An unusual case of chronic urinary retention and bladder diverticulum presenting with unilateral lower limb swelling.

A 64-year-old man presented with 1 month of gradual-onset left leg swelling and lower urinary tract symptoms including enuresis, frequency and poor stream. He was initially treated for suspected cellulitis, however, he returned 2 weeks later with persistence of his symptoms. Routine biochemical investigation revealed renal failure (Cr 623, Ur 29.9) and hyperkalaemia (K 7.2). Abdominal examination revealed a distended urinary bladder and an ultrasound scan revealed hydronephrosis, confirming the diagnosis of chronic high-pressure urinary retention. A urinary catheter was passed that initially drained 1.5 litre of clear urine. Shortly after insertion, this became heavily blood stained. A CT kidney ureter bladder (CTKUB) revealed a large mass behind the bladder thought to represent either an abscess or tumour. Cystoscopic correlation showed this to be a large, narrow-necked bladder diverticulum tensely distended with clot. Following successful clot evacuation and decompression of the bladder the leg swelling resolved and renal function improved.

Cerebral cavernous malformation: a diagnostic challenge in a young patient with intracerebral haemorrhage.

An 18-year-old Caucasian man presented with a sudden onset right hemiparesis. On examination, he had objective evidence of an upper motor neuron lesion affecting the right side of his body. CT scan showed a left thalamic haemorrhage. MRI, gradient echo and cerebral angiogram showed no structural lesion and the cause of the bleeding was ultimately attributed to the use of cocaine. During the subsequent 2 years the patient had two further similar episodes, with an MRI eventually demonstrating a cerebral cavernous malformation. This was excised using frameless stereotactic surgery, following which the patient made an uneventful recovery.

An unusual combination of sciatic and popliteal artery aneurysms.

A 68-year-old male presented with an asymptomatic pulsatile swelling on the back of his left thigh. Angiography revealed this to be aneurysmal degeneration of a persistent sciatic artery (PSA), an embryological variant whereby the primitive vascular tree persists as the main blood supply to the lower limb. Initial treatment was with an inlay graft to exclude the aneurysm from the circulation. The patient was re-referred 12 years later with a pulsatile swelling distal to the old scar. Angiography showed a popliteal artery aneurysm separate to both the sciatic artery and the anastomosis. The second procedure fashioned an inlay graft from the original graft down to the distal popliteal artery. The patient remains under follow-up. Patients with a PSA are prone to aneurysmal degeneration, which may also occur in adjacent vessels. For this reason, the authors recommend these individuals are kept under lifelong follow-up.