RESUMO
A 76-year-old man was referred to the Emergency Department because of collapse, epigastric pain and nausea. The patient had been diagnosed with an infrarenal aneurysm of the abdominal aorta nine years earlier. His symptoms were attributed to an aortic-duodenal fistula originating from the aneurysm. The patient died despite placement of an aortic prosthesis. A hospital screening programme for chronic Q fever in patients with aortic aneurysm revealed chronic Q fever. Until recently, vascular infection with Coxiella burnetii was an unknown disease in the Netherlands. In view of the nonspecific clinical presentation, severity and therapeutic consequences of the disease, we advise screening for chronic Q fever in all symptomatic patients with an aortic aneurysm or prosthesis - whether or not with aspecific symptoms - in regions where the disease is endemic.
Assuntos
Aneurisma da Aorta Abdominal/complicações , Implante de Prótese Vascular , Febre Q/complicações , Febre Q/diagnóstico , Idoso , Aneurisma Infectado/microbiologia , Aneurisma Infectado/cirurgia , Aneurisma Aórtico , Doença Crônica , Evolução Fatal , Humanos , MasculinoRESUMO
The purpose of this study was to investigate the results of a staged treatment of symptomatic focal nodular hyperplasia (FNH), consisting of first embolization and then resection. A 36-year-old woman presented with pulmonary embolism caused by an inferior caval vein thrombosis owing to external compression by FNH in liver segment I (5.2 x 6.7 cm). She was treated with anticoagulants. The FNH lesion was first reduced by radiologic embolization of the feeding branch of the right hepatic artery. A 41% size reduction was obtained, and the symptoms disappeared. FNH resection was performed 5(1/2) months later. The thrombus had disappeared, and the anticoagulant therapy could be stopped perioperatively. A symptomatic FNH lesion was treated successfully in two stages.
Assuntos
Embolização Terapêutica , Hiperplasia Nodular Focal do Fígado/terapia , Hepatectomia , Artéria Hepática , Embolia Pulmonar/terapia , Procedimentos Cirúrgicos Vasculares , Veia Cava Inferior/cirurgia , Trombose Venosa/terapia , Adulto , Anticoagulantes/uso terapêutico , Colecistectomia , Terapia Combinada , Feminino , Hiperplasia Nodular Focal do Fígado/complicações , Hiperplasia Nodular Focal do Fígado/diagnóstico por imagem , Hiperplasia Nodular Focal do Fígado/cirurgia , Humanos , Fotocoagulação a Laser , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/cirurgiaRESUMO
Four patients presented with an acute type B aortic dissection. All were managed medically. However, three of the four patients needed additional invasive treatment. A 67-year-old patient was given a spinal catheter because of neurological symptoms. A 57-year-old patient underwent endovascular fenestration of the right renal artery and stenting of the iliac arteries to treat acute ischemia. In a 71-year-old patient an endograft was placed in the distal aortic arch to close a tear in the aortic wall, and two stents were placed in the right renal artery for stenosis. Currently, medical management is the preferred treatment for uncomplicated type B aortic dissection. In complicated type B aortic dissection, endovascular grafting seems to be a useful solution with a high primary success percentage.