Dense middle cerebral artery computed tomography sign: Confirmation by magnetic resonance (MR) imaging and MR angiography

In acute ischaemic stroke, the dense middle cerebral artery sign on computed tomography indicates occlusion of the middle cerebral artery. A case is described in which the sign was confirmed by magnetic resonance (MR) imaging and MR angiography.     

The dense basilar artery as a sign of basilar territory infarction

Three cases of basilar artery territory infarction, in which a dense basilar artery was noted, are described. The dense basilar artery was recognized on computed tomography (CT) by comparing its density with that of other unaffected intracranial vessels. This sign is thought to represent basilar thrombosis or embolism and has similarities to the dense middle cerebral artery sign. The dense basilar artery is an early sign suggesting basilar territory infarction and its use improves the CT detection of basilar territory infarction.     

肺癌支气管动脉与肺动脉CT血管造影分析

目的利用CT血管造影（CTA）显示支气管动脉（BA）和肺动脉（PA）三维影像学特征,进一步探讨肺癌血供。方法收集原发性肺癌147例及正常对照46例,采用多层螺旋CT胸部增强扫描获得原始图像,用容积显示（VR）、多平面重建（MPR）、最大强度投影（MIP）进行CTA重建,观察和分析BA、PA形态学特征及其与肺癌关系。结果肺癌组BA在VR中清晰显示136例,显示率为92．5％,平均2．3支／例;对照组BA清晰显示32例,显示率为69．6％,平均2．0支／例。肺癌组同侧BA管径较肺癌对侧和正常对照组BA明显增粗（P〈0．05）;肺癌同侧总截面积显著大于正常对照组（P〈0．05）,且较肺癌对侧明显增加（P〈0．05）;肺癌侧BA扩张扭曲呈蚓状走向肿瘤或进入肿瘤内,多分支网状吻合。肺癌组PA均清晰显示,54例PA穿过肿瘤或从瘤旁经过,未见异常变化;25例PA显影完整,受肿块推挤并从周围包绕肿块,形成手握球征;40例PA基本完整,肿块从外对PA环状包埋,PA管腔呈扁平状、偏心性或向心性缩窄或枯树枝征;28例PA受肿块包绕并残缺截断形成残根征。结论原发性肺癌BA明显扩张,总供血量明显增加;PA穿过肿瘤或狭窄截断。多重螺旋CTA同样证明肺癌主要为BA供血,未见PA供血证据。     

Giant cavernous hepatic hemangioma: treatment by ligation of the hepatic artery

We present a case of a giant hepatic hemangioma. We found it at laparotomy and we decided on the course of treatment on the operating table. As right lobectomy was not feasible, we performed ligation of the hepatic artery. The patient made an uneventful recovery. A selective hepatic angiography and a liver scan were performed 8 months postoperatively and they both showed regression of the tumor. The tumor was not demonstrable in the right hepatic artery. The patient is in excellent health 2 years after the operation; the liver is smaller in palpation and the tumor itself is nonpalpable. In this case the ligation of the hepatic artery was a successful therapeutic procedure.     

Traumatic dissection of extracranial internal carotid artery and subclavian artery

A case of a young, adult male presenting with acute post-traumatic dissection involving the left internal carotid and subclavian artery is described.     

Post traumatic psuedoaneurysm of the lingual artery

Post traumatic pseudoaneurysm is a well documented complication of vascular injuries which needs early diagnosis and early management otherwise there may be significant morbidity and mortality. We present a patient who had been operated elsewhere for a foreign body lodged in neck during splinter injury sustained while bursting a cracker. He presented to ENT department of our hospital with bleeding from the wound site. We are reporting this case because pseudoaneurysm of the lingual artery as such is very rare. We could not find any other reported case in available English literature. Moreover the treating ENT surgeons need to be sensitized to the presence of such an entity and hence avoid late complications.     

以胸背血管分叉平面作为乳腺癌腋窝淋巴结清扫术下界的研究

目的 判断乳腺癌患者胸背血管分叉平面下方组织内是否存在淋巴结及其转移情况，分析能否以此平面作为腋窝淋巴结清扫术中胸背血管的解剖终点。方法 在进行腋窝淋巴结清扫术时，将胸背血管分叉平面下方组织切除后标以胸背血管分叉处淋巴结另送病理检查。结果 112例患者中有99例发生腋窝淋巴结转移，阳性率为88．4％；97例(86．6％)胸背动脉分叉平面下方为脂肪组织，有15例(13．4％)存在淋巴结，均未发现癌细胞转移。结论 多数病例胸背动脉分叉平面以下组织内不存在淋巴结。不论患者原发肿瘤大小、腋窝淋巴结有无转移、病理类型等因素如何，该处组织均未发现转移，且胸背血管分叉处位置较为固定，变异较少，可作为腋清扫范围的下界。     

Duplication of the Vertebro-Basilar System

During the examination of 75 fixed brains and 2086 vertebral angiograms we encountered two cases of fenestration of the vertebral artery and two cases of partial duplication of the basilar artery. In the first case, an 81 year old male, there was fenestration, of the basilar artery at the union of the two vertebral arteries. The fenestration was 9mm long with no associated vascular disease. The other partial duplication of the basilar artery was observed in the upper portion of the artery in a 54 year old male patient investigated angiographically for subarachniod haemorrhage. The fenestration of the third case was demonstrated in the intracranial part of the right vertebral artery of a 50 year old female patient during digital substraction angiography for subarachnoid haemorrhage. In the fourth case, the fenestration was found angiographically at the atlanto-axial level in the extracranial portion of the left vertebral artery in a 37 year old female patient with subarachnoid haemorrhage from an arteriovenous malformation in the left cerebral hemisphere. The embryonic, histological and radiological implications of the duplication are discussed.     

Hepatic artery catheterization via the superior pancreaticoduodenal artery

The superior pancreaticoduodenal artery is a continuation of the gastroduodenal artery. Besides being a good-sized artery, it is easily accessible. It is a reasonable vascular access for hepatic artery cannulation.     

Stenosis of the accessory renal artery: Doppler ultrasound findings

Stenosis of an accessory renal artery has been cited as a significant source of false-negative results with conventional renal artery Duplex sonography in the investigation of renal artery stenosis. Two case reports of accessory renal artery stenosis that were detectable using the newer intrarenal Doppler ultrasound technique with sampling from both poles and the hilum are presented. The cases illustrate a further advantage of Doppler ultrasound of the intrarenal arteries over the conventional technique.     

Comparison of transcranial Doppler ultrasound and computed tomography angiography in symptomatic middle cerebral artery stenosis

Transcranial Doppler ultrasound (TCD) and computed tomography angiography (CTA) of 10 patients with middle cerebral artery territory stroke were studied. To obtain data from patients with presumed in situ middle cerebral artery (MCA) stenosis, the study excluded patients with a known source of cardiac emboli, significant carotid stenosis and classical lacunar syndrome. As the gold standard for this study, CTA demonstrated MCA stenosis in all patients (100%), while abnormal TCDs suggesting MCA stenoses were found in only six patients (60%). The stenotic sites differed among patients with normal and abnormal TCDs. Patients with false negative TCDs were found to have more distal lesions (distal M1 or M2 segment) whereas patients with TCD abnormalities tend to have more proximal lesions as demonstrated by CTA. It is concluded that an abnormal TCD is highly suggestive of stenosis of MCA. A normal TCD, however, does not exclude such a lesion, especially in patients with distal M1 or M2 stenoses. Therefore, TCD may not be the best screening test for intracranial vascular stenotic lesion in MCA territory stroke.     

肝动脉变异在肝门淋巴结廓清中的临床意义

目的:探讨肝动脉变异在肝门淋巴结廓清中的识别与预防损伤策略。方法:回顾性分析2013年1 月至2014年7 月蚌埠医学院第一附属医院肝胆外科62例肝门淋巴结廓清中12例肝动脉变异患者术中处理情况。结果:12例肝动脉变异类型分为:MichelsⅢ型3 例（25.0%）,MichelsⅥ型2 例（16.7%）,MichelsⅨ型1 例（8.3%）,Hiatt6 型1 例（8.3%）,肝右动脉与肝总管空间位置变异2 例（16.7%）,肝左右动脉共同起源于肝总动脉2 例（16.7%）,以及肝右动脉起自胃十二指肠动脉1 例（8.3%）。 12例患者无肝动脉损伤;2 例发生术后并发症,其中1 例胰漏,另1 例切口感染;无术后出血、胆漏及肝脓肿等并发症发生。整体恢复良好。结论:在熟知各种肝动脉解剖变异类型的前提下,术前完善的影像学检查与评估,加以术中谨慎且精细的操作,将使肝动脉损伤明显减少。      

Giant right coronary artery aneurysm – A rare presentation

Coronary artery aneurysm (CAA) is focal dilatation of a coronary artery 1.5 times or more its normal size (Res Cardiovasc Med, 2016; 5: e32086). Coronary artery aneurysm is found in 1.2–4.9% of diagnostic coronary angiography and 1.4% at post‐mortem (Heart Views, 2014; 15: 13; Clin Cardiol, 2015; 29: 439). The proximal and middle segments of the right coronary artery (RCA) are most commonly involved, followed by the proximal left anterior descending (LAD) and the left circumflex arteries. The left main stem rarely develops aneurysms (Clin Cardiol, 2015; 29: 439). A giant aneurysm is a CAA> 2 cm. Giant coronary artery aneurysms (GCAA) are rare (incidence 0.02%) although cause serious complications. [4] Given the rarity of this disease, there is limited information in the literature on its presentation and there is no consensus on its optimal management option. We report a case of a GCAA with an atypical presentation and describe its management. This will add to the current small database on CAA to provide clinicians a better insight on the disease.     

Successful treatment of pulmonary artery sarcoma by a two-drug combination chemotherapy consisting of ifosfamide and epirubicin

We describe a case of 63-year-old woman with pulmonary artery sarcoma successfully treated with chemotherapy. She developed acute shortness of breath, and left chest and shoulder pain. Although a diagnosis of acute pulmonary embolism was made at a local hospital and she received anticoagulation and thrombolysis therapy, no improvement was achieved. Thereafter, she underwent a pulmonary thromboectomy in our hospital, and the histological diagnosis was intimal sarcoma of the pulmonary artery. Since post-operative computed tomography (CT) scans of the chest showed obvious persistence of an intraluminal hypoattenuated area in the left main pulmonary artery, the patient was treated with four cycles of a doublet chemotherapy consisting of ifosfamide (2.5 g/m(2)/day) on days 1-5 and epirubicin (45 mg/m(2)/day) on days 2 and 3. CT scans of the chest after four cycles showed marked regression of the intraluminal hypoattenuated area in the left main pulmonary artery. This is the first case of pulmonary artery sarcoma responding to chemotherapy. Surgical resection is currently the most hopeful treatment for pulmonary artery sarcoma. However, intensive chemotherapy is worth trying in unresectable patients.     

Popliteal artery pseudo-aneurysm following penetrating trauma

Popliteal artery pseudo-aneurysm due to accidental penetrating trauma, once common during world wars, is now rare. It may require amputation due to ischaemic complication. One such case is detailed here. The angiographic findings, complications, management and literature review are provided.     

Femoral artery pseudo-aneurysm: Ultrasound guided compression repair

Pseudo-aneurysm is an uncommon complication of catheterization of the femoral artery. The recently described technique of repair of femoral artery pseudo-aneurysms by ultrasound guided compression is discussed and three cases using this treatment presented.     

Functional entrapment of the popliteal artery

A case of functional entrapment missed at the initial angiogram is presented. The imaging of popliteal artery entrapment syndrome and functional entrapment is discussed. The importance of appropriate imaging is emphasized. The classification of popliteal artery entrapment syndrome is discussed and it is proposed that functional entrapment is added to the existing classification in the interest of consistent reporting.     

Pseudoaneurysm of the external carotid artery branch following radiotherapy for nasopharyngeal carcinoma

Rupture of irradiated arteries in patients with head and neck cancer is an uncommon complication. We present the first case of a pseudoaneurysm of the external carotid artery branch that developed after irradiation of nasopharyngeal carcinoma and was successfully treated by microcoil embolization therapy. Clinicians should be aware of this unusual complication to avoid a potentially erroneous management.     

Contrast-enhanced Doppler ultrasound for renal artery stenosis

The use of renal artery Doppler ultrasound for the diagnosis of renal artery stenosis is a well-established technique in selected populations, but the technical failure rate of the examination leading to incomplete studies is a major drawback. The results of ultrasound contrast-enhanced renal artery Doppler for renal artery stenosis, using the echo-enhancing agent, Levovist, are reported here. Sixteen patients (22 arteries) were examined with Levovist. The technical success rate of these examinations was 91%, and all four renal artery stenoses were correctly identified. It is concluded that the use of ultrasound contrast (Levovist) increases the technical success rate of renal artery Doppler ultrasound in this setting, with similar accuracy to unenhanced Doppler examinations.     

Infundibulum of the common origin of fourth lumbar arteries and median sacral artery

We describe an infundibulum of a common origin of the fourth lumbar arteries and the median sacral artery. To the best of our knowledge there has been no such published case thus far and its natural course is unknown, in view of its novelty. Infundibular dilatations in intracranial arteries have been described to progress in size and potentially rupture. Therefore, we recommended follow‐up imaging, as part of the management, to ensure stability of the infundibulum.