Floating thrombus in the proximal aortic arch

Floating thrombus in the aortic arch is an unusual source of systemic embolism. Surgical removal of the thrombus is a therapeutic option, because thrombolytic therapy carries the risk of partial lysis and repeat embolization. We report a case involving a large floating thrombus that originated in the proximal aortic arch and extended into the left subclavian artery and the descending aorta, and we discuss the surgical management.     

Interrupted aortic arch in an asymptomatic adult

Isolated interrupted aortic arch is a rare congenital cardiac disorder believed at one time to be incompatible with life once the ductus arteriosus closed. To our knowledge, only 12 cases have been reported in the literature and mostly in children. The diagnosis was made in all of them by catheterization. We report the first adult patient with an asymptomatic interrupted aortic arch diagnosed by computed tomography.     

Interrupted aortic arch in an adult female

Interrupted aortic arch is a rare and usually lethal malformation, representing approximately 1% of congenital heart disease. This presents as a missing segment of the aortic arch and is divided into three types: A-called extreme form of coarctation, and is characterized by disruption of aorta's continuity distal to the left subclavian artery (30-40%), B-disruption between the left subclavian and the left carotid arteries (55-60%), and C-the most uncommon type, interruption proximal to the left common carotid artery. The suspicion of coarctation of the aorta can be made from a combination of physical findings including systolic ejection murmur, the murmurs of collateral blood vessels, diminished or absent femoral pulse, and difference in blood pressure between arms and legs. Interrupted aortic arch is an extremely rare anomaly in adult patients. To our knowledge, the world medical literature contains only about 13 reports of interrupted aortic arch diagnosed in adults.     

Interrupted aortic arch in an adolescent male

Interrupted aortic arch (IAA) is an uncommon and usually lethal congenital malformation. The present report describes an unusual case of IAA, an aneurysmal ascending aorta and a bicuspid aorta in a 15-year-old boy. He presented with general malaise, weakness of his legs, headache and hypertension that began six months earlier. He had suffered from effort intolerance since childhood. A three-dimensional gadolinium contrast-enhanced magnetic resonance angiogram demonstrated IAA and a markedly developed collateral circulation. IAA is an uncommon disease that is rarely encountered in an adolescent patient with nonspecific symptoms or hypertension. The present case also shows the clinical value of three-dimensional gadolinium contrast-enhanced magnetic resonance angiography for noninvasive assessment of the aortic arch, and magnetic resonance angiography can replace angiography in the assessment of aortic arch anomalies and visualization of well-developed collaterals.     

Difficulties in diagnosing trichinella encephalitis

Trichinella encephalitis remains a rare but life-threatening illness. Although well known to clinicians of another era, this disease currently may represent a diagnostic dilemma because of its infrequent occurrence and varied presentations. This report of trichinella encephalitis, presenting as quadriplegia, demonstrates that technological advances such as CAT scan, angiogram, and EEG are of no diagnostic assistance and add nothing to traditional diagnostic modalities, i.e., eosinophilia, sedimentation rate, and muscle biopsy. In some cases of trichinosis encephalitis where hypersensitivity reaction and/or vasculitis is believed to be the inciting factor, cortical steroids may have a role in treatment.     

Massive thrombus in the aortic arch: a 59-year-old lady with an unknown familial predisposition to vascular thrombosis

The following is an account of a 58-year-old lady who presentedto our institution with two episodes of acute limb ischemia:one upper, which required embolectomy; and one lower, whichrequired a below knee amputation. We subsequently performedtransesophageal echocardiography (TOE), which revealed verylarge mobile echogenic masses adherent to the wall of her aorticarch, described below.     

Difficulties in diagnosing Brucella spondylitis

We describe a case of culture-proven Brucella spondylitis in a 28-y-old Turkish male asylum seeker who had arrived to Norway 6 months earlier. Several diagnostic difficulties, including rapid in vitro growth and misidentification of the causative microorganism in biochemical gallery strip tests, resulted in late diagnosis.     

Rapidly growing mural thrombus in an abdominal aortic aneurysm

Summary While mural thrombus accompanied by an abdominal aortic aneurysm (AAA) is not rare, the growth rate of such a thrombus has not yet been adequately documented. We present here a very rare case of a 62-year-old female patient with an AAA in whom the mural thrombus in the aneurysm grew very rapidly over a short period. We could follow the growth of the mural thrombus in the AAA by two-dimensional (2-D) abdominal echography. Patients with an AAA must be closely monitored by this technique which is able to detect the presence of the thrombus and allow evaluation of its growth.     

Interrupted aortic arch: an eight-year experience

INTRODUCTION: Interrupted aortic arch (IAA) is a rare congenital heart defect with a high mortality rate in the neonatal period. Surgical correction of associated intracardiac anomalies can be performed in a one-stage (primary) or two-stage approach. OBJECTIVES: Case review of children with IAA operated in our center and to evaluate the surgical outcomes and the occurrence of complications. METHODS: A retrospective chart review of children operated from June 1998 to October 2006. RESULTS: Twelve children (nine girls and three boys) were operated. Nine patients had ventricular septal defect with septal malalignment, two had univentricular hearts and two had transposition of the great arteries. Primary correction was performed in eleven patients (aged between two and 38 days), including two Norwood procedures. There was no early mortality. The follow-up time ranged from 30 days to six years (median 2.6 years), with late mortality of 33%. Two children required reintervention for aortic arch restenosis, which was successfully treated by catheterization. DISCUSSION: Our experience is that early primary repair of IAA has low early and late mortality and is the method of choice most situations. Late mortality depends the severity of associated anomalies.     

Ankylosing spondylitis and an aortic arch syndrome

A 63 year old woman with a 16 year history of ankylosing spondylitis and peripheral joint involvement later presented with a large vessel arteritis affecting the branches of the arch of the aorta.     

Recurrent rupture of an infected aortic arch

Severe bacterial aortitis without an aneurysmal component is a rare but life-threatening problem that requires aggressive treatment to eliminate the infection and prevent recurrence. Herein, we present the case of a 58-year-old man who underwent patch repair of a nonaneurysmal aorta that had ruptured due to Staphylococcus aureus infection. Postoperatively, he experienced a recurrent rupture that required reoperation. We successfully performed wide-margin débridement followed by aortic arch replacement with a prosthetic vascular graft and omental flap.     

Posterior pericardial ascending-to-descending aortic bypass for interrupted aortic arch in an adult

Interrupted aortic arch (IAA) in the adult population is an extremely rare condition. In this case report, we present a 35-year old male patient with Type A interrupted aortic arch (IAA) and discuss the successful surgical treatment.     

Interrupted aortic arch in an adult single-stage extra-anatomic repair

Interrupted aortic arch is a rare congenital malformation of the aortic arch that occurs in 3 per million live births. Defined as a loss of luminal continuity between the ascending and descending portions of the aorta, this anomaly entails a very poor prognosis without surgical treatment. To our knowledge, the world medical literature contains only 12 reports of isolated interrupted aortic arch diagnosed in adults. Nine of these patients underwent successful surgical repair, but 1 died during the early postoperative period. We describe a 10th successful surgical repair, which involved a 42-year-old woman who had an asymptomatic type B interrupted aortic arch (characterized by interruption between the left subclavian and left carotid arteries). We performed a single-stage extra-anatomic repair by placing a 16-mm extra-anatomic Dacron graft between the ascending and descending portions of the thoracic aorta and by interposing a 7-mm extra-anatomic Dacron graft between the 16-mm graft and the left subclavian artery. The patient recovered uneventfully and continued to do well 6 months later.     

Ankylosing spondylitis and an aortic arch syndrome.

A 63 year old woman with a 16 year history of ankylosing spondylitis and peripheral joint involvement later presented with a large vessel arteritis affecting the branches of the arch of the aorta.