Asunto(s)
Leiomioma , Embolización de la Arteria Uterina , Miomectomía Uterina , Arterias , Femenino , Humanos , Leiomioma/cirugíaRESUMEN
45-year-old female presenting initially with fever, nonproductive cough, night sweats, pleuritic chest pain, fatigue and weight loss over the past month.
Asunto(s)
Blastomyces/aislamiento & purificación , Blastomicosis/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagen , Blastomicosis/diagnóstico , Líquido del Lavado Bronquioalveolar/microbiología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Tos/diagnóstico , Tos/etiología , Diagnóstico Diferencial , Fatiga/diagnóstico , Fatiga/etiología , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Persona de Mediana Edad , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Tuberculosis Pulmonar/diagnóstico , Pérdida de PesoAsunto(s)
Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos/cirugía , Hemangioma/cirugía , Pericardio/cirugía , Arteria Pulmonar/cirugía , Obstrucción del Flujo Ventricular Externo/cirugía , Manejo de la Enfermedad , Neoplasias Cardíacas/inducido químicamente , Neoplasias Cardíacas/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Hemangioma/complicaciones , Hemangioma/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pericardio/diagnóstico por imagen , Atención Perioperativa/métodos , Arteria Pulmonar/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/etiologíaAsunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Infecciones por Mycobacterium/etiología , Osteomielitis/etiología , Enfermedades de la Columna Vertebral/etiología , Infección de la Herida Quirúrgica/etiología , Anciano , Resultado Fatal , Humanos , Vértebras Lumbares , Imagen por Resonancia Magnética , Masculino , Mycobacterium/aislamiento & purificación , Infecciones por Mycobacterium/diagnóstico , Infecciones por Mycobacterium/microbiología , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/microbiología , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/microbiología , Vértebras TorácicasAsunto(s)
Enfermedades de la Aorta/fisiopatología , Arteriopatías Oclusivas/fisiopatología , Circulación Colateral , Arteria Ilíaca/fisiopatología , Anciano , Enfermedades de la Aorta/diagnóstico por imagen , Aortografía/métodos , Arteriopatías Oclusivas/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Humanos , Arteria Ilíaca/diagnóstico por imagen , Masculino , Flujo Sanguíneo RegionalRESUMEN
BACKGROUND: Superior mesenteric arteriovenous fistula is a rare vascular anomaly often presenting with sequelae of portal hypertension, heart failure, or mesenteric ischemia. This report describes a patient with a previously unidentified superior mesenteric arteriovenous fistula who presented with variceal bleeding, thought to be the leading cause of mortality associated with this condition. Although this patient was initially referred for a transjugular intrahepatic portosystemic shunt procedure, following a thorough review of her clinical history and imaging, she instead underwent embolization of the arteriovenous fistula likely responsible for her symptoms. CASE PRESENTATION: A 75-year-old woman with a past surgical history of extensive small bowel resection presented with active variceal bleeding requiring transfusions. She was referred to vascular and interventional radiology for transjugular intrahepatic portosystemic shunt procedure; however, her clinical presentation was inconsistent with cirrhosis. This prompted a further review of her imaging, which identified a superior mesenteric arteriovenous fistula as the probable etiology of her varices. This fistula was subsequently embolized with a vascular plug and follow-up upper endoscopy at 1-month demonstrated complete resolution of her varices. CONCLUSIONS: This report highlights a potential etiology of variceal bleeding in the acutely ill patient. Through a thorough consultation, the patient described here was able to avoid a procedure with the potential to cause catastrophic consequences, and instead receive the appropriate treatment for an uncommon condition. LEVEL OF EVIDENCE: Level 4, Case Report.
RESUMEN
Cavernous sinus thrombosis (CST) is a rare condition that can cause death, neurologic disability, and visual loss. A pre-teen with septic CST leading to ocular hypertension and acute visual loss was treated at our institution with thrombectomy and thrombolysis of the cavernous sinuses and superior ophthalmic veins. Successful recanalization of the bilateral cavernous sinuses and superior ophthalmic veins was achieved in two separate procedures without complication. The patient showed immediate symptomatic relief. He was neurologically intact without visual deficits at the 2 month follow-up. This is the first report in the literature showing the feasibility of cavernous sinus thrombectomy using current devices and techniques. Early endovascular therapy may help preserve vision in patients with acute CST.
Asunto(s)
Trombosis del Seno Cavernoso/diagnóstico por imagen , Trombosis del Seno Cavernoso/cirugía , Vena Femoral/diagnóstico por imagen , Órbita/irrigación sanguínea , Órbita/diagnóstico por imagen , Trombectomía/métodos , Trombosis del Seno Cavernoso/complicaciones , Niño , Humanos , Masculino , Hipertensión Ocular/etiología , Venas/diagnóstico por imagen , Venas/cirugíaRESUMEN
Cavernous sinus thrombosis (CST) is a rare condition that can cause death, neurologic disability, and visual loss. A pre-teen with septic CST leading to ocular hypertension and acute visual loss was treated at our institution with thrombectomy and thrombolysis of the cavernous sinuses and superior ophthalmic veins. Successful recanalization of the bilateral cavernous sinuses and superior ophthalmic veins was achieved in two separate procedures without complication. The patient showed immediate symptomatic relief. He was neurologically intact without visual deficits at the 2 month follow-up. This is the first report in the literature showing the feasibility of cavernous sinus thrombectomy using current devices and techniques. Early endovascular therapy may help preserve vision in patients with acute CST.
Asunto(s)
Trombosis del Seno Cavernoso/terapia , Órbita/irrigación sanguínea , Trombectomía/métodos , Venas , Trombosis de la Vena/terapia , Anticoagulantes/administración & dosificación , Trombosis del Seno Cavernoso/complicaciones , Trombosis del Seno Cavernoso/diagnóstico por imagen , Niño , Fluoroscopía , Humanos , Masculino , Hipertensión Ocular/etiología , Órbita/diagnóstico por imagen , Activadores Plasminogénicos/administración & dosificación , Retratamiento/métodos , Tomografía Computarizada por Rayos X , Venas/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagenRESUMEN
The anatomy of aortic aneurysms from the proximal neck to the access vessels may create technical challenges for endovascular repair. Upwards of 30% of patients with abdominal aortic aneurysms (AAA) have unsuitable proximal neck morphology for endovascular repair. Anatomies considered unsuitable for conventional infrarenal stent grafting include short or absent necks, angulated necks, conical necks, or large necks exceeding size availability for current stent grafts. A number of advanced endovascular techniques and devices have been developed to circumvent these challenges, each with unique advantages and disadvantages. These include snorkeling procedures such as chimneys, periscopes, and sandwich techniques; "homemade" or "back-table" fenestrated endografts as well as manufactured, customized fenestrated endografts; and more recently, physician modified branched devices. Furthermore, new devices in the pipeline under investigation, such as "off-the-shelf" fenestrated stent grafts, branched stent grafts, lower profile devices, and novel sealing designs, have the potential of solving many of the aforementioned problems. The treatment of aortic aneurysms continues to evolve, further expanding the population of patients that can be treated with an endovascular approach. As the technology grows so do the number of challenging aortic anatomies that endovascular specialists take on, further pushing the envelope in the arena of aortic repair.