Anatomical and surgical considerations for Bow Hunter's syndrome in an elderly patient.

Bow Hunter's syndrome (BHS) is an uncommon condition characterized by impingement of one of the two vertebral arteries induced by cervical rotation, causing symptomatic vertebrobasilar insufficiency of the posterior cerebral circulation. We report a case of BHS in an 84-year-old male. Two months following a motor vehicle accident, the patient presented to an urgent care facility with subsequent transfer to the emergency department with complaints of lightheadedness upon right-lateral head movement. A cerebral angiogram demonstrated mild focal stenosis in the dominant left vertebral artery at the C2 level when in neutral position with significant worsening of the stenosis in the right-lateral head position with absent anterograde flow, consistent with BHS. Resultantly, the patient was referred for neurosurgery and successfully underwent placement of right-sided C2-C4 postero-lateral instrumentation and left-sided C2-C3 laminar screws projected towards the right side. This case highlights the importance of imaging in BHS diagnosis and guidance for treatment, as well as the need for a surgical standard of care for BHS patients.

Pulmonary artery involvement in Behçet's disease: A challenging case and comprehensive management approach.

A 26-year-old male with Behçet's disease (BD) presented with recurrent oral and genital ulcers, bilateral pneumonia, and a left lower pulmonary artery aneurysm. Endovascular coil embolization was initially performed, followed by treatment with prednisone, colchicine, and azathioprine. Despite treatment, disease progression occurred, requiring additional embolization, intravenous pulse methylprednisolone, and cyclophosphamide. Ultimately, a combination of medical and endovascular interventions resolved the pulmonary arterial aneurysms. This case highlights BD's systemic inflammatory nature and vascular complications like pulmonary artery aneurysms. It emphasizes the importance of early detection and individualized, multidisciplinary care for such complications.

A complicated presentation of vertebral coccidioidomycosis dissemination: A case report and discussion.

Coccidioidomycosis, also known as San Joaquin Valley fever, is an illness caused by the dimorphic fungus Coccidioides. Coccidioidomycosis is endemic to desert regions of the Western Hemisphere, including California, Arizona, Utah, Nevada, and New Mexico. We report a case of disseminated coccidioidomycosis in a 42-year-old male. Months after an upper respiratory infection of unidentified origin, the patient began experiencing back pain. The persistence of the back pain prompted MRI and CT imaging, which revealed lytic lesions. His clinical and radiological presentation mimicked, and was originally approached, as if it were a malignancy. Metastasis or multiple myeloma were considered the most likely differential diagnoses. As a result, the patient underwent surgical exploration. Pathology results indicated the presence of a fungal infection, without evidence of malignancy. PCR confirmed the diagnosis of coccidioidomycosis. The patient began treatment with fluconazole 800 mg daily and is anticipated to receive antifungal treatment for an indefinite period.

Aplastic Internal Carotid Artery: A Potentially Catastrophic Vascular Anomaly.

Congenital absence of an internal carotid artery (ICA) is a rare vascular anomaly and occurs in less than 0.01% of the population. We report a case of aplastic internal carotid artery in a 34-year-old female. The patient presented to the emergency department with complaints of new-onset involuntary swaying-like movement of her right arm. Brain magnetic resonance imaging showed multifocal tiny areas of acute infarcts in the bilateral frontal, parietal, and left occipital lobes in the watershed distribution. There was no visualization of the flow of the intracranial left internal carotid artery. Follow-up CTA of the head and neck showed a congenital absence of the left internal carotid artery with no evidence of arterial dissection, occlusion, or aneurysm. Obstruction of the internal carotid artery has significant consequences for patients. This effect is amplified if the disruption occurs in the sole anterior blood supply to the parenchyma of the brain, as in this case. In our patient care, imaging was vital to the detection and subsequent treatment with anticoagulation to avoid further cerebral complications, and the patient will now have a better understanding of the increased lifetime risk of further events.

Traumatic Pseudoaneurysms of the Internal Mammary Artery: Two Cases and Percutaneous Intervention.

Pseudoaneurysms involving the internal mammary artery/internal thoracic artery (IMA/ITA) are rare occurrences, and the presentation and treatment approaches for such cases can be variable. Due to the potentially life-threatening risk of rupture, leading to conditions like hemothorax, it is important to have a comprehensive understanding of safe and effective diagnostic and therapeutic techniques. We present two cases of IMA/ITA artery pseudoaneurysms. A 91-year-old male presented to the emergency department following a motor vehicle accident. A CT scan of the chest revealed an anterior mediastinal hemorrhage with active extravasation. Percutaneous intervention revealed a pseudoaneurysm arising from a left IMA/ITA side branch. Coil embolization effectively treated the pseudoaneurysm. In the second case, a 79-year-old male presented with a sternal fracture after a ground-level fall, with parasternal hematoma and active bleeding (pseudoaneurysm) on Trauma Computerized Tomography of the chest with contrast. He underwent coil embolization, and subsequent post-procedure angiograms confirmed the effective occlusion of the left IMA/ITA, with no further visualization of the pseudoaneurysm. These two cases underscore the importance of tailored approaches in treating internal mammary artery pseudoaneurysms.

Osteochondral Allograft Transplantation Of Posterior Femoral Condyle Lesions Utilizing An Open Posterior Approach To The Knee.

Osteochondral allograft transplantation is a viable option for large chondral defects >2 cm squared, as well as in a revision setting after failure of a previous surface chondral restoration procedure. Osteochondral lesions involving the posterior aspect of the femoral condyle, however, are less common and easily underappreciated. Treatment of posterior osteochondral lesions is more technically demanding because they cannot be adequately addressed through standard arthroscopic approaches or an anterior arthrotomy. The challenges of the posterior approach include the relative unfamiliarity for many surgeons and the inherent risks due to the proximity of the neurovascular structures. The following technique reviews relevant anatomy and approach to osteochondral allograft transplant involving the posterior femoral condyles.