The subclavius posticus muscle: an unusual cause of thoracic outlet syndrome.

We present the case of a 30-year-old female, complaining of thoracic outlet compression symptoms caused by a supernumerary muscle, the subclavius posticus, accompanied by a caudally inserted middle scalenus muscle on the second rib. This rare anatomic variant was clearly shown on CT angiography and MRI images and surgical treatment was successful. As first described by Rosenmuller in 1800, subclavius posticus is a supernumerary muscle originating from the cranial surface of the sternal end of the first rib, running laterodorsally beneath the clavicle, and inserting into the superior border of the scapula. Its role in thoracic outlet syndrome has been seldom demonstrated in living patients nor described in imaging, although it is theoretically easily recognizable on modern imaging modalities. It should be taken into account during workout of patients with thoracic outlet syndrome, since it can be potentially treated.

Spontaneous plantar vein thrombosis: state of the art.

We aim here to highlight the importance of diagnosing and treating promptly the rarely thought of diagnosis of plantar vein thrombosis. We hereby report two cases with no known thrombotic risk factors. Less than 20 cases are reported in the literature. Detection of this unusual site of involvement of the deep venous system can be easily made by ultrasound examination if searched for. Plantar vein thrombosis is a rarely evoked pathology. Knowledge of its occurrence could further improve its diagnosis especially that it could reveal an unknown neoplasia or coagulation abnormality.

Case report of a rare spontaneous superficial temporal artery aneurysm.

Unlike posttraumatic temporal artery aneurysm, spontaneous temporal artery aneurysm is an exceptional finding. We report the case of a 34-year-old woman with no history of previous trauma who presented a progressively enlarging right temporal lump. A CT scan revealed a 1.6 cm diameter aneurysm arising from the superficial temporal artery. The aneurysm was surgically resected. The postoperative course was uneventful. Histological examination revealed the presence of intima, media and adventitia.

[Massive iatrogenic haemothorax treated by lidocaïne-adrenaline intercostal injection]. / Hémothorax iatrogène massif jugulé par injection intercostale de lidocaïne-adrénaline.

INTRODUCTION: Massive haemothorax is a relatively rare complication of thoracocentesis or the placement of tube thoracostomy. It is principally caused by intercostal vessel injury. The therapeutic approach consists in pleural drainage and sometimes thoracotomy for haemostasis. CASE REPORT: We describe a frail 72 year old patient, who developed a massive haemothorax occurring after a tube thoracostomy placing, persisting despite second pleural drainage, and complicated by deep haemodynamic shock. He was considered to have a very high risk of mortality if surgery was undertaken. Haemorrhage was totally stopped after intercostal instillation of lidocaïne-adrenaline. CONCLUSION: This case report suggests a role for pleural vasoconstrictor injection as initial treatment in case of persistent pleural haemorrhage caused by intercostal vessel injury.

[Hydatid disease diagnosed following a pulmonary embolism]. / Une hydatidose diagnostiquée à l'occasion d'une embolie pulmonaire.

Hydatidosis is a parasitic disease found worldwide, particularly in Mediterranean countries, caused by Echinococcus granulosis infection. Humans are an intermediate and accidental host in the cycle of this parasite. The hydatid pulmonary arterial embolism is extremely rare, usually arising in the heart or the liver. We report a case of hydatid pulmonary embolism explored with multidetector scanner and MRI, and confirmed at pathology of the operative specimen. To our knowledge, this is the first case of inaugural hydatid pulmonary arterial embolism found on CT scan establishing the diagnosis of the disease in a patient who had no other location of hydatid cyst.

[Segmental variations of great saphenous vein diameters in a coronary triple vessel disease population]. / Variations des diamètres segmentaires des veines saphènes internes chez une population coronaire tritronculaire.

BACKGROUND: Great saphenous vein is one of the most used grafts in cardiovascular surgery. There is little amount of data in the medical literature describing dimensions of this vein. This series describes dimensions of the great saphenous vein in a coronary population and their variations. PATIENTS AND METHODS: Retrospective series of patients admitted to the cardiovascular surgery department of Hotel-Dieu de France Hospital - Beirut, between January 2003 and June 2006 for elective coronary artery bypass grafting and having a preoperative Doppler ultrasound of the saphenous veins according to a standardized protocol. Great saphenous vein dimensions were analyzed with regard to patients' characteristics using multivariable analysis of variance. RESULTS: Four hundred and two subjects were included with a mean age 64.4+/-9.3 years and a mean body mass index 27.9+/-4.5 kg/m(2). Women presented 22.6% of the series. Great saphenous vein dimensions' variations according to gender were significant (Multivariate Pillay trace=0.001) below the knee. Dimensions' variations were also significant as function of body mass index (P=0.001) and body surface (P=0.001). Age and cardiovascular risk factors did not influence GSV diameters. CONCLUSION: This series allowed constructing reference tables of the great saphenous vein segmental diameters in patients admitted for coronary artery surgery. Female sex is associated with lower segmental diameters below the knee and body mass index and body surface are linearly associated with segmental diameters at all levels.

[Predictive factors of long-term functional rehabilitation in thoracic outlet syndromes: 85 patients]. / Facteurs prédictifs des résultats à long terme de la rééducation fonctionnelle des syndromes de la traversée thoracobrachiale: à propos de 85 patients.

INTRODUCTION: Thoracic outlet syndromes are expressed by various clinical manifestations. Treatment is mainly rehabilitation. We aimed to identify factors predicting long-term functional rehabilitation in patients with this treatment and recurrence of symptoms. PATIENTS AND METHODS: We performed a descriptive retrospective analysis of 84 patients who underwent rehabilitation for thoracic outlet syndrome as defined by Revel and colleagues. Data collection involved a questionnaire exploring personal information, risk factors for developing thoracic outlet syndrome, clinical signs, and x-ray results. Long-term results of treatment were evaluated by telephone questionnaire. Data analysis involved use of Stata 6 software. RESULTS: Univariate analysis: predictive factors of negative results with treatment were ligament hypermobility, sensitive disturbances at the time of diagnosis, and a positive Adson's test result. Predictive factors of positive results were absence of paresthesia at the end of the treatment, and a negative "bell sign" at the end of the treatment. Predictive factors of nonrecurring symptoms were age younger than 34, bilateral positive Adson test result, and need for a supplementary number of sessions. MULTIVARIATE ANALYSIS: predictive factors of positive results with treatment were absence of sensitive impairment at the time of diagnosis, compliance with home exercises, initial negative Adson's test result, absence of hypermobility, and absence of paresthesia at the end of treatment. Predictive factors of recurring symptoms were age younger than 34, the need for a supplementary number of sessions and bilateral positive Adson's test result. CONCLUSION: A larger number of subjects are needed to further explore the predictive factors of rehabilitation and recurring symptoms in thoracic outlet syndrome for better validity and significance.

[Gadolinium-medium filter-protected percutaneous stended carotid angioplasty]. / Stenting carotidien protégé sous gadolinium.

We report on a patient who underwent a percutaneous carotid angioplasty with stenting. The procedure was protected by a filter and used gadolinium instead of iodine. No neurological or renal complication occurred. This observation represents one of the first publications describing the use of this contrast medium in a complex neuroradiological intervention.

Substernal goitre: a rare cause of pulmonary hypertension and heart failure.

Benign substernal goitres usually extend into the upper anterior mediastinum and are easily extractable through a cervical approach. Very infrequently these tumours extend into the thoracic cavity causing compression of mediastinal structures. The authors report a case of pulmonary hypertension and severe cardiac failure secondary to a long-standing substernal goitre, and support the surgical management of this disease.

Mycotic aneurysm of the popliteal artery secondary to tuberculosis. A case report and review of the literature.

Mycotic aneurysms of the popliteal artery are rare; 33 cases have been reported in the literature. The treatment of choice is a large excision with extra-anatomic revascularization. In situ revascularization is sometimes possible. To the best of our knowledge, tuberculosis has never been reported as a causal factor of mycotic aneurysms of the popliteal artery. We report a case of a recurrent tuberculous false aneurysm of the popliteal artery. After 2 attempts at in situ revascularization, the femoral artery was ligated with no distal ischemia.

Renal artery pseudoaneurysm after blunt abdominal trauma.

Renal artery pseudoaneurysms are rare after blunt abdominal trauma; only 11 cases have been previously reported. Pseudoaneurysms are caused by decelerating injuries of the renal artery after major falls or automobile accidents. Patients may be asymptomatic for many years, and the pseudoaneurysm may expand and rupture before diagnosis or treatment. The patients in four untreated cases died. The diagnosis of renal artery pseudoaneurysm can be made by Doppler sonography, computerized tomography, renal perfusion imaging, or contrast angiography. Treatment requires either surgical or percutaneous intervention. Renal salvage was possible in five of the seven patients treated. We report two additional patients with successful outcomes after surgical intervention.

[Triple filling plasty in Clagett thoracostomy]. / Triple plastie de comblement d'une thoracostomie de Clagett.

Clagett's thoracostomy is a widely used procedure in the initial treatment of postpneumonectomy empyema. We describe in this paper an original one-step operation of thoracic filling after empyema sterilization. The triple plasty includes an apical thoracoplasty limited to the first 3 ribs, a pedicle flap of the latissimus dorsi transferred inside the thoracic cavity, and an upper translation of the diaphragm to the 4th rib in order to reduce residual pleural space. Three patients were operated and followed up clinically (for 20, 29, and 30 months), and radiologically with a MRI on the 12th month. Complete tissue healing and loss of all residual space was observed in all patients. We therefore recommend the use of this technique rather than thoracic wall coverage procedures.

[Renovascular arterial hypertension in the framework of von Recklinghausen's neurofibromatosis. Apropos of a case]. / Hypertension artérielle rénovasculaire dans le cadre de la neurofibromatose de Von Recklinghausen. A propos d'un cas.

Arterial hypertension in patients with neurofibromatosis is most often due to an associated pheochromocytoma. In rare cases the etiology of arterial hypertension is renovascular. Surgical treatment is mandatory when the stenosis is located in the proximal segment of the vessel. Angioplasty is hazardous in this setting due to the fibrotic nature of the culprit lesion. The authors report a case of ostial narrowing of the right renal artery in a 16-year-old girl with severe arterial hypertension and neurofibromatosis. The operation consisted of resection of the culprit lesion and reimplantation of the renal artery on the aorta. Postoperatively her blood pressure returned to normal.

[Cardiac failure caused by renal arteriovenous fistula fifty years after nephrectomy. A new case and review of the literature]. / Insuffisance cardiaque par fistule artérioveineuse rénale cinquante ans aprés néphrectomie. Nouvelle observation et revue de la littérature.

Arterio-venous fistulae are rare after nephrectomy. They are the cause of congestive cardiac failure. This case report has two particularities: an exceptionally long interval, 50 years after nephrectomy, and a severe hypertension due to stenosis of the contra-lateral renal artery. Surgical treatment of these fistulae is essential and gives excellent results with rapid regression of the signs of cardiac failure. Percutaneous embolization is an alternative in patients with a high surgical risk. All previously reported cases are reviewed (n = 72) with their aetiological, clinical and therapeutic features.