较大样本冠状动脉造影资料分析国人冠状动脉造影的人群中冠状动脉瘤的检出率、病因、临床特点和预后。方法回顾性研究分析1993年12月至2006年12月8628例成年人冠状动脉造影资料,将检出的冠状动脉瘤进行总结和分类,并与国内外文献进行比较。结果8628例行冠状动脉造影术的人群中,共检出冠状动脉瘤80例,检出率为0.927%,其中男性61例,女性19例。冠状动脉瘤检出率在男女性别之间无显著性差异(P>0.01)。好发部位依次为右冠状动脉、左前降支和左回旋支;有心绞痛病史者72例,42例合并心肌梗死;同时存有冠状动脉狭窄≥50%的病人72例;瘤体内发现血栓61例;瘤体发生于单支冠状动脉者63例,2支者6例,3支并左主干者6例;无一例瘤体破裂。本病可引起心肌梗死等严重临床后果,抗血小板、抗凝及血运重建可明显改善预后。结论国人成年人冠状动脉瘤是冠状动脉粥样硬化的一个少见的亚类或变异型,非一个独立临床疾病,动脉瘤和狭窄通常是共有的。动脉瘤内常有血栓,易引起心肌梗死,如不积极干预,则愈后较差。     

老年髂动脉多发炎性动脉瘤的临床特点分析

目的了解髂动脉多发炎性腹主动脉瘤的临床特点,提高对本病诊断及药物治疗的认识。方法对1例发生于髂动脉的炎性腹主动脉瘤老年患者的临床资料进行分析,并复习有关文献。结果炎性腹主动脉瘤好发于70岁左右老年人,临床表现为突发腹痛或背痛,体重下降,C反应蛋白和红细胞沉降率升高,影像学检查可见动脉瘤壁增厚,炎症累及输尿管可引起肾盂积水,常规治疗需手术,早期经糖皮质激素及免疫抑制剂联合治疗可避免或推迟手术。结论突发严重腹痛的腹主动脉瘤患者,应尽早行影像学检查,发现动脉瘤壁增厚及肾盂积水支持本病诊断。早期糖皮质激素及免疫抑制剂治疗能显著缓解症状,并消除尿路梗阻。     

症状性颈动脉狭窄合并未破裂颅内动脉瘤的临床研究

目的探讨颈动脉狭窄合并未破裂颅内动脉瘤患者的临床特点、发病率及临床处理策略。方法 2012年7月1日~2013年12月31日于我中心就诊,通过数字减影血管造影(DSA)确诊的狭窄程度≥50%的颈动脉狭窄患者191例,通过电话和门诊进行3~12个月随访,其中5例患者进行了DSA随访。结果 191例患者中,合并未破裂动脉瘤患者12例,检出率6.3%。12例未破裂颅内动脉瘤患者中,9例干预治疗,其中1例单纯行颈动脉狭窄支架置入,1例行动脉瘤手术夹闭后择期行颈动脉内膜剥脱术,2例单纯行动脉瘤栓塞,5例行狭窄支架置入并动脉瘤栓塞;另3例未干预治疗,仅控制危险因素,定期随访。所有患者均合并有糖尿病,高血压及吸烟等危险因素。随访期间,未破裂动脉瘤干预患者中,有1例患者动脉瘤复发;未干预患者中,有1例患者频繁短暂性脑缺血发作,给予抗血小板治疗后好转。结论在颈内动脉狭窄患者中,颅内动脉瘤发生率较高。对颈动脉狭窄合并颅内动脉瘤患者通过个性化的方案治疗后,可取得良好治疗效果。     

Spontaneous rupture of a congenital hepatic artery aneurysm

A 74-year-old woman with new, but vague abdominal pain developed an intra-abdominal hemorrhage. Ultrasound and CT scans before and after this event demonstrated an acute hepatic lesion with hemorrhage into the peritoneal cavity. The patient died, and a ruptured hepatic artery aneurysm was revealed at autopsy. Hepatic artery aneurysm is uncommon, usually extra-hepatic, and, in most cases, is caused by atherosclerosis, medial degeneration, trauma, or infection. In this case, the aneurysm was intrahepatic and no underlying abnormalities of the hepatic vessels were found. We discuss the clinical scenario of patients with hepatic artery aneurysm and stress the importance of considering the diagnosis in the setting of a catastrophic abdominal event. In addition, the various diagnostic and therapeutic options are explored.     

Enormous right coronary arterial aneurysm in a patient with type IV Ehlers-Danlos syndrome.

A patient with a giant aneurysm in the right coronary artery combined with dilated and tortuous left descending and circumflex arteries is described. The clinical features and implications are discussed.     

Left ventricular aneurysm in a patient with mildly dilated cardiomyopathy

We describe the case of a patient with mildly dilated idiopathic cardiomyopathy and left ventricular aneurysm, diagnosed in absence of a prior clinical history and anatomo-pathological features of myocardial infarction. To ascertain the diagnosis of idiopathic cardiomyopathy, the patient underwent cardiac catheterization with coronary angiography, that showed the lack of epicardial artery stenosis and a slow run-off of the contrast. An endomyocardial biopsy showed the presence of hypertrophic myocytes and interstitial fibrosis. Moreover, a thoracic high resolution computed tomography showed the features of pulmonary bilateral basal emphysema, interstitial thickening and bronchiectasis. Alfa1-anti-trypsin plasma levels were reduced. The patient, because of worsening of clinical and hemodynamic conditions, underwent at age of 36 a combined heart-lung transplantation. The pathological examination of the native organs confirmed the previous diagnosis. At the moment, this is the second report in the literature concerning the presence of left ventricular aneurysm in a patient with idiopathic cardiomyopathy without an underlying coronary artery disease or prior history of myocardial infarction.     

Ruptured gastric artery aneurysm: An uncommon manifestation of microscopic polyangiitis

Gastric artery aneurysm is a rare and lethal condition, and is caused by inflammatory or degenerative vasculopathies. We describe herein the clinical course of a patient with a ruptured gastric artery aneurysm associated with microscopic polyangiitis. Absence of vasculitic changes in the aneurysm resected and negative results of autoantibodies interfered with our diagnostic process. We should have adopted an interventional radiology and initiated steroid therapy promptly to rescue the patient.     

Aneurysm of a persistent sciatic artery

Angiographic examination in a patient with sciatic-like pain on the right side and a firm, pulsatile, non-tender mass in the right buttock revealed a large sciatic artery aneurysm. The aneurysm was successfully resected at surgery. The primitive sciatic artery is the main arterial supply to the lower extremities in the 9-mm embryo. Its persistence, while very rare, is of clinical significance because of the tendency for aneurysms to develop in the artery. Surgical resection is indicated in sciatic artery aneurysms because of the danger of rupture or embolic occlusion of arteries distal to the aneurysm.     

40-year-old patient with an aneurysm of the extracranial arteria carotis interna

A case of extracranial internal carotid artery aneurysm Aneurysms of the extracranial internal carotid artery are uncommon but can be responsible for serious complications such as rupture, thrombosis, or embolism. The underlying causes of aneurysm include atherosclerosis, fibromuscular dysplasia, trauma, previous carotid artery surgery, infection, dissection, syphilis and a congenital defect. Five distinct clinical types of aneurysms are reported with different symptoms and treatment. We report a case of extracranial internal carotid artery aneurysm and its successfully surgical treatment.     

Successful embolization of the left gastric artery aneurysm obtained in preoperative diagnosis: a report of 2 cases

Gastric artery aneurysm is rare and accounts for fewer than 5% of all splanchnic artery aneurysms. The diagnosis is usually established during emergent surgery or at autopsy because warning signs or symptoms are vague, absent, or unrecognized. Nearly 80% of the patients reported with gastric artery aneurysm die. Preoperative diagnosis of gastric artery aneurysm is an essential contribution to treat safely and effectively the aneurysms and to reduce the high mortality rate. We report a successful treatment with transcatheter arterial embolization (TAE) of two cases of a left gastric artery aneurysm diagnosed using contrast-enhanced computed tomography. Case 1 was a ruptured aneurysm with shock. Embolization was successfully performed as the left gastric artery aneurysm was diagnosed by computed tomography at rupture. Case 2 had multiple hepatocellular carcinomas, and a left gastric artery aneurysm was diagnosed by follow-up computed tomography. Embolization was successfully performed for the left gastric artery aneurysm, and chemoembolization was repeatedly performed for multiple hepatocellular carcinomas after embolization of the aneurysm.     

Coronary artery aneurysm related to percutaneous coronary intervention

We report a case of coronary artery aneurysm possibly related to percutaneous coronary intervention. The various clinical features, epidemiology and management of the condition are also discussed in detail.     

Spontaneous rupture of a coronary artery aneurysm: a case report and review of the literature

Coronary artery aneurysm (CAA) is a rare disorder, characterized by abnormal dilatation of a localized portion or diffuse segments of the coronary artery. CAA may cause angina, myocardial infarction, sudden death due to thrombosis, embolisation, or rupture. In this report, a 63 year old Turkish male patient is presented who had an acute non-Q wave myocardial infarction due to spontaneous rupture of the left circumflex artery aneurysm. An extremely rare clinical presentation of rupture of a left circumflex CAA is discussed.     

3D-CTA、3D-DSA评估脑动脉瘤患者行显微外科夹闭术的治疗效果

目的 以三维CT血管成像（3D-CTA）、三维脑血管造影（3D-DSA）检查评估脑动脉瘤患者行显微外科夹闭术的效果,为合理选择脑动脉瘤显微外科夹闭后的评估方法提供依据.方法 对25例行显微外科夹闭术后的脑动脉瘤患者行3D-CTA、3D-DSA复查,分别对有无动脉瘤夹闭不全、动脉瘤颈残留/成角、载瘤动脉狭窄、载瘤动脉闭塞和动脉瘤夹滑脱移位5种影像学特征进行分析、赋值和计分,并进行统计分析.结果 25例患者中,术后3D-CTA复查显示载瘤动脉狭窄2例,未见动脉瘤夹闭不全、动脉瘤颈残留/成角、载瘤动脉闭塞和动脉瘤夹滑脱移位;3D-DSA复查显示动脉瘤夹闭不全1例、动脉瘤颈残留/成角1例、载瘤动脉狭窄2例,未见载瘤动脉闭塞和动脉瘤夹滑脱移位.两种检查方法的评分比较无统计学差异（P＞0.05）.结论 3D-CTA对显微外科夹闭术后的总体评价效果与3D-DSA具有可比性,但其对动脉瘤夹闭不全和动脉瘤颈残留/成角的显示不及3D-DSA.