Successful endovascular treatment of spontaneous intrarenal pseudoaneurysm in a case of tuberous sclerosis.

Tuberous sclerosis is a complex disorder which has multisystem involvement and varied clinical manifestations. Almost half of the patients have associated angiomyolipoma which contains fat, vascular and smooth muscle components. Spontaneous pseudoaneurysm formation is a complication of angiomyolipoma. Here we present a case of a female child presenting with hematuria who after thorough clinical and radiological investigations was diagnosed as a case of tuberous sclerosis with right intrarenal pseudoaneurysm. She was successfully treated with endovascular coil embolization.

Same-day angiography and embolization in delayed hematuria following percutaneous nephrolithotomy: an effective, safe, and time-saving approach.

PURPOSE: To evaluate the results of prompt, same-day selective angiography and transcatheter angioembolization (TAE) on delayed post-percutaneous nephrolithotomy (PCNL) hematuria. MATERIALS AND METHODS: Between 2011 and 2017, 21 patients with a mean age of 37 years (range, 21-60 years; males, 18) underwent digital subtraction angiography (DSA) and TAE to control delayed gross hematuria following PCNL. Discharged patients who following an uneventful PCNL presented to the emergency room with gross, brisk hematuria were included in the study and taken up for prompt, same-day DSA and same-session TAE with N-butyl-2-cyanoacrylate glue, without resorting to any initial conservative measures. All patient data were retrieved from medical records. RESULTS: Angiography revealed vascular lesions in all the cases (pseudoaneurysms, 14 cases; arteriovenous fistula, 2; mixed lesions, 5). The mean time of onset of delayed hemorrhage was 10.10±2.67 days. The average time from onset of bleeding to TAE was 4.31±0.64 hours (range 3.5-5.5 hours). Bleeding was controlled in all the cases without any recurrence or the need for further embolization. There were no procedural complications except for transient elevation of serum creatinine in four cases. CONCLUSION: Primary DSA and TAE is a safe, effective, and time-saving alternative to conservative management for post-PCNL, delayed, gross hematuria.

Vascular hamartoma of the paranasal sinuses: report of 3 rare cases and a short review of the literature.

The paranasal sinuses are an extremely unusual location for a vascular hamartoma. As far as we know, only 1 such case has been previously reported in the English-language literature. We report 3 new cases of vascular hamartoma of the paranasal sinuses, which occurred in a 20-year-old woman and in 2 men aged 36 and 45 years. Radiologically, the lesion in the woman was confined to the sinuses, while evidence of intraorbital extension was seen in the 2 men. No intracranial extension was seen in any patient. The diagnosis was confirmed by histopathologic examination of the excised lesions. All 3 patients were alive without recurrence at 12 to 24 months of follow-up.

Percutaneous glue embolization of a visceral artery pseudoaneurysm in a case of sickle cell anemia.

Although aneurysmal complications of sickle cell anemia have been described in the intracranial circulation, visceral artery pseudoaneurysms in this disease entity have not previously been reported in the literature. Conventional treatment of visceral pseudoaneurysms has been surgical ligation or resection of the aneurysm. Transcatheter embolization has emerged as an attractive, minimally invasive alternative to surgery in the treatment of these lesions. In certain situations, however, due to the unfavorable angiographic anatomy precluding safe transcatheter embolization, direct percutaneous glue injection of the pseudoaneurysm sac may be considered to achieve successful occlusion of the sac. The procedure may be rendered safer by simultaneous balloon protection of the parent artery. We describe this novel treatment modality in a case of inferior pancreaticoduodenal artery pseudoaneurysm in a patient with sickle cell anemia. Although a complication in the form of glue reflux into the parent vessel occurred that necessitated surgery, this treatment modality may be used in very selected cases (where conventional endovascular embolization techniques are not applicable) after careful selection of the balloon diameter and appropriate concentration of the glue-lipiodol mixture.

Infantile fibromatosis of the nose and paranasal sinuses: report of a rare case and brief review of the literature.

Infantile fibromatosis is an uncommon, usually cutaneous, nonmetastasizing but locally aggressive fibroblastic proliferation. Involvement of the sinonasal area is extremely uncommon, and only 5 cases have been previously reported. We report a new case, which occurred in a 2-year-old boy. The mass involved the nasal cavity and the paranasal sinuses and extended into the cranial cavity. We also discuss the clinicopathologic features of this lesion, including its ultrastructural characteristics, and we review the literature.

Solitary malignant schwannoma of the nasal cavity and paranasal sinuses: report of two rare cases.

Malignant schwannomas of the paranasal sinuses are extremely uncommon tumors, as only 18 well-documented cases have been previously published in the English-language literature. We report two new cases of solitary malignant schwannoma--one in a 23-year-old man and the other in a 45-year-old woman. Neither was associated with von Recklinghausen's disease. These tumors involved the maxillary sinus, nasal cavity, and orbit and extended intracranially. Following surgery, both patients experienced recurrences. The male patient developed a slowly enlarging intranasal mass at the same site 8 years following excision of the original tumor and postoperative radiotherapy. Microscopic examination of the recurrent tumor revealed that its features were similar histologically to those of the original. The female patient experienced a recurrence 1 year following her first operation.