ABSTRACT
Cerebrospinal fluid venous fistulas (CSF-VFs) are an uncommon, yet increasingly recognized, cause of spontaneous intracranial hypotension.1-5 The workup involves magnetic resonance imaging (MRI) of the brain with and without contrast and MRI of the neuroaxis without contrast before dynamic myelography, either computed tomography or digital subtraction.6 The present case of an older woman with symptomatic intracranial hypotension is notable for the specific appearance of CSF-VFs on digital spinal myelography (Video 1). Among her numerous perineural cysts, it was the "disappearing" or "empty" cyst from which the fistula originated. The diagnosis was made using a second lateral fluoroscopy view, not typically used in digital spinal myelography, which demonstrated emptying of contrast from the T6 perineural cyst into the segmental vein at this level, or the "empty cyst sign." The patient then underwent transvenous onyx embolization with resolution of her orthostatic headaches and improvement of contrast-enhanced MRI of the brain with the Bern score decreasing from 7 to 0 at 3 months of follow-up.7 Because transvenous embolization of CSF-VFs is a relatively new procedure, the long-term outcomes of the procedure are not yet known.
Subject(s)
Intracranial Hypotension , Myelography , Humans , Female , Myelography/methods , Intracranial Hypotension/diagnostic imaging , Intracranial Hypotension/therapy , Intracranial Hypotension/complications , Intracranial Hypotension/etiology , Embolization, Therapeutic/methods , Aged , Magnetic Resonance Imaging , Vascular Fistula/diagnostic imaging , Vascular Fistula/complications , Cerebrospinal FluidSubject(s)
Heart Ventricles , Mitral Valve Insufficiency , Humans , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/physiopathology , Heart Ventricles/diagnostic imaging , Fistula/diagnostic imaging , Fistula/complications , Vascular Fistula/diagnostic imaging , Vascular Fistula/complications , Male , Diastole , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/complications , Female , Coronary Vessels/diagnostic imaging , Middle Aged , Echocardiography/methodsABSTRACT
An 11-year-old male neutered American bulldog was presented for evaluation of thrombocytopenia, acute onset of ataxia, and vomiting. A new murmur was auscultated on physical examination. Transthoracic echocardiographic examination revealed a bicuspid aortic valve, vegetative lesions on the aortic valve, and continuous shunting from the aortic root to the left atrium through an aorta to left atrial fistula. The dog was euthanized due to its guarded prognosis and critical condition. Pathological examination confirmed presence of a bicuspid aortic valve, aorto-left atrial fistula, and aortic infective endocarditis. Antemortem blood culture revealed two unusual organisms: Achromobacter xylosoxidans and Fusobacterium mortiferum.
Subject(s)
Aortic Valve , Bicuspid Aortic Valve Disease , Dog Diseases , Endocarditis, Bacterial , Heart Atria , Dogs , Animals , Male , Dog Diseases/microbiology , Dog Diseases/diagnostic imaging , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Endocarditis, Bacterial/veterinary , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Heart Atria/pathology , Heart Atria/abnormalities , Bicuspid Aortic Valve Disease/complications , Vascular Fistula/veterinary , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Aortic Diseases/veterinary , Aortic Diseases/complications , Aortic Diseases/diagnostic imaging , Heart Valve Diseases/veterinary , Heart Valve Diseases/complications , Echocardiography/veterinary , Heart Diseases/veterinary , Heart Diseases/complications , Fistula/veterinary , Fistula/complications , Aortic Valve Disease/veterinary , Aortic Valve Disease/complicationsABSTRACT
We describe what we believe to be the first reported case of a neonate with right coronary ostial atresia with the right coronary artery originating from the left circumflex coronary artery, in conjunction with a right coronary artery to right ventricle fistula in a patient with otherwise normal cardiac anatomy. This was found following an evaluation for a continuous murmur at 2 weeks of life with elevated troponin and abnormal electrocardiogram. Thus far the child has required no intervention and is asymptomatic at 17 months of age, but he will require long-term follow-up to monitor the size of the fistula and potential for myocardial insufficiency.
Subject(s)
Coronary Vessel Anomalies , Heart Murmurs , Humans , Heart Murmurs/etiology , Infant, Newborn , Male , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/complications , Heart Ventricles/abnormalities , Electrocardiography , Vascular Fistula/complications , Vascular Fistula/diagnosis , Vascular Fistula/surgery , EchocardiographyABSTRACT
A dog was presented for lameness, fever, and extreme lethargy. On physical exam, a new heart murmur, arrhythmia, and joint effusion were detected. These findings were not detected two months prior. A diagnostic work-up confirmed septic suppurative inflammation in multiple joints. Echocardiogram revealed aortic valvular endocarditis along with a communication, as a consequence of a fistula, that extended from just below the aortic sinotubular junction to the left atrial lumen. Due to a poor prognosis, humane euthanasia was elected. Necropsy and histopathology confirmed infective endocarditis of the aortic valve and an aorto-left atrial fistulous tract extending from the left coronary sinus of the aortic valve to the lumen of left atrium.
Subject(s)
Dog Diseases , Echocardiography , Heart Atria , Animals , Dogs , Dog Diseases/pathology , Dog Diseases/diagnostic imaging , Heart Atria/pathology , Heart Atria/diagnostic imaging , Echocardiography/veterinary , Fistula/veterinary , Fistula/diagnostic imaging , Endocarditis, Bacterial/veterinary , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/pathology , Vascular Fistula/veterinary , Vascular Fistula/diagnostic imaging , Vascular Fistula/complications , Male , Aortic Diseases/veterinary , Aortic Diseases/diagnostic imaging , Aortic Diseases/pathology , Aortic Diseases/complications , Endocarditis/veterinary , Endocarditis/complications , Endocarditis/diagnostic imaging , Endocarditis/pathology , Heart Diseases/veterinary , Heart Diseases/diagnostic imaging , Heart Diseases/pathology , Heart Diseases/etiology , Heart Diseases/complications , FemaleABSTRACT
A man in his 60s attended emergency for acute-onset abdominal pain and haematemesis. Requiring resuscitation, a CT abdomen/pelvis revealed a primary aortoenteric fistula actively bleeding into the duodenum. His background included a previous severe Q-fever infection and a heavy smoking history. Despite attempts at resuscitation and an emergent surgical attempt at haemostasis, the patient did not survive the massive gastrointestinal haemorrhage.Even in less severe cases, management of aortoenteric fistulas is tricky. Blood cultures and angiographic imaging are important investigations in guiding surgical approach. The pathology tends to have a significant rate of mortality even at tertiary-level vascular surgical centres.
Subject(s)
Aortic Diseases , Intestinal Fistula , Vascular Fistula , Male , Humans , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Intestinal Fistula/complications , Intestinal Fistula/diagnostic imaging , Intestinal Fistula/surgery , Aortic Diseases/complications , Aortic Diseases/diagnostic imaging , Tomography, X-Ray Computed , Gastrointestinal Hemorrhage/therapy , Gastrointestinal Hemorrhage/surgeryABSTRACT
BACKGROUND: We report a one-stage surgery to the case of secondary aortoenteric fistula (sAEF) after prosthetic reconstruction of abdominal aortic aneurysm, by multifaceted approach. CASE PRESENTATION: A 63-year-old male was admitted to our unit under diagnosed of sAEF after prosthetic reconstruction of abdominal aortic aneurysm, and a pseudoaneurysm of thoracoabdominal aorta due to infection. The patient underwent emergency operation. Firstly, we placed the patient in a modified right lateral decubitus position and performed thoracoabdominal aortic replacement with retroperitoneal approach by thoracoretroperitoneal incision which combined thoracotomy and pararectal incision, and secondly, we changed to a supine position and performed closure of the duodenal fistula and omental flap transposition by midline abdominal incision. The patient was doing well without complications. CONCLUSIONS: A one-stage, multifaceted surgical approach covering both prosthetic reconstruction of thoracoabdominal aorta and closure of sAEF with omentopexy is reasonable and useful strategy.
Subject(s)
Aortic Aneurysm, Abdominal , Aortic Diseases , Blood Vessel Prosthesis Implantation , Duodenal Diseases , Intestinal Fistula , Surgical Wound , Vascular Fistula , Male , Humans , Middle Aged , Aortic Diseases/surgery , Aortic Diseases/etiology , Intestinal Fistula/etiology , Intestinal Fistula/surgery , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Aorta/surgery , Duodenal Diseases/complications , Duodenal Diseases/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Vascular Fistula/surgery , Vascular Fistula/complications , Aorta, Abdominal/surgerySubject(s)
Coronary Aneurysm , Fistula , Vascular Fistula , Humans , Coronary Aneurysm/complications , Coronary Aneurysm/diagnosis , Coronary Aneurysm/surgery , Fistula/complications , Fistula/diagnosis , Heart Ventricles/diagnostic imaging , Heart , Coronary Vessels , Coronary Angiography , Vascular Fistula/complications , Vascular Fistula/diagnosisSubject(s)
Aortic Aneurysm, Thoracic , Aortic Diseases , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Esophageal Fistula , Vascular Fistula , Humans , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Endovascular Aneurysm Repair , Aortic Diseases/complications , Aortic Diseases/diagnostic imaging , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , StentsABSTRACT
PURPOSE OF REVIEW: Coronary artery fistulas (CAFs) are rare coronary anomalies that most often occur as congenital malformations in children. Although most children with CAFs are asymptomatic at the time of diagnosis, some present with symptoms of congestive heart failure in the setting of large left-to-right shunts. Others may develop additional complications including coronary artery ectasia and coronary thrombosis. Surgical and transcatheter closure techniques have been previously described. This review presents the classifications of CAFs in children and the short and long-term outcomes of CAF closure in children in the reported literature. We also summarize previously-reported angiographic findings and post-treatment remodeling characteristics in pediatric patients. RECENT FINDINGS: With advancements in cross-sectional imaging technologies, anatomic delineation of CAFs via these modalities has become crucial in procedural planning. Recent reports of surgical and transcatheter closure of CAFs in children have reported good procedural success and low rates of short-term morbidity and mortality. Distal-type CAFs have elevated risk for long-term sequelae post-closure compared to proximal-type CAFs. A recent report of a multi-institutional cohort also describes post-closure remodeling classifications which may predict long-term outcomes in these patients as well as guide individualized anticoagulation management. Invasive closure of significant CAFs via surgical or transcatheter techniques is feasible and safe in most children with good short and intermediate-term outcomes. However, close clinical and imaging follow-up is required to monitor for late complications even after successful closure. Antiplatelet and anticoagulation regimens remain important aspects of post-closure management, but the necessary intensity and duration of such therapy remains unknown.
Subject(s)
Coronary Artery Disease , Coronary Vessel Anomalies , Vascular Fistula , Child , Humans , Infant , Anticoagulants , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/therapy , Treatment Outcome , Vascular Fistula/diagnostic imaging , Vascular Fistula/therapy , Vascular Fistula/complications , Multicenter Studies as TopicABSTRACT
Arterioenteric fistulas (AEF) are rare and devastating complications of colorectal/pelvic malignancies. These fistulas can be seen following neoadjuvant or adjuvant therapy but are exceptionally rare de novo. The reported incidence of AEF is less than 1% and iliac artery-enteric fistulas make up less than .1% of all AEF. Here we present a patient in hemorrhagic shock secondary to an advanced colorectal malignancy without adjuvant therapies with local invasion of the right external iliac artery. Following initial resuscitation and hemorrhage control with coil embolization, definitive control with ligation and excision of the involved artery, end colostomy, and ureteral stent placement was achieved. It is important to consider malignancy as the source of lower gastrointestinal bleeds, especially in elderly patients without current colonoscopy studies. The management of this unfortunate diagnosis often involves a multidisciplinary approach with early and frequent goals of care discussions.
Subject(s)
Colorectal Neoplasms , Intestinal Fistula , Vascular Fistula , Humans , Aged , Intestinal Fistula/etiology , Intestinal Fistula/surgery , Intestinal Fistula/diagnosis , Iliac Artery , Blood Vessel Prosthesis/adverse effects , Colorectal Neoplasms/complications , Aorta, Abdominal , Vascular Fistula/complications , Vascular Fistula/surgeryABSTRACT
Aortoesophageal fistula is a very rare cause of upper gastrointestinal bleeding, however its interest lies in the high mortality rate associated with it. Due to this, early diagnosis and treatment of this entity is essential to increase survival. The typical symptoms known as the Chiari´s triad are only present in 45% of reported cases. We present the case of a patient with upper gastrointestinal bleeding due to an aortoesophageal fistula as well as the importance of endoscopic use for its differential diagnosis.
Subject(s)
Aortic Diseases , Esophageal Fistula , Esophageal Perforation , Vascular Fistula , Humans , Esophageal Perforation/diagnostic imaging , Esophageal Perforation/etiology , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Esophageal Fistula/etiology , Esophageal Fistula/complications , Gastrointestinal Hemorrhage/complications , Aortic Diseases/etiology , Aortic Diseases/complicationsABSTRACT
Coronary artery fistula (CAF) is a relatively rare disease, many of which are asymptomatic and are not indicated for surgery. However, CAF's patients with angina, heart failure due to shunt, and fistula hemangiomas are usually indicated for surgical treatment. A 49-year-old woman with severe congestive heart failure was found to have a fistula from the main trunk of the left coronary artery to the left atrium, and a fistula aneurysm. This patient had heart failure due to shunt blood flow, and also had a fistula aneurysm, so surgical treatment was indicated. During surgery, the fistula aneurysm was incised and the origin and opening of the fistula were closed without any problems. The postoperative course is good, and as of three years after the operation, the patient is being followed up at an outpatient clinic without recurrence of shunt flow and heart failure.
Subject(s)
Coronary Aneurysm , Coronary Artery Disease , Fistula , Heart Defects, Congenital , Heart Failure , Vascular Fistula , Coronary Aneurysm/surgery , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/surgery , Coronary Vessels/surgery , Dilatation , Female , Fistula/complications , Fistula/diagnostic imaging , Fistula/surgery , Heart Atria/diagnostic imaging , Heart Atria/surgery , Heart Failure/etiology , Heart Failure/surgery , Humans , Middle Aged , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Vascular Fistula/surgerySubject(s)
Humans , Aortic Diseases/complications , Aortic Diseases/diagnostic imaging , Esophageal Fistula/complications , Esophageal Fistula/etiology , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Endoscopy , ThoraxSubject(s)
Arterio-Arterial Fistula , Coronary Artery Disease , Coronary Vessel Anomalies , Fistula , Vascular Fistula , Arterio-Arterial Fistula/complications , Arterio-Arterial Fistula/diagnostic imaging , Arterio-Arterial Fistula/surgery , Cardiac Catheterization , Coronary Angiography , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/surgery , Coronary Vessels/diagnostic imaging , Humans , Infant, Newborn , Vascular Fistula/complications , Vascular Fistula/diagnostic imagingABSTRACT
Primary aortoesophageal fistula, an abnormal communication between native aorta and oesophagus, is an extremely rare cause of upper gastrointestinal bleeding. The typical symptoms, known as the Chiari´s triad, are only present in 45% of cases. It has a high mortality, so early diagnosis is essential to increase the probability of survival. We present a case report of a patient with massive upper gastrointestinal bleeding due to primary aortoesophageal fistula.
Subject(s)
Aortic Diseases , Esophageal Fistula , Vascular Fistula , Aortic Diseases/complications , Aortic Diseases/diagnostic imaging , Endoscopy , Esophageal Fistula/complications , Esophageal Fistula/etiology , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Humans , Thorax , Vascular Fistula/complications , Vascular Fistula/diagnostic imagingABSTRACT
AIM OF THE STUDY: Laryngotracheal separation (LTS) is known to be the definitive solution for intractable aspiration pneumonia in neurologically impaired children. Postoperatively, a tracheostomy cannula is usually required. However, there are fatal cannula related complications such as a tracheo-innominate artery fistula (TIAF). We present our methods of preventing TIAF. METHODS: A retrospective review in a single center from 2011 to 2019 identified 57 cases treated with LTS. We divided them into three groups: no pre-existing tracheostomy (n = 26), pre-existing tracheostomy with preservation of the pre-existing fistula (n = 20), and pre-existing tracheostomy without preservation of the pre-existing fistula (n = 11). The first group underwent traditional modified Lindeman's procedure. The second received transection of the trachea above the tracheostomy site, while the third had transection of the trachea at the tracheostomy site and creation of a distal end tracheostomy. Proper length and the angle of the cannula were selected to prevent damaging the innominate artery by the tip of the cannula. If the innominate artery compressed the trachea anteriorly, prophylactic arterial transection was considered. RESULTS: Three patients (5.3%) died from causes unrelated to the surgical treatment. Only one patient had a postoperative TIAF followed by LTS (1.8%). Other postoperative complications were: wound infection (8.8%), intratracheal granuloma (12.3%), intratracheal minor bleeding (10.5%), wound granuloma (43.9%), leakage (1.8%). No one required revision of LTS. CONCLUSION: Success rates of LTS were high without major complications in all three groups and implies a safe operation and a definitive solution to intractable aspiration.
Subject(s)
Fistula , Vascular Fistula , Brachiocephalic Trunk/surgery , Child , Fistula/surgery , Hospitals, Pediatric , Humans , Retrospective Studies , Trachea/surgery , Tracheostomy , Vascular Fistula/complications , Vascular Fistula/prevention & controlABSTRACT
BACKGROUND: Coronary artery fistula refers to an abnormal communication between a coronary artery and great vessel, a cardiac chamber or other structure. The left circumflex artery (LCX) pericardia fistula combined with huge pseudoaneurysm is extremely rare. CASE PRESENTATION: A 39-year-old young female was admitted into our hospital because of palpitation and shortness of breath. Coronary computed tomography angiography (CCTA) showed a huge pseudoaneurysm located in pericardium. Coronary angiography revealed the LCX pericardia fistula. Then surgical treatment was performed. She was in good condition without complications after surgery. CONCLUSIONS: Coronary artery fistula combined with pseudoaneurysm can be caused by congenital factors. Early surgical treatment can relieve the patient's symptoms and prevent the occurrence of adverse cardiovascular events.
Subject(s)
Aneurysm, False/complications , Coronary Aneurysm/complications , Coronary Vessel Anomalies/complications , Pericardium/abnormalities , Vascular Fistula/complications , Adult , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Computed Tomography Angiography , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/surgery , Coronary Angiography , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/surgery , Female , Humans , Pericardium/diagnostic imaging , Pericardium/surgery , Treatment Outcome , Vascular Fistula/diagnostic imaging , Vascular Fistula/surgerySubject(s)
Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/surgery , Endoleak/diagnostic imaging , Endoleak/etiology , Renal Veins , Vascular Fistula/diagnostic imaging , Aortic Aneurysm, Abdominal/diagnostic imaging , Humans , Male , Middle Aged , Vascular Fistula/complications , Vascular Fistula/surgeryABSTRACT
We present the case of a 72-year-old male with upper gastrointestinal bleeding. He had been discharged from hospital two weeks before after severe COVID-19 infection, treated with lopinavir-ritonavir (L-R), hydroxychloroquine, tocilizumab, and methylprednisolone. On presentation, he was in hypovolemic shock. Esophagogastroduodenoscopy showed an ulcer in the third duodenal portion, which was sclerosed and hemodynamic stability was recovered. A scan was performed as it was in an atypical location for ulcers, showing an aortic aneurysm in close relationship to the duodenum, suggesting a primary aortoenteric fistula (PAEF).