[Intracranial Dural Arteriovenous Fistula Associated with Multiple Arterio-arterial Fistulas between the Systemic Arteries and the Pulmonary Artery:A Case Report].

An intracranial dural arteriovenous fistula(dAVF)was incidentally detected in a 39-year-old man during a medical checkup. Except for a mild episode of pneumonia at the age of 22 years, his medical history was unremarkable. He had no family history of hereditary hemorrhagic telangiectasia(HHT). The dAVF was treated radically via ligation of the fistula, without any complications. Postoperative angiography demonstrated that the dAVF had completely healed, but showed an aberrant, dilatated, and tortuous internal mammary artery. A contrast-enhanced computed tomography scan revealed multiple arterio-arterial fistulas between various systemic arteries and the pulmonary artery(an intercostal artery to the pulmonary artery fistula, an internal mammary artery to the pulmonary artery fistula, and an inferior phrenic artery to the pulmonary artery fistula). These thoracic lesions did not require additional treatment because they did not cause any symptoms, e.g., respiratory or cardiac failure. In most previous cases, such aberrant thoracic arterial fistulas were detected incidentally or based on the presence of minor clinical symptoms. However, in some cases, they caused severe respiratory or cardiac failure and were treated via the embolization of the responsible vessels. Therefore, the co-existence of thoracic arterial fistulas in patients with dAVF should be evaluated, even if the dAVF does not meet the criteria for HHT. Such thoracic lesions might cause a chest murmur that can be detected via a stethoscope or via a blunt costophrenic angle on chest radiography.

[Successful treatment of dysphagia due to Wallenberg syndrome using intermittent air stretching method with balloon catheter: a case report].

A 69-year-old woman presented with dysphagia due to Wallenberg syndrome. Videofluorography revealed unilateral dysfunction of the cricopharyngeal muscle, which caused stenosis of the esophageal entrance on the affected side. Pharyngeal fiberscopy indicated that glottal function and the cough reflex were preserved and that the pharyngeal reflex was lost. The stenosis of the esophageal entrance due to dysfunction of the cricopharyngeal muscle on the affected side and the loss of the pharyngeal reflex were considered to cause the patient's dysphagia. Based on above mentioned findings, the intermittent air stretching method with balloon catheter(IASM)was performed. As a result, dysphagia showed rapid improvement without any complications such as aspiration or bleeding. Thus, the IASM may be effective in some cases of dysphagia due to Wallenberg syndrome.

[Migration of the distal catheter of ventriculo-peritoneal shunt into the thoracic cavity].

A 69-year-old woman suffered from ataxia of her right upper and lower limbs and infection in a distal tube of a ventriculo-peritoneal shunt (VPS). She had a thirty-year history of treatment for intracranial hemangioblastoma due to von Hippel-Lindau disease and hydrocephalus. Head magnetic resonance imaging demonstrated recurrent multiple hemangioblastoma in the cerebellum without hydrocephalus. Chest computed tomography showed a migrated distal tube of a VPS into the thoracic cavity. The VPS had been revised several times because of repeated infection before the present admission. The hydrocephalus was considered to be independent on the VPS because the VPS had become obstructed. A pleural effusion, which was probably caused by hypoalbuminemia during the postoperative course of the hemangioblastoma, increased and disappeared in association with her postoperative nutritional status. Therefore, revision of the migrated distal catheter was not needed. The distal tube most likely migrated through the intercostal space because the patient was very skinny. Migration of the distal catheter of VPS into the thoracic cavity may occur when the course of the distal tube is close to the thoracic cavity, especially in thin patients. Care should be taken when routing the distal catheter after VPS in skinny patients.