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BMJ Case Reports Sep 2023Sarcomas of the aorta are rare tumours with various clinical presentations. The most common symptoms are embolic events, constitutional symptoms, claudication, abdominal...
Sarcomas of the aorta are rare tumours with various clinical presentations. The most common symptoms are embolic events, constitutional symptoms, claudication, abdominal complaints, aneurysm/pseudoaneurysm, back pain and hypertension. We present a case of a woman in her early 60s having fever, fatigue and cough for 3 months. The chest CT revealed an aneurysm measuring 64.1×65.6 mm. The oncology and thoracic surgical teams were consulted and decided to do an open repair of the aorta and take specimens for histopathological examination, which later confirmed a pleomorphic undifferentiated sarcoma of the aorta. She was temporarily discharged on day 9th after the surgery, followed up by chemotherapy in subsequent admission.
Topics: Female; Humans; Aorta; Sarcoma; Aneurysm, False; Cough; Fatigue
PubMed: 37730425
DOI: 10.1136/bcr-2023-256722 -
IJU Case Reports May 2024Renal pseudoaneurysms reportedly occur after partial nephrectomy, renal trauma, or percutaneous procedures. Renal pseudoaneurysms can also occur after renal...
INTRODUCTION
Renal pseudoaneurysms reportedly occur after partial nephrectomy, renal trauma, or percutaneous procedures. Renal pseudoaneurysms can also occur after renal inflammation; however, such cases are rare and seldom reported.
CASE PRESENTATION
A 53-year-old man presented to our emergency room with a 3-day history of fever and right back pain. A blood sample revealed severe inflammation and computed tomography showed an 8 mm diameter stone in the right middle ureter and hydronephrosis. The patient was diagnosed with calculous pyelonephritis and underwent emergency ureteral stenting and antibiotic therapy. On day 8 of hospitalization, hematuria and right back pain developed, and on day 9 bladder tamponade and anemia developed. Contrast-enhanced computed tomography revealed a ruptured pseudoaneurysm, and the patient underwent successful angioembolization. The patient was discharged on day 23.
CONCLUSION
We report a case of a renal pseudoaneurysm possibly caused by calculous pyelonephritis.
PubMed: 38686079
DOI: 10.1002/iju5.12711 -
European Journal of Neurology May 2024The causal association between inflammatory cytokines and the development of intracranial aneurysm (IA), unruptured IA (uIA) and subarachnoid hemorrhage (SAH) lacks...
BACKGROUND AND PURPOSE
The causal association between inflammatory cytokines and the development of intracranial aneurysm (IA), unruptured IA (uIA) and subarachnoid hemorrhage (SAH) lacks clarity.
METHODS
The summary-level datasets for inflammatory cytokines were extracted from a genome-wide association study of the Finnish Cardiovascular Risk in Young Adults Study and the FINRISK survey. The summary statistics datasets related to IA, uIA and SAH were obtained from the genome-wide association study meta-analysis of the International Stroke Genetics Consortium and FinnGen Consortium. The primary method employed for analysis was inverse variance weighting (false discovery rate), supplemented by sensitivity analyses to address pleiotropy and enhance robustness.
RESULTS
In the International Stroke Genetics Consortium, 10, six and eight inflammatory cytokines exhibited a causal association with IA, uIA and SAH, respectively (false discovery rate, p < 0.05). In FinnGen datasets, macrophage Inflammatory Protein-1 Alpha (MIP_1A), MIP_1A and interferon γ-induced protein 10 (IP_10) were verified for IA, uIA and SAH, respectively. In the reverse Mendelian randomization analysis, the common cytokines altered by uIA and SAH were vascular endothelial growth factor (VEGF), MIP_1A, IL_9, IL_10 and IL_17, respectively. The meta-analysis results show that MIP_1A and IP_10 could be associated with the decreased risk of IA, and MIP_1A and IP_10 were associated with the decreased risk of uIA and SAH, respectively. Notably, the levels of VEGF, MIP_1A, IL_9, IL_10 and TNF_A were increased with uIA. Comprehensive heterogeneity and pleiotropy analyses confirmed the robustness of these results.
CONCLUSION
Our study unveils a bidirectional association between inflammatory cytokines and IA, uIA and SAH. Further investigations are essential to validate their relationship and elucidate the underlying mechanisms.
PubMed: 38709145
DOI: 10.1111/ene.16326 -
Journal of the American College of... May 2024Postinfarction ventricular free-wall rupture is a rare mechanical complication, accounting for <0.01% to 0.02% of cases. As an often-catastrophic event, death typically... (Review)
Review
Postinfarction ventricular free-wall rupture is a rare mechanical complication, accounting for <0.01% to 0.02% of cases. As an often-catastrophic event, death typically ensues within minutes due to sudden massive hemopericardium resulting in cardiac tamponade. Early recognition is pivotal, and may allow for pericardial drainage and open surgical repair as the only emergent life-saving procedure. In cases of contained rupture with pseudo-aneurysm (PSA) formation, hospitalization with subsequent early surgical intervention is warranted. Not uncommonly, PSA may go unrecognized in asymptomatic patients and diagnosed late during subsequent cardiac imaging. In these patients, the unsettling risk of complete rupture demands early surgical repair. Novel developments, in the field of transcatheter-based therapies and multimodality imaging, have enabled percutaneous PSA repair as a feasible alternate strategy for patients at high or prohibitive surgical risk. Contemporary advancements in the diagnosis and treatment of postmyocardial infarction ventricular free-wall rupture and PSA are provided in this review.
Topics: Humans; Aneurysm, False; Myocardial Infarction; Heart Rupture, Post-Infarction; Heart Ventricles; Heart Aneurysm
PubMed: 38719370
DOI: 10.1016/j.jacc.2023.10.054 -
Internal Medicine (Tokyo, Japan) Jul 2023Objective Pseudoaneurysm rupture associated with unresected pancreatic cancer can cause rare but fatal hemobilia and gastrointestinal bleeding. This study aimed to...
Objective Pseudoaneurysm rupture associated with unresected pancreatic cancer can cause rare but fatal hemobilia and gastrointestinal bleeding. This study aimed to identify factors predicting pseudoaneurysm rupture. Methods We conducted a single-center case-control study of unresected pancreatic cancer patients treated at Shizuoka General Hospital between January 2011 and July 2020 using a retrospective cancer registry database. Included in the study were 611 consecutive patients with unresected pancreatic cancer, of whom 55 developed overt upper gastrointestinal bleeding or hemobilia. Twenty patients were excluded, as they had not undergone contrast-enhanced computed tomography (CT) or angiography. Patients were classified into pseudoaneurysm and non-pseudoaneurysm groups. One patient with arterial bleeding but without obvious pseudoaneurysm was included in the pseudoaneurysm group. Factors predicting pseudoaneurysm rupture at the onset of overt gastrointestinal bleeding were investigated using a logistic regression analysis. CT findings revealing air bubbles inside the tumor were described as intratumoral air bubbles. Results Thirty-five patients were included (15 in the pseudoaneurysm group, 20 in the non-pseudoaneurysm group). In the multivariate analysis, intratumoral air bubbles [odds ratio (OR), 12.9; 95% confidence interval (CI), 2.14-77.9; p=0.005] and hematemesis (OR, 6.30; 95% CI, 1.03-38.6; p=0.047) were independent predictors of pseudoaneurysm rupture. In addition, patients who experienced successful hemostasis and were re-administered chemotherapy survived more than six months. Conclusion This study reveals that intratumoral air bubbles and hematemesis may predict pseudoaneurysm rupture at the onset of overt gastrointestinal bleeding. For patients presenting these findings, an examination with conventional or CT angiography may lead to an early diagnosis and improve the patient prognosis.
Topics: Humans; Hematemesis; Hemobilia; Case-Control Studies; Retrospective Studies; Aneurysm, False; Gastrointestinal Hemorrhage; Pancreatic Neoplasms
PubMed: 36384903
DOI: 10.2169/internalmedicine.0856-22 -
The American Surgeon Sep 2023An inferior epigastric artery pseudoaneurysm is an exceptionally rare occurrence. Formation of an inferior epigastric artery pseudoaneurysm can be seen following...
An inferior epigastric artery pseudoaneurysm is an exceptionally rare occurrence. Formation of an inferior epigastric artery pseudoaneurysm can be seen following surgical intervention and is more common after laparoscopy. A sixty-eight-year-old male presented with a right upper quadrant bulge at his incision site two months following laparoscopic appendectomy. The patient reported sudden onset of a non-reducible bulge at a 5 mm trocar incision site with minimal pain and without obstructive symptoms. Computed tomography of his abdomen and pelvis with intravenous contrast revealed a 4.2 cm pseudoaneurysm with peripheral thrombosis within the right inferior epigastric artery. The patient subsequently underwent open exploration with the evacuation of pseudoaneurysm thrombus and ligation of arteriovenous fistula. The patient recovered well without complication from pseudoaneurysm. Inferior epigastric artery pseudoaneurysm following any laparoscopic procedure is rare. This case highlights the importance of understanding the abdominal wall anatomy and its vascular supply to avoid such injury. We present this case to bring light to this rare occurrence and to highlight the importance of proper trocar placement during any laparoscopic procedure.
Topics: Male; Humans; Aged; Epigastric Arteries; Aneurysm, False; Appendectomy; Laparoscopy; Abdominal Wall
PubMed: 37344963
DOI: 10.1177/00031348231161682 -
Radiographics : a Review Publication of... Mar 2024Infective endocarditis (IE) is a complex multisystemic disease resulting from infection of the endocardium, the prosthetic valves, or an implantable cardiac electronic...
Infective endocarditis (IE) is a complex multisystemic disease resulting from infection of the endocardium, the prosthetic valves, or an implantable cardiac electronic device. The clinical presentation of patients with IE varies, ranging from acute and rapidly progressive symptoms to a more chronic disease onset. Because of its severe morbidity and mortality rates, it is necessary for radiologists to maintain a high degree of suspicion in evaluation of patients for IE. Modified Duke criteria are used to classify cases as "definite IE," "possible IE," or "rejected IE." However, these criteria are limited in characterizing definite IE in clinical practice. The use of advanced imaging techniques such as cardiac CT and nuclear imaging has increased the accuracy of these criteria and has allowed possible IE to be reclassified as definite IE in up to 90% of cases. Cardiac CT may be the best choice when there is high clinical suspicion for IE that has not been confirmed with other imaging techniques, in cases of IE and perivalvular involvement, and for preoperative treatment planning or excluding concomitant coronary artery disease. Nuclear imaging may have a complementary role in prosthetic IE. The main imaging findings in IE are classified according to the site of involvement as valvular (eg, abnormal growths [ie, "vegetations"], leaflet perforations, or pseudoaneurysms), perivalvular (eg, pseudoaneurysms, abscesses, fistulas, or prosthetic dehiscence), or extracardiac embolic phenomena. The differential diagnosis of IE includes evaluation for thrombus, pannus, nonbacterial thrombotic endocarditis, Lambl excrescences, papillary fibroelastoma, and caseous necrosis of the mitral valve. The location of the lesion relative to the surface of the valve, the presence of a stalk, and calcification or enhancement at contrast-enhanced imaging may offer useful clues for their differentiation. RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
Topics: Humans; Aneurysm, False; Endocarditis, Bacterial; Endocarditis; Tomography, X-Ray Computed; Multimodal Imaging
PubMed: 38329903
DOI: 10.1148/rg.230031 -
Current Problems in Cardiology Aug 2023Left ventricular pseudoaneurysm is a well-known complication of myocardial infarction and open-heart surgery and has recently been described as succeeding transapical... (Review)
Review
Left ventricular pseudoaneurysm is a well-known complication of myocardial infarction and open-heart surgery and has recently been described as succeeding transapical transcatheter aortic valve replacement. While surgical intervention is the conventional therapeutic approach, transcatheter closure can be considered in patients at high risk for surgical procedures. In this article, we present a postmyocardial infarction pseudoaneurysm for which closure was done via retrograde left ventricular access using an Amplatzer Septal Occluder, and provide a review of recent literature focusing on indications and outcomes of the different percutaneous techniques and devices.
Topics: Humans; Aneurysm, False; Cardiac Catheterization; Transcatheter Aortic Valve Replacement; Heart Valve Prosthesis Implantation; Myocardial Infarction; Treatment Outcome
PubMed: 37084993
DOI: 10.1016/j.cpcardiol.2023.101743 -
Revista Espanola de Enfermedades... Sep 2023We present the case of a 75-year-old male admitted due to severe epigastric pain. His medical history was remarkable for chronic alcohol abuse, diabetes mellitus type 2,...
We present the case of a 75-year-old male admitted due to severe epigastric pain. His medical history was remarkable for chronic alcohol abuse, diabetes mellitus type 2, arterial hypertension, dyslipidemia. At admission he was hemodynamically stable. The initial workup showed elevated amylase, and the abdominal ultrasound excluded gallstone disease, so the diagnosis of acute pancreatitis was assumed. Despite appropriate fluid therapy, the patient developed hemodynamic instability. No signs of GIB were detected. An urgent laboratory workup revealed a new onset anemia and liver tests, including hyperbilirrubinemia. He underwent an urgent abdominal computed tomography with contrast, which showed a bleeding gastroduodenal artery (pseudoaneurysm and a hematoma adjacent to the second part of the duodenum. The patient underwent coil embolization achieving hemostasis without complications. GAD (pseudo)aneurysm is rare, accounting for 1.5% of all visceral artery aneurysms. Our patient presented with elevated pancreatic and liver enzymes, a more unique and challenging presentation since another more common differential diagnosis should be considered. The aneurysm can cause extrinsic common bile duct and main pancreatic duct pressure, which could explain the raised liver tests. Gastroenterologists should be aware of this rare and life-threatening entity, especially among patients presenting with common findings such as elevated amylase, jaundice, or altered liver tests. Hemodynamic instability is the main clue unmasking this diagnosis.
Topics: Male; Humans; Aged; Aneurysm, False; Pancreatitis; Hyperamylasemia; Acute Disease; Aneurysm; Hepatic Artery; Abdominal Pain; Amylases; Embolization, Therapeutic
PubMed: 36537340
DOI: 10.17235/reed.2022.9407/2022 -
Journal of Vascular Surgery Jul 2023
Topics: Humans; Mesenteric Artery, Superior; Aneurysm, False; Abdomen; Stents
PubMed: 37349010
DOI: 10.1016/j.jvs.2022.10.004