ABSTRACT
Epithelioid haemangiomas are rare benign vascular tumors that usually present as subcutaneous nodules in the head and neck area. Occasionally these tumors can arise in a peripheral artery. When it does so, it is often confused with an aneurysmal dilatation of the respective vessel. In these circumstances, surgical resection with vascular reconstruction is the preferred treatment option.
Subject(s)
Aneurysm/pathology , Epithelioid Cells/pathology , Hemangioma/pathology , Ulnar Artery/pathology , Vascular Neoplasms/pathology , Aneurysm/diagnostic imaging , Diagnosis, Differential , Dilatation, Pathologic , Female , Hemangioma/diagnostic imaging , Hemangioma/surgery , Humans , Predictive Value of Tests , Ulnar Artery/diagnostic imaging , Ulnar Artery/surgery , Vascular Neoplasms/diagnostic imaging , Vascular Neoplasms/surgery , Young AdultABSTRACT
We present a rare case of epithelioid hemangioendothelioma arising from the wall of ulnar artery in distal forearm. The presentation was interesting in a 34-year-old man, with progressively worsening symptoms of ulnar neuropathy. A mass was seen arising from the ulnar artery on imaging with ultrasound and magnetic resonance imaging. Soft tissue epithelioid hemangioendothelioma in extremities almost always arise from the veins. Existing literature do not have elaborated imaging findings of epithelioid hemangioendothelioma arising from the arterial wall. The aim of this paper is to briefly review the interesting presentation and imaging features of this rare entity. Knowledge of such vascular tumor would avoid the mishap during surgery. Our case will add an interesting presentation of such rare pathology to the existing literature.
Subject(s)
Hemangioendothelioma, Epithelioid/complications , Ulnar Artery , Ulnar Neuropathies/etiology , Vascular Neoplasms/complications , Adult , Hemangioendothelioma, Epithelioid/diagnostic imaging , Hemangioendothelioma, Epithelioid/pathology , Hemangioendothelioma, Epithelioid/surgery , Humans , Male , Treatment Outcome , Ulnar Artery/diagnostic imaging , Ulnar Artery/pathology , Ulnar Neuropathies/diagnosis , Vascular Neoplasms/diagnostic imaging , Vascular Neoplasms/pathology , Vascular Neoplasms/surgeryABSTRACT
Aneurysm of the proximal ulnar artery is extremely rare. Ultrasonography, computed tomography, and magnetic resonance imaging generally provide accurate diagnosis of aneurysm. A 29-year-old woman who had undergone an excision biopsy of a mass in her right arm by an orthopedic surgeon was referred to our department. We resected the mass and interposed it with a reversed great saphenous vein. Histopathological examination suggested that the mass was a pseudoaneurysm consisting of organized thrombi with recanalization. Clinicians should be aware of the possibility of misdiagnosis of soft tissue tumor in cases of pseudoaneurysm, especially if imaging examination reveals a density consistent with organized thrombus with recanalization.
Subject(s)
Aneurysm, False/diagnostic imaging , Multimodal Imaging/methods , Soft Tissue Neoplasms/diagnostic imaging , Ulnar Artery/diagnostic imaging , Adult , Aneurysm, False/pathology , Aneurysm, False/surgery , Biopsy , Computed Tomography Angiography , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Predictive Value of Tests , Saphenous Vein/transplantation , Treatment Outcome , Ulnar Artery/pathology , Ulnar Artery/surgery , Ultrasonography, Doppler, ColorSubject(s)
Fingers/pathology , Ischemia/etiology , Lupus Coagulation Inhibitor/blood , Movement/physiology , Thrombosis/etiology , Anti-Bacterial Agents/therapeutic use , Aspirin/therapeutic use , Combined Modality Therapy , Fibrinolytic Agents/therapeutic use , Fingers/blood supply , Hand/blood supply , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Hyperbaric Oxygenation/methods , Ischemia/diagnosis , Ischemia/therapy , Male , Middle Aged , Radial Artery/diagnostic imaging , Radial Artery/pathology , Thrombosis/diagnosis , Thrombosis/therapy , Treatment Outcome , Ulnar Artery/diagnostic imaging , Ulnar Artery/pathology , Ultrasonography, Doppler/methods , Vasodilator Agents/therapeutic useSubject(s)
Cosmetic Techniques/adverse effects , Dermal Fillers/adverse effects , Embolism/etiology , Hyaluronic Acid/adverse effects , Ulnar Artery/pathology , Adult , Dermal Fillers/administration & dosage , Drug Therapy, Combination/methods , Embolism/diagnosis , Embolism/drug therapy , Female , Hand/blood supply , Heparin, Low-Molecular-Weight/administration & dosage , Humans , Hyaluronic Acid/administration & dosage , Hyaluronic Acid/antagonists & inhibitors , Hyaluronoglucosaminidase/administration & dosage , Magnetic Resonance Angiography , Rejuvenation , Treatment Outcome , Ulnar Artery/diagnostic imagingABSTRACT
Non-traumatic or infective peripheral aneurysms of the upper extremities are rare. We report a case of an aneurysm involving the left proximal ulnar artery leading to upper limb ischemia in a patient following a Bentall procedure for a type A dissection.
Subject(s)
Aneurysm, False/etiology , Aneurysm, False/surgery , Aortic Aneurysm/surgery , Aortic Dissection/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery , Ulnar Artery/surgery , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/methods , Adult , Aneurysm, False/diagnostic imaging , Aneurysm, False/pathology , Female , Humans , Postoperative Complications/diagnostic imaging , Postoperative Complications/pathology , Tomography, X-Ray Computed , Treatment Outcome , Ulnar Artery/diagnostic imaging , Ulnar Artery/pathologySubject(s)
Arterial Occlusive Diseases , Hand , Peripheral Vascular Diseases , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/pathology , Arterial Occlusive Diseases/surgery , Hand/blood supply , Hand/diagnostic imaging , Hand/pathology , Hand/surgery , Humans , Male , Middle Aged , Necrosis/etiology , Necrosis/pathology , Peripheral Vascular Diseases/complications , Peripheral Vascular Diseases/diagnostic imaging , Peripheral Vascular Diseases/pathology , Peripheral Vascular Diseases/surgery , Ulnar Artery/diagnostic imaging , Ulnar Artery/pathology , Ulnar Artery/surgerySubject(s)
Fingers/blood supply , Pain/etiology , Adult , Computed Tomography Angiography/methods , Cyanosis/etiology , Emergency Service, Hospital/organization & administration , Fingers/abnormalities , Humans , Male , Tobacco Use/adverse effects , Tobacco Use/physiopathology , Ulnar Artery/abnormalities , Ulnar Artery/pathology , Wounds and Injuries/complications , Wounds and Injuries/diagnosisABSTRACT
A healthy 30-year-old woman presented to the emergency department with a pulsatile right forearm mass and numbness of her fourth and fifth fingers. Duplex scan imaging revealed an ulnar artery aneurysm with intramural thrombus. After resection, histopathology revealed intravascular papillary endothelial hyperplasia, also known as Masson's tumor, a rare but benign vascular neoplasm. Local resection of the tumor with vascular reconstruction is curative and resulted in resolution of her neurologic symptoms. To our knowledge, this is the first reported case of a Masson's tumor occurring in an ulnar artery.
Subject(s)
Hemangioendothelioma/diagnostic imaging , Hemangioendothelioma/surgery , Saphenous Vein/transplantation , Ulnar Artery/pathology , Vascular Neoplasms/diagnostic imaging , Vascular Neoplasms/surgery , Adult , Female , Hemangioendothelioma/pathology , Humans , Ultrasonography , Vascular Neoplasms/pathologyABSTRACT
A 5-month-old previously healthy girl presented to the emergency department with a large palpable nontender mass in the hypothenar soft tissues of her left hand. US revealed a well-demarcated nonvascular soft tissue mass. Subsequent MR imaging showed a rim-enhancing mass with heterogeneous intrinsic signal characteristics. Abscess and necrotic tumor were the primary considerations. Surgery demonstrated a thrombosed aneurysm continuous with the ulnar artery system. The aneurysm was resected and the ulnar artery was ligated at the wrist.
Subject(s)
Aneurysm/complications , Aneurysm/diagnosis , Thrombosis/diagnosis , Thrombosis/etiology , Ulnar Artery/diagnostic imaging , Ulnar Artery/pathology , Diagnosis, Differential , Female , Humans , Infant , Magnetic Resonance Imaging , UltrasonographyABSTRACT
The persistent median artery (PMA) may compress the median nerve (MN) and may be a significant supply of blood to the hand. Two cases of unilateral PMA (4%) were detected during the dissection of 50 upper limbs. The first case was a 75-year-old, right-handed male who suffered from chronic pain in both upper limbs, especially the left side. A dissection of his left upper limb revealed a PMA piercing both the MN and the medial branch of the anterior interosseous nerve. This artery coursed distally, deep to the transverse carpal ligament (TCL), forming a median-ulnar pattern for the superficial palmar arch (SPA). The PMA was superficial to two nerves at the distal edge of the TCL; the extraligamentous recurrent thenar (RT) branch of the MN and the third common digital nerve (TCDN). The second case was from the left side of an 80-year-old female found to have a high origin of the radial artery with trifurcation of the latter into PMA, common interosseous, and ulnar arteries. The PMA passed deep to the TCL forming a radial-median-ulnar pattern of SPA. Both the transligamentous RT branch of the MN and the TCDN passed deep to the PMA inside the carpal tunnel, before the abnormal crossing of the latter nerve ventral to the SPA on its way to the digits. The relationships of the PMA to various MN branches may have important implications regarding the diagnosis and treatment of MN compressive neuropathies.
Subject(s)
Carpal Tunnel Syndrome/pathology , Hand/anatomy & histology , Median Nerve/blood supply , Radial Artery/pathology , Ulnar Artery/pathology , Aged , Aged, 80 and over , Cadaver , Carpal Tunnel Syndrome/physiopathology , Dissection , Female , Genetic Variation , Humans , Male , Pain/pathology , Pain/physiopathology , PhenotypeABSTRACT
BehƧet's disease is a systemic disease characterized by oral aphthosis, genital ulcers, ocular lesions, gastrointestinal, musculoskeletal, neurological and major vessel involvement. Arterial involvement, aneurysms and arterial thrombosis have been reported in 1.5-3% of patients. In this case report, we present a patient with ulnar arterial aneurysm associated with BehƧet's disease.
Subject(s)
Aneurysm/diagnosis , Behcet Syndrome/complications , Hand/pathology , Ulnar Artery/pathology , Aneurysm/etiology , Aneurysm/physiopathology , Angiography , Anti-Inflammatory Agents/therapeutic use , Antirheumatic Agents/therapeutic use , Cyclophosphamide/therapeutic use , Hand/diagnostic imaging , Humans , Male , Oral Ulcer/etiology , Prednisolone/therapeutic use , Thrombosis/diagnosis , Thrombosis/etiology , Thrombosis/physiopathology , Tomography, X-Ray Computed , Turkey , Ulnar Artery/diagnostic imaging , Ultrasonography , Young AdultABSTRACT
During anatomical dissection, an unusual bilateral muscle in the region of Guyon's canal was found in a 29-year-old human male cadaver. It originated from the pisiform bone and inserted to the flexor retinaculum. The muscle passed between the superficial and deep branch of the ulnar nerve. The ulnar artery passed anteriorly to the muscle. This work reports this finding and tries to categorize it in one of the groups following the literature.
Subject(s)
Muscle, Skeletal/abnormalities , Ulnar Artery/pathology , Ulnar Nerve/pathology , Wrist/pathology , Adult , Cadaver , Humans , MaleABSTRACT
INTRODUCTION: This is a clinical case illustrating a diagnosis of an IgG4 related-disease (IgG4-RD) diagnosed in a vascular context. CASE REPORT: A 47-year-old man with no past medical history consulted for a recent and disabling Raynaud phenomenon without trophic disorder. Vascular examinations revealed multiple arterial thromboses with no abnormal finger and toe pressures. Secondly, weight loss and submandibular glands enlargement appeared, leading to the diagnosis of IgG4-RD without a link being able to be established with vascular involvement. This is the second observation of this association. A French translation of the new classification criteria for IgG4-RD published in 2019 by the American College of Rheumatology and European Ligue Against Rhumatism (ACR/EULAR) is offered with direct application to the clinical case. CONCLUSION: A Raynaud phenomenon with distal arterial thrombosis is rarely observed in the IgG4-RD.
Subject(s)
Immunoglobulin G4-Related Disease/diagnosis , Raynaud Disease/diagnosis , Thrombosis/diagnosis , France , Humans , Immunoglobulin G4-Related Disease/complications , Male , Middle Aged , Radial Artery/diagnostic imaging , Radial Artery/pathology , Raynaud Disease/complications , Salivary Gland Diseases/complications , Salivary Gland Diseases/diagnosis , Salivary Gland Diseases/pathology , Thrombosis/complications , Thrombosis/pathology , Tobacco Smoking/pathology , Ulnar Artery/diagnostic imaging , Ulnar Artery/pathologyABSTRACT
BACKGROUND: Forearm artery lesions are a frequent cause of distal fistula maturation failure. Surgical treatment is difficult because of highly calcified arteries. To redo the arteriovenous anastomosis higher up the forearm is technically difficult and often ineffective because arteries cannot be enlarged. It also causes a loss in puncture zone. Creation of brachial accesses leads to a high risk of distal ischemia. METHODS: From September 2000 to September 2006, we performed percutaneous transluminal angioplasty (PTA) of forearm arteries in 25 patients with failing distal access maturation. We reported immediate results of the dilatation and retrospectively analyzed the outcome of the accesses after the procedure. RESULTS: Forearm artery PTA was achieved in all 25 patients. Three main complications occurred: severe spasms precluding precise assessment of the artery patency after dilatation, rupture easily treated by prolonged low-pressure balloon inflation, and early rethrombosis leading to access loss. Follow-up was available in 23 patients. PTA failed to restore a sufficient access flow in two patients (the access loss and an insufficient increase in flow). In the remaining 21 (91%), accesses started to be used for hemodialysis without difficulties. Primary patency access rates after PTA were 83% (range, 60%-93%) at 1 year and 74% (range, 47%-89%) at 2 years. Secondary access patency rates were 86% (range, 64%-95%) at 1 and 3 years. CONCLUSION: When a distal access fails to mature because of forearm artery lesions, PTA should be done and will salvage the fistula without risk of distal ischemia and cardiac failure. Efficacy of PTA clearly influences surgical strategy and is a major argument in favor of attempting to create distal accesses in patients with mild distal artery lesions. Even in cases of failure, such as early occlusion of the fistula, this technique does not jeopardize further proximal access creation. Forearm access creation should be avoided only in cases of extremely severe distal artery lesions.
Subject(s)
Angioplasty, Balloon , Arteriovenous Shunt, Surgical/adverse effects , Forearm/blood supply , Radial Artery/surgery , Renal Dialysis , Ulnar Artery/surgery , Adult , Aged , Aged, 80 and over , Angiography , Angioplasty, Balloon/adverse effects , Arterial Occlusive Diseases/etiology , Brachiocephalic Veins/surgery , Female , Humans , Male , Middle Aged , Radial Artery/injuries , Radial Artery/pathology , Radial Artery/physiopathology , Retrospective Studies , Rupture , Spasm/etiology , Thrombosis/etiology , Time Factors , Treatment Failure , Ulnar Artery/injuries , Ulnar Artery/pathology , Ulnar Artery/physiopathology , Ultrasonography, Doppler, Duplex , Vascular PatencyABSTRACT
Although digital ulceration frequently occurs in patients with systemic sclerosis, there have been few reports on macrovascular involvement. Macrovascular disease in systemic sclerosis has recently been described. We retrospectively reviewed the medical records and brachial angiographic findings of 19 systemic sclerosis patients, who exhibited Raynaud's phenomenon and digital ulceration. We found that ulnar artery involvement is frequent in systemic sclerosis, although the precise mechanism is not known. There was no significant difference in risk factors of macrovascular disease between ulnar artery-involved patients and not-involved subjects. Thirteen patients underwent surgical intervention; five of the 13 patients had vascular graft performed due to ulnar artery involvement. We suggest that angiographic screening and early surgical intervention such as revascularization should be considered in patients with systemic sclerosis who manifest a severe form of Raynaud's phenomenon and/or digital ulceration and especially in patients with diffuse sclerosis.
Subject(s)
Raynaud Disease/etiology , Scleroderma, Systemic/complications , Skin Ulcer/complications , Ulnar Artery/pathology , Adult , Aged , Angiography/adverse effects , Brachial Artery/surgery , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Vascular Surgical Procedures/adverse effectsABSTRACT
Ulnar artery pseudoaneurysms are very uncommon. The least common etiological mechanism is a single direct trauma. It is important to identify these lesions, which may have important clinical complications such as distal thrombosis with digital ischemia or gangrene. This report describes the features of sonography and magnetic resonance angiography of a histologically confirmed ulnar artery pseudoaneurysm.
Subject(s)
Aneurysm, False/diagnosis , Aneurysm, False/etiology , Martial Arts/injuries , Ulnar Artery/diagnostic imaging , Ulnar Artery/pathology , Wounds, Nonpenetrating/diagnosis , Humans , Magnetic Resonance Angiography , Male , Ultrasonography , Young AdultABSTRACT
A 26-year-old, right-handed male professional hockey player presented for a second opinion with dysesthesia of the tips of his right third, fourth, and fifth fingers after 2 previous incidents of hyperextension injuries to his right wrist while holding his hockey stick. Radiographs and computed tomography scans were negative for fracture. After magnetic resonance angiography and Doppler ultrasound imaging, the athlete was diagnosed with hypothenar hammer syndrome (HHS) with ulnar artery aneurysm and thrombosis. He underwent successful surgery with ligation and excision of the aneurysmal, thrombosed ulnar artery and was able to return to hockey 4 weeks after surgery. HHS is thought to be a rare posttraumatic digital ischemia from thrombosis and/or aneurysm of the ulnar artery and was traditionally considered an occupational injury but has been reported more frequently among athletes. There have only been 2 previous case reports of hockey players diagnosed with HHS, and in the previous 2 case reports, both involved repetitive trauma from the hockey stick, which resulted in thrombotic HHS. We present a case of a professional hockey player diagnosed with HHS also due to repetitive trauma from the hockey stick, but this time resulting in aneurysmal HHS with thromboembolism. This case report highlights the importance of keeping HHS in the differential diagnosis in athletes with pain, cold sensitivity, and paresthesia in their fingers with or without a clear history of repetitive trauma to the hypothenar eminence, as HHS is a condition with good outcomes after proper treatment.