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1.
BMC Surg ; 21(1): 71, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530973

RESUMO

BACKGROUND: Hemobilia due to rupture of hepatic artery pseudoaneurysm and recurrent hemorrhage caused by hepatic artery collateral circulation are both rare complications after liver trauma. There have been a number of separate reports of both complications, but no cases have been reported in which the two events occurred in the same patient. Here we report a recurrent hemorrhage in the bile duct due to hepatic artery pseudoaneurysm secondary to collateral circulation formation after hepatic artery ligation in a patient with liver trauma. CASE PRESENTATION: A 52-year-old male patient was admitted to our hospital for liver trauma (Grade IV according to the American Association for the Surgery of Trauma (AAST) grading system) with active bleeding after a traffic accident. Hepatic artery ligation was performed for hemostasis. Three months after the surgery, the patient was readmitted for melena and subsequent hematemesis. Selective angiography examination revealed the formation of collateral circulation between the superior mesenteric artery and right hepatic artery. Moreover, a ruptured hepatic artery pseudoaneurysm was observed and transcatheter arterial embolization (TAE) was performed for hemostasis at the same time. After the treatment, the patient recovered very well and had an uneventful prognosis until the last follow-up. CONCLUSION: For patients with hepatic trauma, the selection of the site of hepatic artery ligation and the diagnosis and treatment methods of postoperative biliary hemorrhage are crucial for the prognosis of the disease.


Assuntos
Falso Aneurisma , Aneurisma Roto , Hemobilia , Artéria Hepática , Ligadura/efeitos adversos , Fígado , Traumatismos Abdominais/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Angiografia/métodos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/lesões , Circulação Colateral , Embolização Terapêutica , Hematemese/etiologia , Hematemese/terapia , Hemobilia/etiologia , Hemobilia/terapia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/lesões , Artéria Hepática/cirurgia , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Melena/etiologia , Melena/terapia , Pessoa de Meia-Idade , Recidiva , Circulação Esplâncnica
2.
J Assoc Physicians India ; 69(2): 73-74, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33527820

RESUMO

Pseudo-aneurysm of the brachial artery is relatively rare condition affecting the arterial vessels of the limbs. It can be due to trauma, infections or systemic vasculitis. We report a patient with aplastic anemia who developed pseudoaneurysm of the brachial artery following an episode of bacterial sepsis. Methicillin resistant Staphylococcus aureus (MRSA) was isolated on blood culture. Patient was treated with systemic antibiotics and underwent embolization of the pseudo-aneurysm. He later developed vascular insufficiency of the forearm and a stent had to be placed in the brachial artery at the site of calcified thrombus inside the pseudo-aneurysm to produce the patency of the artery and ensure adequate blood flow to forearm and hand.


Assuntos
Anemia Aplástica , Falso Aneurisma , Aneurisma Infectado , Staphylococcus aureus Resistente à Meticilina , Anemia Aplástica/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/terapia , Artéria Braquial/diagnóstico por imagem , Humanos , Masculino
3.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431455

RESUMO

Takayasu's arteritis (TA) is a vasculitis with a predilection for young women. Left ventricular pseudoaneurysm (PSA) in TA is a rare phenomenon. We report a 36 years old Filipina who presented with heart failure symptoms. Years prior, she had a recurrent fever, headache, myalgia and left arm claudication. On workup, a 2D echo revealed a left ventricular PSA with mural thrombus and moderate mitral regurgitation. Cardiac MRI further characterised the PSA with a sac diameter of 8×7.5×8.4 cm (CC×T×AP). Carotid Duplex Scan revealed total occlusion of the mid to distal right common carotid artery and left subclavian artery. She was started on immunosuppresants and guideline-directed medical therapy (GDMT) for heart failure and subsequently underwent successful endoventricular patch closure and mitral valve repair. This case highlights the importance of actively searching for cardiac complications of TA which although very rare, can dominate the clinical picture and may carry a dismal prognosis if left untreated.


Assuntos
Falso Aneurisma/diagnóstico , Aneurisma Cardíaco/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência da Valva Mitral/diagnóstico , Arterite de Takayasu/diagnóstico , Adulto , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Ecocardiografia Doppler em Cores , Eletrocardiografia , Feminino , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Insuficiência Cardíaca/terapia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Imagem de Perfusão do Miocárdio , Arterite de Takayasu/complicações , Arterite de Takayasu/tratamento farmacológico , Arterite de Takayasu/imunologia
4.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509873

RESUMO

Acute upper gastrointestinal (UGI) bleeding is one of the most frequent presentations to a surgical emergency. Most of them respond to initial resuscitation, and a definite diagnosis is established as soon as possible, thereby helping the clinician in management. We present the diagnostic challenges that we faced with a 70-year-old man who presented with UGI bleed. He initially responded to resuscitation, but later deteriorated and became haemodynamically unstable. The source of the UGI bleed on evaluation was found to be pseudoaneurysm of the gastroduodenal artery (PsGDA) and treated successfully by coil embolisation. The cause of the PsGDA was diverticulum arising from the first part of duodenum with changes of diverticulitis. Diverticulum originating from the first part of the duodenum is seldom reported. Moreover, diverticulitis involving this part and causing PsGDA has not been reported so far.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Diverticulite/diagnóstico por imagem , Duodenopatias/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Artéria Hepática , Idoso , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angiografia Digital , Antibacterianos/uso terapêutico , Diverticulite/complicações , Diverticulite/tratamento farmacológico , Duodenopatias/complicações , Duodenopatias/tratamento farmacológico , Embolização Terapêutica , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 100(2): e24299, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466219

RESUMO

RATIONALE: Renal vein pseudoaneurysm after blunt trauma is an extremely rare clinical disease. Different interventions, such as conservative, surgical, and endovascular treatments, can be considered. However, previous studies have not described the optimal treatment strategies for this condition. Furthermore, there is a significant lack of prior case reports and of standardized treatment guidelines for trauma-induced renal vein pseudoaneurysm patients who previously maintained antithrombotic agent. PATIENT CONCERNS: A 23-year-old female patient visited the emergency department after sustaining blunt injury caused by falling. The patient was diagnosed with multiple limb and rib fractures. A right renal vein pseudoaneurysm was found on abdominal computed tomography scan. Initially, there was no other organ damage, and the patient was hemodynamically stable. Thus, nonsurgical, conservative management was considered. However, the patient's hematocrit and hemoglobin levels decreased, and there was no hemodynamic improvement. The patient required lifelong treatment with aspirin because she previously underwent Fontan surgery, and orthopedic surgery for multiple fractures was planned. Thus, considering these factors, the treatment method was changed from conservative management to endovascular stent insertion. DIAGNOSES: Abdominal computed tomography and renal venography revealed a right renal vein pseudoaneurysm. INTERVENTIONS: On the basis of the abdominal computed tomography scan and renal venography findings, the endovascular stent graft was inserted across the pseudoaneurysm area. OUTCOMES: Upon placement of the endovascular stent, hemoglobin and hematocrit levels gradually returned to normal. The patient's vital signs and general condition had improved. The patient recovered without any complications and was discharged 29 days after hospitalization. LESSONS: Some patients with traumatic renal vein pseudoaneurysm do not experience hemodynamic improvement despite conservative treatment. Hence, endovascular procedure may be considered for these patients, particularly those who require antithrombotic treatment for a previous disease.


Assuntos
Falso Aneurisma/etiologia , Veias Renais , Ferimentos não Penetrantes/complicações , Feminino , Humanos , Adulto Jovem
6.
Vasc Endovascular Surg ; 55(1): 73-76, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32869730

RESUMO

Visceral artery pseudoaneurysms are common complications of pancreatitis that carry a high mortality rate. Early detection and treatment of the pseudoaneurysms should be done as they carry high mortality following rupture. The splenic artery is the commonest artery involved followed by gastroduodenal and pancreaticoduodenal arteries. Gastric artery pseudoaneurysms are less common with less than 50 cases reported in the literature till now. We describe a case of gastric artery pseudoaneurysm secondary to chronic pancreatitis in a patient who presented with intermittent GI bleeding and also describe the role of endovascular management in the treatment of the same.


Assuntos
Falso Aneurisma/terapia , Embolização Terapêutica , Artéria Gástrica , Pancreatite Crônica/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Artéria Gástrica/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Crônica/diagnóstico , Resultado do Tratamento
8.
Cardiovasc Pathol ; 50: 107268, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32858206

RESUMO

We report the sudden unexpected death from exsanguination of a 60-year-old white female who underwent balloon angioplasty of her right popliteal artery via a right common femoral arteriotomy 3 weeks before death. This resulted in a mycotic pseudoaneurysm of the right femoral artery that ruptured, causing fatal exsanguination. A pseudoaneurysm is an arterial wall defect in which part of the wall consists of fibrin and fibrous tissue, lacking components of the normal arterial wall, that is intima, media, and adventitia. Pseudoaneurysms result from traumatic arterial injury, infection, rupture of a true aneurysm, or surgery. A literature search revealed no reports with the patient dying unexpectedly outside the hospital. Immediate surgical intervention and antibiotic therapy are preferred treatments.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma Roto/etiologia , Angioplastia com Balão/efeitos adversos , Artéria Femoral/lesões , Lesões do Sistema Vascular/etiologia , Falso Aneurisma/patologia , Aneurisma Infectado/patologia , Aneurisma Roto/patologia , Autopsia , Evolução Fatal , Feminino , Artéria Femoral/patologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões do Sistema Vascular/patologia
11.
Heart Lung ; 49(6): 779-782, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32980627

RESUMO

COVID-19 pandemic triggered in many patients the fear to go to the emergency rooms in order to avoid a possible infection. This phenomenon caused a significant reduction in acute coronary syndrome-related interventional procedures with a subsequent increase in critical hospitalizations and post-infarction mechanical complications. A case series of cardiac ruptures during the COVID-19 lockdown and the surgical treatment of a huge post-ischemic cardiac pseudoaneurysm complicated by a "contained" free wall rupture are presented.


Assuntos
Infarto do Miocárdio , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Infecções por Coronavirus , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Pandemias , Pneumonia Viral
12.
J Oral Maxillofac Surg ; 78(11): 2008.e1-2008.e9, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32771443

RESUMO

A pseudoaneurysm (PA) is a collection of blood caused by an incomplete tear in the vessel wall. PA can be arterial or venous in origin. In the maxillofacial region, arterial PA can result from surgical interventions. Venous PAs in the maxillofacial region have never been described. A standardized protocol for management of post-traumatic PAs in the maxillofacial region would help clinicians make treatment decisions. On the basis of the available literature and our institutional experience, we present an algorithm for management of post-traumatic maxillofacial PAs. We also present patients from our institution who illustrate some of the management options in the algorithm.


Assuntos
Falso Aneurisma , Algoritmos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Humanos
14.
Vasc Endovascular Surg ; 54(8): 741-746, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32729388

RESUMO

BACKGROUND: Pseudoaneurysms that develop after surgical repair of a patent ductus arteriosus (PDA) are more likely to rupture, but open surgery including a repeat thoracotomy would be highly invasive. We report 2 cases of thoracic endovascular aortic repair (TEVAR) for such pseudoaneurysms. METHODS/RESULTS: A 59-year-old woman who underwent PDA surgical ligation at 13 years of age presented with sudden hemoptysis. She was diagnosed with a ruptured distorted pseudoaneurysm sized 26 mm; emergency TEVAR was performed. A 23-year-old woman with a history of Down syndrome, endocardial cushion defect, and PDA underwent 2 thoracotomy surgeries including PDA ligation. During a medical checkup, an abnormal shadow was detected on chest radiography. She was diagnosed with a 15-mm pseudoaneurysm after PDA surgical repair; TEVAR was performed. In both cases, the postoperative course was uneventful. CONCLUSIONS: To the best of our knowledge, this is the first report of emergency TEVAR for ruptured pseudoaneurysms after PDA ligation. Thoracic endovascular aortic repair is an important therapeutic option for such cases as it eliminates the need for repeat thoracotomy.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Permeabilidade do Canal Arterial/cirurgia , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Adulto Jovem
15.
Acta Neurochir (Wien) ; 162(11): 2725-2729, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32720013

RESUMO

The clinical manifestations of coronavirus disease 2019 (COVID-19) are non-specific and multi-inflammatory. They vary from mild to severe manifestations that can be life-threatening. The association of SARS-CoV-2 infection and pseudoaneurysm formation or rupture of an already existing aneurysm is still unexplored. Several mechanisms may be involved, including the direct destruction to the artery by the viral infection or through the release of the inflammatory cytokines. We are presenting a case of a 13-year-old girl with a ruptured cerebral pseudoaneurysm of the left middle cerebral artery (M2 segment) with severe intracerebral hemorrhage as the earliest manifestation of COVID-19 infection.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Roto/etiologia , Hemorragia Cerebral/etiologia , Infecções por Coronavirus/complicações , Artéria Cerebral Média , Pneumonia Viral/complicações , Adolescente , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Digital , Ascite/etiologia , Betacoronavirus , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Angiografia por Tomografia Computadorizada , Coronavirus , Infecções por Coronavirus/diagnóstico , Craniotomia , Progressão da Doença , Feminino , Hepatomegalia/etiologia , Humanos , Nefropatias/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Infarto do Baço/etiologia , Tomografia Computadorizada por Raios X
16.
Am J Cardiol ; 128: 161-162, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650913

RESUMO

We describe an 84-year-old man who presented with hemoptysis and acute blood loss anemia due to a pulmonary artery pseudoaneurysm (PAP). The etiology of his PAP was thought to be an abandoned epicardial defibrillator patch that was implanted at age 55. To our knowledge, PAP has never been reported as a possible complication of an abandoned epicardial defibrillator patch.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Desfibriladores Implantáveis , Corpos Estranhos/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Idoso de 80 Anos ou mais , Anemia/etiologia , Anemia/terapia , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Angiografia Digital , Transfusão de Sangue , Procedimentos Endovasculares , Corpos Estranhos/complicações , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Masculino , Artéria Pulmonar/cirurgia , Tomografia Computadorizada por Raios X
17.
J Card Surg ; 35(8): 2103-2105, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652642

RESUMO

A 59-year-old man with acute mitral regurgitation due to papillary muscle rupture after myocardial infarction was admitted to our hospital. He underwent emergent mitral valve replacement with a mechanical valve by median sternotomy. Although postoperative echocardiography showed no sign of a ventricular aneurysm, echocardiography performed 5 weeks after the surgery showed enlarging left ventricular pseudoaneurysm of the inferior to the posterior cardiac wall. He underwent dacron patch closure of the orifice by fifth intercostal left thoracotomy. The postoperative course was uneventful and he was discharged on postoperative day 10. The patient was successfully treated for two life-threatening complications occurring subsequently after myocardial infarction.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Cardíaco/cirurgia , Ruptura Cardíaca Pós-Infarto/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/cirurgia , Valva Mitral/cirurgia , Infarto do Miocárdio/complicações , Músculos Papilares , Complicações Pós-Operatórias , Toracotomia/métodos , Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
18.
J Card Surg ; 35(8): 2070-2072, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652682

RESUMO

OBJECTIVE: Highlight our management of a Pasteurella Multiocida-infected descending thoracic aorta mycotic pseudoaneurysm. METHODS: Report a case of a canine bite resulting in a P. Multiocida descending thoracic aorta mycotic pseudoaneurysm. RESULTS: We present a 61-year-old gentleman who was initially seen in an emergency department after a canine bite. He was admitted and treated with a course of IV antibiotics for P. Multiocida bacteremia and discharged. Three weeks after discharge, he continued to feel generalized malaise and work-up was significant for a descending thoracic aorta mycotic pseudoaneurysm. The patient underwent a low left posterior lateral thoracotomy and femoral-femoral cardiopulmonary bypass for complete pseudoaneurysm resection and aortic replacement with a 24-mm Gelweave graft. Given purulence and gross infection, we planned for a staged approach, with a secondary washout and omental flap for biologic coverage of the graft. The patient did well clinically and was discharged at 14 days to rehabilitation with 6-week intravenous course of antibiotics. CONCLUSIONS: The patient's clinical course with subsequent follow-up suggest that complete resection of the mycotic pseudoaneurysm, followed by omental flap coverage is a viable strategy to manage mycotic aortic infections with virulent organisms.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aneurisma Infectado/etiologia , Aneurisma Infectado/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Bacteriemia/etiologia , Mordeduras e Picadas/complicações , Infecções por Pasteurella/etiologia , Infecções por Pasteurella/cirurgia , Pasteurella multocida , Animais , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar , Cães , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Toracotomia/métodos
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