Inadvertent insertion of a venous catheter into the internal thoracic vein: a word of caution.

Central venous catheters are widely used in clinical practice and are linked to many types of complications, including incorrect positioning at the time the catheter is fitted. Here, the authors describe a case in which a fully implantable catheter was inadvertently positioned in the right internal thoracic vein. The complication was identified when the nursing team attempted to use the catheter. The right internal thoracic vein is within the radiographic projection of the right brachiocephalic vein and the superior vena cava, simulating correct catheter placement on an anteroposterior radiograph. In cases of central catheter malfunction during the immediate postoperative period, work-up should include oblique and lateral views, to rule out the complication described here without a need for computed tomography.

Os cateteres venosos centrais são amplamente usados na prática clínica e estão relacionados a vários tipos de complicações, entre elas o mau posicionamento no momento do implante do cateter. Os autores relatam o caso de um cateter totalmente implantável que foi inadvertidamente posicionado na veia torácica interna direita, sendo a complicação reconhecida após tentativa do uso do cateter na enfermaria. A veia torácica interna direita fica na projeção da veia inominada direita e da veia cava superior, simulando um bom posicionamento do cateter na radioscopia em projeção anteroposterior. Em caso de mau funcionamento de um cateter central no pós-operatório imediato, a conduta deve incluir imagens oblíquas ou de perfil, para excluir a complicação relatada neste trabalho sem necessidade de tomografia computadorizada.

Spontaneous dissection of the renal artery: case report.

Spontaneous renal artery dissection is rare and most cases are considered idiopathic. Previous renal arterial disease may be present in some cases and clinical presentation is often non-specific. Here, the authors present a case of spontaneous renal artery dissection in a 40-year-old male patient with uncontrolled hypertension discovered during investigation of secondary hypertension. Duplex ultrasound initially showed 80% left renal artery stenosis which was shown to be a renal artery dissection during angiography. The patient was successfully managed by percutaneous placement of a renal artery stent.

Late presentation of critical upper limb ischemia caused by pseudarthrosis of the clavicle.

Compression of the subclavian artery in the thoracic outlet is a well-known phenomenon. In rare cases, bone abnormalities, such as pseudarthrosis of the clavicle, can cause arterial compression at this level. Pseudarthrosis may develop as a result of trauma, which is the more common form, or it may be congenital. Here, the authors describe the case of a 44-year-old patient with critical ischemia of the right upper limb. She had a history of untreated right clavicle fracture at 9 months of age which had progressed to pseudarthrosis and extrinsic compression of the subclavian artery causing occlusion. The segment of the clavicle involved was resected and late thromboembolectomy of the subclavian, brachial, distal arteries was performed, with good results.

Correção endovascular de pseudoaneurisma de tronco tibiofibular secundário a endocardite ­ relato de caso / Endocarditis-related tibioperoneal trunk pseudoaneurysm managed with endovascular treatment ­ case report

Os aneurismas do tronco tibiofibular são raros e consistem principalmente em pseudoaneurismas. Os autores descrevem um caso incomum de pseudoaneurisma do tronco tibiofibular secundário a endocardite bacteriana diagnosticada e tratada vários anos antes. Após a exclusão de um processo infeccioso ativo, o paciente foi tratado com sucesso através do implante percutâneo de um stent recoberto. O tratamento endovascular, neste contexto, apresentou uma alternativa segura e eficaz

ibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment

Dissecção espontânea da artéria renal: relato de caso / Spontaneous dissection of the renal artery: case report

A dissecção espontânea da artéria renal é uma patologia rara que, na maioria dos casos, ocorre de forma idiopática. Em alguns casos, pode estar associada à presença de alterações arteriais prévias. Os sintomas geralmente são discretos e inespecíficos, dificultando o diagnóstico. Os autores relatam o caso de um paciente do sexo masculino, de 40 anos, com quadro de hipertensão arterial não controlada de início recente. Na investigação da etiologia da hipertensão arterial, o eco-Doppler de artérias renais revelou a presença de estenose (> 80%) no terço médio da artéria renal esquerda, e a angiografia evidenciou uma dissecção com dupla luz e redução do calibre do vaso. O paciente foi submetido a tratamento com implante de stent com evolução satisfatória.

Spontaneous renal artery dissection is rare and most cases are considered idiopathic. Previous renal arterial disease may be present in some cases and clinical presentation is often non-specific. Here, the authors present a case of spontaneous renal artery dissection in a 40-year-old male patient with uncontrolled hypertension discovered during investigation of secondary hypertension. Duplex ultrasound initially showed 80% left renal artery stenosis which was shown to be a renal artery dissection during angiography. The patient was successfully managed by percutaneous placement of a renal artery stent.

Compressão da artéria subclávia por pseudoartrose de clavícula: apresentação na quinta década de vida / Late presentation of critical upper limb ischemia caused by pseudarthrosis of the clavicle

A compressão da artéria subclávia no desfiladeiro torácico é um fenômeno amplamente conhecido. Anormalidades ósseas, como a pseudoartrose da clavícula, podem raramente causar compressão arterial a esse nível. A pseudoartrose pode desenvolver-se em decorrência de um trauma, que é a forma mais comum, ou ser congênita. Os autores descrevem o caso de uma paciente de 44 anos com quadro de isquemia crítica de membro superior direito. Apresentava história de fratura não tratada de clavícula direita aos 9 meses de idade que evoluiu com pseudoartrose e compressão extrínseca com oclusão da artéria subclávia. O segmento da clavicula acometido pela pseudoartrose foi ressecado e realizada uma tromboembolectomia tardia das artérias subclávia, braquial e distais, com boa evolução.

Compression of the subclavian artery in the thoracic outlet is a well-known phenomenon. In rare cases, bone abnormalities, such as pseudarthrosis of the clavicle, can cause arterial compression at this level. Pseudarthrosis may develop as a result of trauma, which is the more common form, or it may be congenital. Here, the authors describe the case of a 44-year-old patient with critical ischemia of the right upper limb. She had a history of untreated right clavicle fracture at 9 months of age which had progressed to pseudarthrosis and extrinsic compression of the subclavian artery causing occlusion. The segment of the clavicle involved was resected and late thromboembolectomy of the subclavian, brachial, distal arteries was performed, with good results.

Endocarditis-related tibioperoneal trunk pseudoaneurysm managed with endovascular treatment - case report.

Tibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment.