RESUMO
The formation of a fistula between the internal mammary artery and the pulmonary vasculature (IMA-to-PV) is a rare anomaly. The etiology can be congenital; however, most recent cases have been associated with coronary artery bypass grafting, trauma, inflammatory conditions, chronic infections, or neoplasia. The knowledge base on the formation of these fistulas is derived primarily from case reports. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage these cases, and the treatment of an IMA-to-PV fistula is controversial. To our knowledge, this report is the first to review 80 cases of IMA-to-PV fistulas reported in the literature. We describe the etiologies, clinical presentation, and management of these fistulas.
Assuntos
Fístula Artério-Arterial/etiologia , Fístula Arteriovenosa/etiologia , Artéria Torácica Interna , Artéria Pulmonar , Veias Pulmonares , Lesões do Sistema Vascular/etiologia , Adulto , Fístula Artério-Arterial/diagnóstico por imagem , Fístula Artério-Arterial/terapia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Feminino , Humanos , Doença Iatrogênica , Masculino , Artéria Torácica Interna/anormalidades , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/lesões , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/lesões , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/lesões , Fatores de Risco , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapiaRESUMO
The confluence of atrial septal aneurysm and patent foramen ovale in noncoronary sinus of Valsalva has not been previously documented in the literature.
RESUMO
Intrathecal therapy with cytarabine is widely used in the treatment of acute lymphocytic leukemia. We report the first case of accidental intrathecal cytarabine overdose in an adult patient. Overdose of intrathecal chemotherapy has been reported to cause severe neurological damage including seizures, coma and death. Methotrexate levels can help guide intrathecal dosing of methotrexate, but no such test is commercially available for cytarabine. There are no standardized treatment recommendations for the management of this medical emergency. Intrathecal methotrexate overdose has been variously treated with cerebrospinal fluid drainage or exchange. Ventriculo-lumbar perfusion, steroids and leucovorin have also been used. It seems crucial to quickly remove as much drug as possible from the cerebrospinal fluid. Our patient was successfully treated with large-volume cerebrospinal fluid aspiration through an Ommaya reservoir. She did not suffer any significant immediate or late complications at 4 months of follow-up.
