[Screening for chronic Q fever in symptomatic patients with an aortic aneurysm or prosthesis]. / Screening op chronische Q-koorts bij symptomatische patiënt met aneurysma of prothese van de aorta.

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.

Inferior caval vein thrombosis owing to compression of focal nodular hyperplasia: surgical resection after shrinkage by hepatic artery embolization.

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.

[Treatment of acute aortic dissection type B]. / Behandeling van acute aortadissecties type B.

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.