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BMJ Case Reports Aug 2021Nosebleeds are among the most familiar presentations to the emergency department as well as otorhinolaryngologic outpatient services. Bleeding from nasal septal branches...
Nosebleeds are among the most familiar presentations to the emergency department as well as otorhinolaryngologic outpatient services. Bleeding from nasal septal branches of the anterior ethmoid artery (AEA) is common and can be effectively controlled endoscopically. However, the bleeding from a pseudoaneurysm involving the nasal septal branches of AEA is extremely rare and can be troublesome to control using endoscopic methods. We report an adult patient presenting with profuse nasal bleeding postroad traffic accident due to the formation of AEA septal branch pseudoaneurysm. The patient required repeated nasal packing, and the diagnosis was revealed using digital subtraction angiography. Since profuse active bleeding precluded endoscopic visualisation, an external approach had to be adopted to ligate the AEA to control the bleeding. We discuss the management options and nuances for this rare cause of the troublesome nasal bleeding.
Topics: Accidents, Traffic; Adult; Aneurysm, False; Arteries; Endoscopy; Epistaxis; Humans
PubMed: 34400430
DOI: 10.1136/bcr-2021-244231 -
Texas Heart Institute Journal Sep 2022Left ventricular pseudoaneurysm is a rare disease; it is defined as a ventricular rupture contained by epicardium, pericardial adhesions, or both. It most frequently... (Review)
Review
Left ventricular pseudoaneurysm is a rare disease; it is defined as a ventricular rupture contained by epicardium, pericardial adhesions, or both. It most frequently occurs as a complication of acute myocardial infarction. Surgical treatment is recommended for pseudoaneurysms that are large or symptomatic and for those discovered less than 3 months after myocardial infarction. We report our experience with 2 patients who had left ventricular pseudoaneurysms discovered less than a week after inferior myocardial infarction. Both patients were middle-aged men with right coronary occlusion in whom the diagnoses were established by echocardiography during the first week after infarction. Because both patients were clinically stable, we opted to defer surgery until scarring could facilitate correction; this decision was based on a review of the literature showing that in-hospital mortality is higher with early surgery. The patients were monitored closely in the intensive care unit and were prescribed β-blockers and vasodilators. Both patients underwent left ventricular patch reconstruction with exclusion of the pseudoaneurysm and posterior septum; both received moderate inotropic support and prophylactic intra-aortic balloon pump assistance. Their postoperative courses were uneventful. In 5 prior reports describing 45 patients (13 with acute pseudoaneurysm [≤2 wk after infarction] and 32 with nonacute pseudoaneurysm), in-hospital mortality was 61.5% for patients in the acute group and 15.6% for the nonacute group (P = .0066). We recommend that clinicians consider deferring surgery for patients with stable acute left ventricular pseudoaneurysm to reduce the risks associated with early repair.
Topics: Aneurysm, False; Coronary Occlusion; Heart Aneurysm; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Vasodilator Agents
PubMed: 36194723
DOI: 10.14503/THIJ-20-7462 -
Liver International : Official Journal... Aug 2022Cases of coronary and pulmonary artery pseudoaneurysms secondary to COVID-19 have been reported in the literature and are supposed to be secondary to inflammatory and...
Cases of coronary and pulmonary artery pseudoaneurysms secondary to COVID-19 have been reported in the literature and are supposed to be secondary to inflammatory and vasculitis processes linked to a viral multisystem inflammatory syndrome. Although the incidence of COVID-19-associated liver injury ranges from 14% to 53% in hospitalized patients, COVID-19-associated hepatic artery pseudoaneurysms have never been reported so far. We present the case of a patient whose follow-up CT after cryoablation of renal cell carcinoma revealed seven fusiform pseudoaneurysms of the two hepatic arteries secondary to COVID-19. Anticoagulant or anti-inflammatory treatments were not introduced. Vascular lesions were unchanged on the 3-month follow-up CT. At 6-month CT, the proximal pseudoaneurysm was replaced by a proximal occlusion of the accessory RHA.
Topics: Aneurysm, False; COVID-19; Hepatic Artery; Humans; Liver
PubMed: 35748622
DOI: 10.1111/liv.15344 -
Vascular and Endovascular Surgery Aug 2022New treatment options, like endovascular aortic repair, reduced the mortality rate of patients suffering from complications after an acute type A aortic dissection...
INTRODUCTION
New treatment options, like endovascular aortic repair, reduced the mortality rate of patients suffering from complications after an acute type A aortic dissection repair. Nevertheless, initial successful treatment of an aortic dissection does not fully eliminate the risk of later adverse aortic events like anastomotic pseudoaneurysm. Pseudoaneurysm of the anastomosis between the ascending and the arch graft could initiate complications like peripheral embolization, dysphagia or compression of mediastinum organs. Re-operation via re-sternotomy bears enormous morbidity and mortality for these patients. There is a high unmet need for percutaneous therapeutic options to treat pseudoaneurysms.
CASE PRESENTATION
A 59-year-old-man treated 15 years ago for type A aortic dissection, was hospitalized due to intermittent abdominal pain. A detailed examination revealed 2 pseudoaneurysms: 1 symptomatic at the level of the reimplanted celiac trunk and 1 asymptomatic at the anastomosis between the brachiocephalic trunk and the aortic arch graft. Due to multiple co-morbidities and previous operations, the risk for surgery was considered too high. Both pseudoaneurysm were treated percutaneously, the symptomatic 1 with covered stent and the asymptomatic with Amplatzer™ septal-occluder.
DISCUSSION
We present an alternative percutaneous therapy approach for treatment of pseudoaneurysm using a septal-occluder. A follow-up computed tomography 3 months later showed successfully excluded pseudoaneurysm.
Topics: Aortic Dissection; Aneurysm, False; Humans; Middle Aged; Septal Occluder Device; Stents; Treatment Outcome
PubMed: 35466833
DOI: 10.1177/15385744221095922 -
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 -
JPMA. the Journal of the Pakistan... Feb 2021People who inject drugs (PWIDs) reuse injection equipment and other paraphernalia, which is a major source of transmission of human immunodeficiency (HIV) and hepatitis...
People who inject drugs (PWIDs) reuse injection equipment and other paraphernalia, which is a major source of transmission of human immunodeficiency (HIV) and hepatitis C virus (HCV) infections. PWIDs who use infected injections develop many surgical complications which are life- threatening. The most common complication is infected pseudoaneurysm. To assess complications requiring surgery in drug abusers, a study was conducted in the East Surgical Ward of Mayo Hospital Lahore, Pakistan from Jan 2017 to Jan 2019. A total of 48 PWIDs presented to the surgical department, out of which 39 (81%) were HIV positive, and 31 (64%) were HCV positive. Of the 52% who had pseudoaneurysm, 92% had femoral and popliteal aneurysm and 8% had brachial aneurysm. After ligation and excision of pseudoaneurysm only 8% required major amputation. Mortality rate was 0%. Ligation and excision is a safe option in pseudoaneurysm. Most common site for pseudoaneurysm was left femoral artery.
Topics: Aneurysm, False; Aneurysm, Infected; Drug Users; Femoral Artery; Humans; Pakistan; Substance Abuse, Intravenous
PubMed: 33819251
DOI: 10.47391/JPMA.644 -
Acta Ortopedica Mexicana 2021Aneurysms and pseudoaneurysms of the arteries of the foot and ankle are rare clinical entities. In most cases occur within months or years of the initial trauma,...
INTRODUCTION
Aneurysms and pseudoaneurysms of the arteries of the foot and ankle are rare clinical entities. In most cases occur within months or years of the initial trauma, complications in the aforementioned situations are very uncommon, however, they should be ruled out at medical check-ups. We will present a clinical case in which pseudoaneurysm of the Distal Peroneal Artery occurred as a result of a fracture- dislocation of the ankle.
CLINICAL CASE
Patient of 60 years of age with trauma in right ankle, his radiographic study of the right ankle evidencing fracture- dislocation of the same. Surgical treatment is decided four days after the injury. In the postoperative course with edema, circulatory changes of abnormal form that merited imaging complement and arteriography was performed which indicates the presence of pseudoaneurysm of approximately 28 × 30 mm in distal peroneal artery meriting specific treatment with adequate control of symptoms.
CONCLUSION
We believe that it is of the utmost importance the correct assessment and physical examination of patients undergoing ankle surgery in successive post-surgical controls to detect these types of complications early and treat them in time.
Topics: Aneurysm, False; Ankle Joint; Humans; Lower Extremity; Tibial Arteries
PubMed: 34921541
DOI: No ID Found -
European Journal of Vascular and... Mar 2022
Topics: Aneurysm, False; Aorta; Humans; Surgical Instruments
PubMed: 34972628
DOI: 10.1016/j.ejvs.2021.11.017 -
International Heart Journal Sep 2019Postcatheterization pseudoaneurysm is a serious complication following diagnostic or therapeutic catheterization. Because radial access is unsuitable in some situations,... (Comparative Study)
Comparative Study
Postcatheterization pseudoaneurysm is a serious complication following diagnostic or therapeutic catheterization. Because radial access is unsuitable in some situations, there is still a need to use femoral or brachial access for arterial catheterization. The aim of this study was to compare the incidence and clinical characteristics of pseudoaneurysm between brachial and femoral access. We identified patients who underwent arterial catheterization from our cardiac catheter records. A total of 5,990 cardiac catheter records and discharge summaries were reviewed, and 23 pseudoaneurysm cases were identified. Those pseudoaneurysm cases were divided into a brachial pseudoaneurysm group (n = 9) and a femoral pseudoaneurysm group (n = 14). The incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access (odds ratio: 4.16, 95% confidence interval: 1.80-9.65; P < 0.001). Successful manual compression was frequently achieved in both the brachial (77.8%) and the femoral (92.9%) pseudoaneurysm groups (P = 0.295). Surgical intervention was more frequently performed in the brachial pseudoaneurysm group (22.2%) than in the femoral pseudoaneurysm group (0%) without reaching statistical significance (P = 0.07). Moreover, neurological disorders were observed only in the brachial pseudoaneurysm group (22.2%). In conclusion, the incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access, indicating the potential risk of brachial access. Successful manual compression was frequently achieved in both groups, but neurological disorders were observed only in brachial access, suggesting the greater risk of brachial pseudoaneurysms.
Topics: Adult; Age Distribution; Aged; Aneurysm, False; Brachial Artery; Cardiac Catheterization; Conservative Treatment; Databases, Factual; Female; Femoral Artery; Hospitals, University; Humans; Incidence; Japan; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prognosis; Retrospective Studies; Risk Assessment; Sex Distribution; Treatment Outcome
PubMed: 31447463
DOI: 10.1536/ihj.18-551 -
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