Mycotic iliac artery aneurysm with appendicitis in a pediatric patient.

Iliac aneurysms are rare in children, especially mycotic aneurysms. Re-vascularization is challenging given the infected field and concern on patency due to their growth potential and a longer life-span. We report a complex case of a mycotic iliac aneurysm in a child. A 12-years-old boy with a previous history of infective endocarditis was referred to us for a right common iliac mycotic aneurysm after presenting with pain. A balloon-expandable stent-graft was deployed across the aneurysm during the acute presentation. He improved post-operatively, but developed abdominal pain four weeks later. A repeat computed tomography (CT) imaging showed a new inflammation of the appendix which was adhered to the calcified wall of the aneurysm and an endoleak from the internal iliac artery. A laparotomy was performed and the right internal iliac artery ligated along with an appendicectomy and omental pedicle. Postoperatively the patient was well and discharged home. Six-month surveillance revealed a healthy child and imaging showed a patent stent-graft and no residual collection.

Systemic review of global case reports on ankle pseudo aneurysm: Analysis of epidemiology, clinical presentation, diagnosis and treatment.

INTRODUCTION: Pseudo aneurysm of the ankle is a rare presentation and the management is complex due to the complex anatomy. The aim of this review is to examine the epidemiology, etiology, diagnostic modalities used and management. This is the first systematic review of this topic in literature. METHODS: We performed a systematic review in multiple databases (including PubMed, MEDLINE, EMBASE, and Scopus) from 1966 to May 18, 2019, to identify all case reports and case series describing patients with ankle pseudo aneurysm. This systematic review was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA). Our inclusion criteria included patients with ankle pseudo aneurysm of any age. We excluded reports in which the individual level data is not available. Patients demographic (gender, age), clinical characteristics (precipitating event, duration), diagnostic modality and treatment were recorded. RESULT: There were in total 23 case reports identified on ankle pseudo aneurysm from 1966 until 2018. Among these twenty-three reports, 16 (70%) were male and seven (30%) patients were female. Age distribution showed higher number of reports among young adults, 15 patients (65%). Based on our systematic review trauma (48%), arthroscope (48%) and arthrodesis (4%) were the etiologies described in all these case reports. Ultrasound duplex and CT Angiogram has been used as a single modality in three reports each. In fifteen patients (65%) combination of imaging has been used for diagnosis. Anterior tibial artery is the most commonly injured vessel among the reported cases, comprised of 14 (61%) patients. Among these arthroscopes were the highest reported precipitating events, 9 (64%), followed by trauma in four patients (29%) and arthrodesis in one patient (7%). Treatment modalities described in all previous reports were excision and ligation, 10 (42%); excision of sac and primary repair, 4 (17%); excision of sac followed by reversed saphenous venous graft repair, 2 (8%); US guided compression, 2 (8%); US guided thrombin injection, 4 (17%); stenting, 1 (4%) and coiling, 1 (4%). CONCLUSION: Ankle pseudoaneurysm is mostly preventable by detailed initial assessment following trauma or careful approach during arthroscope. Evolving diagnostic modality and treatment has shed some light into noninvasive management of pseudo aneurysm of ankle.

Case report of a chest wall cystic hygroma in a teenager.

Cystic hygroma or cystic lymphangioma is a congenital malformation of lymphatic origin. Their occurrence on the chest wall is very rare, and they progressively grow with age infiltrating into the local tissues, around muscle fibers and nerves, making them difficult and hazardous to remove. There are various treatment modalities of such lesion. Based on the literature surgical excision is the preferred treatment of choice in cystic hygroma because it gives a better cure rate compared to other modalities. We report a case successful excision of anterolateral chest wall cystic hygroma in a teenager in Hospital Serdang.