Same features, different diagnosis: A case of ilio-iliac arteriovenous fistula presenting as decompensated heart failure.

In case of high output cardiac failure, an arteriovenous fistula should be considered.

Perforated sigmoid diverticulum mimicking acute appendicitis in a young patient: a case report.

Acute colonic diverticula are uncommon in patients <40 years of age, with an incidence between 2% and 10%. In such patients, the condition may be misdiagnosed in the acute setting, because it is often not considered and may be mistaken for acute appendicitis, particularly if there are predominantly right-sided signs. As a result, it may result in diagnostic delay and complications. We report a case of a young patient who presented with a perforated sigmoid diverticulum mimicking acute appendicitis, which was not diagnosed initially, and the resulting course of events.

Screening and ultrasound surveillance of large abdominal aortic aneurysms do not improve suitability for endovascular repair.

OBJECTIVE: The effect of population screening for abdominal aortic aneurysm (AAA) disease on morbidity and mortality has been comprehensively studied and reported. However, the effect of early AAA detection on suitability for endovascular aneurysm repair (EVAR) remains unknown. Considering the importance of such an effect on future health economics, we sought to assess the possible effect of AAA ultrasound surveillance on suitability for EVAR. METHODS: This was a prospective cohort study. From January 2002 to August 2003, consecutive AAA patients selected for open elective repair were placed into one of two groups according to mode of presentation. The first group included patients referred from a local well-established AAA ultrasound screening and surveillance program (ultrasound surveillance [AAA-S] group). The second group included patients referred from neighboring unscreened regions with incidentally diagnosed AAA (incidental [AAA-I] group). All patients underwent preoperative computed tomographic angiography. By using three-dimensional reconstruction software, computed tomographic images were assessed by two blinded observers for suitability for EVAR by using the criteria for a modular endovascular device. RESULTS: Of 74 patients included in the study, 41 were in the AAA-S group, and 31 were in the AAA-I group. The median aneurysm diameter was 72.3 mm (range, 50.7-83.7 mm) for AAA-I and 65 mm (range, 50.7-79.2 mm) for AAA-S (P < .47). Suitability for EVAR was 41% in the AAA-S group and 45% in the AAA-I group (P < .47). CONCLUSIONS: Early detection and surveillance of AAA does not seem to increase suitability for EVAR. Suitability for EVAR seems to be determined early on in an aneurysm's life. On the basis of current device technology, referral for intervention from an AAA surveillance program may need to be initiated at a size well below 5.5 cm if an increase in EVAR suitability is to be expected.

Color duplex ultrasonography is insensitive for the detection of endoleak after aortic endografting: a systematic review.

PURPOSE: To synthesize the available evidence regarding the diagnostic accuracy of color duplex ultrasonography (CDU) versus the accepted gold-standard of contrast-enhanced computed tomography (CT) for the detection and classification of endoleaks after aortic endografting. METHODS: A systematic search of the literature was conducted using electronic bibliographical databases and other means to gather articles published between 1991 and 2004. Articles were scrutinized against inclusion/exclusion criteria that broadly followed the QUADAS quality assessment guidelines. The results of diagnostic CDU were expressed for each study as a 2x2 contingency table, and summary statistics (sensitivity/specificity with 95% confidence intervals [CI]) were calculated. Pooled and random effects meta-analyses were performed. RESULTS: Eight published studies and 2 unpublished studies from Charing Cross and St. George's Hospitals (711 patients, 1355 paired scans performed > or = 1 month after endografting) were eligible for inclusion. From meta-analyses, the pooled sensitivity of CDU (versus CT as the gold standard) was 69% (95% CI 52% to 87%) and the specificity of CDU was 91% (95% CI 87% to 95%). These parameters did not appear to vary over time when a smaller dataset of 117 patients with 239 paired scans was used to compare CT and CDU specifically at 3, 12, and 24 months after endografting. Endoleak classification data, which was derived from only 5 small studies, indicated that CDU appeared to have better diagnostic accuracy in detecting type I or type III endoleaks compared with type II endoleaks; however, the data were insufficient for statistical analysis. CONCLUSIONS: CDU currently does not have sufficient diagnostic accuracy for the detection of all endoleaks in routine clinical practice. The diagnostic accuracy of CDU may improve if type II endoleaks are ignored.