RESUMO
A case of persistent proatlantal artery (PA) is described in a 60-year-old woman who presented with cerebellar ataxia, homonymous hemianopia, and aphasia. Both Doppler scan and magnetic resonance angiography (MRA) showed agenesis of both vertebral arteries, 80% stenosis of the left internal carotid artery (ICA), and an anastomotic vessel between the left external carotid artery (ECA) and the left vertebral artery (LVA) with a tight stenosis at the origin. It was thought to be a type II PA. Both lesions were successfully treated by ICA endarterectomy and common carotid artery to PA bypass. This case demonstrates the clinical significance of persistent PA in the evolution of an ischemic cerebrovascular disease.
Assuntos
Artéria Carótida Interna , Estenose das Carótidas/complicações , Cérebro/irrigação sanguínea , Ataque Isquêmico Transitório/etiologia , Malformações Vasculares/complicações , Artéria Vertebral/anormalidades , Insuficiência Vertebrobasilar/etiologia , Afasia/etiologia , Implante de Prótese Vascular , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Ataxia Cerebelar/etiologia , Angiografia Cerebral , Endarterectomia das Carótidas , Feminino , Hemianopsia/etiologia , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/cirurgia , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia Doppler , Ultrassonografia Doppler Transcraniana , Malformações Vasculares/diagnóstico , Malformações Vasculares/cirurgia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/cirurgiaRESUMO
OBJECTIVE: Pulmonary sequestration (PS) is an uncommon congenital disease. Symptoms when present are usually secondary to pyogenic infection. Our objective was to draw attention on superimposed fungal infection. METHODS: During the last 20 years, we operated upon 19 intralobar PS. Four of six patients operated during the last decade proved to have intralobar PS containing Aspergillus. RESULTS: In one patient aspergillosis presented as an aspergilloma and communications between the sequestration and small bronchi were present. In another patient diagnosis was made before operation because of positive precipitins test. In two patients aspegillosis was discovered by the pathologist. CONCLUSIONS: Review of literature demonstrates PS fungal colonization to be a rare but recently reported entity (14 cases reported). The observation of four consecutive patients leads us to suggest that PS aspergillosis must be considered in order to evaluate its incidence.