RESUMEN
Carotid mycotic aneurysm is extremely rare and even more unusual when it is associated with a persistent primitive hypoglossal artery. This artery is the second most common of the embryonic carotid-vertebrobasilar anastomoses. It originates from the cervical internal carotid artery and enters the cranium through a widened hypoglossal canal before anastomosing with the basilar artery. We report a case of an elderly man with a rare Salmonella-induced mycotic aneurysm associated with a persistent primitive hypoglossal artery. Surgical resection of the mycotic aneurysm was complicated by a posterior circulation stroke. To the best of our knowledge, there was no previous report of a carotid mycotic aneurysm associated with a persistent primitive hypoglossal artery thus far in the literature. Owing to the high mortality rate of the carotid mycotic aneurysm, it is imperative to be familiar with the vascular and imaging anatomy prior to surgery particularly in the presence of an embryonic carotid-vertebrobasilar anastomosis. In this report, we highlight the imaging characteristics and treatment options for this rare mycotic aneurysm together with a literature review.
Asunto(s)
Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/patología , Arteria Basilar/anomalías , Arteria Carótida Interna/anomalías , Infecciones por Salmonella/diagnóstico por imagen , Infecciones por Salmonella/patología , Anciano , Aneurisma Infectado/cirugía , Angiografía , Arteria Basilar/diagnóstico por imagen , Arteria Carótida Interna/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Masculino , Complicaciones Posoperatorias , Infecciones por Salmonella/cirugía , Accidente Cerebrovascular/etiología , Tomografía Computarizada por Rayos XRESUMEN
A 14-year-old boy presented with left anterior knee pain, which was aggravated by exercise and relieved by rest. On clinical examination, there was tenderness at the tibial tuberosity with reproducible pain on resisted active extension of the knee. Radiographs showed heterotopic ossification of the patellar tendon with irregularity and fragmentation of the tibial tubercle. Clinical and radiological findings were consistent with Osgood-Schlatter disease, which is a traction apophysitis of the tibial tubercle commonly occurring in adolescents. The clinical presentation and imaging features are discussed.
Asunto(s)
Rodilla/diagnóstico por imagen , Osteocondrosis/diagnóstico por imagen , Dolor/diagnóstico , Adolescente , Ejercicio Físico , Humanos , Procesamiento de Imagen Asistido por Computador , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Osificación Heterotópica/diagnóstico por imagen , Ligamento Rotuliano/diagnóstico por imagen , Radiografía , Tibia/diagnóstico por imagenRESUMEN
The persistent primitive trigeminal artery is the most common persistent carotid-vertebrobasilar anastomosis. Patients are usually asymptomatic and the persistent primitive trigeminal artery is commonly found incidentally on imaging. Rarely, they may present with symptoms of neurovascular conflict or cranial nerve compression syndromes as the artery may be intimately related to the cranial nerves. The basilar artery is often hypoplastic in this condition and blood supply to the posterior circulation is predominantly via the persistent primitive trigeminal artery. Recognizing the persistent primitive trigeminal artery is imperative as disease of the artery may result in ischemia of the posterior circulation. To date, there is no clear association between this artery and cerebral aneurysms. We present a rare case of a patient with a persistent primitive trigeminal artery and a concomitant cavernous carotid aneurysm together with a literature review.