Authors: Mathilde Stærk, Anders Jørgensen, Zenia Hadad...

Pseudoaneurysms and thrombosis in the jugular vein are very rare. This case report presents a case of a 57-year-old female with a thrombosis in the internal jugular vein and a pseudoaneurysm in the external jugular vein. The diagnosis is often delayed due to the less-frequent occurrence of either. Ultrasound and/or computer tomographic scan are useful in the diagnostic process. Pseudoaneurysms in the external jugular vein are often benign and treatment spans from none to surgical removal. The treatment of venous thrombosis is anticoagulant medication.

Topics: Female; Humans; Middle Aged; Aneurysm, False; Jugular Veins; Thrombosis; Venous Thrombosis; Subclavian Vein

PubMed: 37114571
DOI: No ID Found

Authors: D Tagerman, G Romero-Velez, S Bellemare...

Topics: Humans; Aneurysm, False; Cholecystitis; Arteries

PubMed: 36243676
DOI: 10.1016/j.rgmxen.2022.10.002

Review

Authors: C Frances, A Romero, D Grady...

Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. We evaluated the clinical presentation, diagnostic accuracy of imaging modalities, results of therapy and prognosis of 290 patients with LV pseudoaneurysms. Most cases of LV pseudoaneurysm were related to myocardial infarction (particularly inferior wall myocardial infarction) and cardiac surgery. Congestive heart failure, chest pain and dyspnea were the most frequently reported symptoms, but >10% of patients were asymptomatic. Physical examination revealed a murmur in 70% of patients. Almost all patients had electrocardiographic abnormalities, but these were usually nonspecific ST segment changes; only 20% of patients had ST segment elevation. Although radiographic findings were also usually nonspecific, the appearance of a mass was present in more than one half of patients and may be an important clue to the correct diagnosis. Left ventricular angiography was the most definitive test and can be useful in planning surgery since concomitant coronary angiography can be performed. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Because the symptoms, signs, electrocardiographic abnormalities and radiographic findings seen in patients with LV pseudoaneurysms can be indistinguishable from those in patients with coronary disease alone, a high clinical index of suspicion is needed to avoid missing the diagnosis.

Topics: Aneurysm, False; Diagnosis, Differential; Diagnostic Imaging; Electrocardiography; Female; Heart Aneurysm; Heart Rupture; Humans; Male; Middle Aged; Survival Rate

PubMed: 9741493
DOI: 10.1016/s0735-1097(98)00290-3

Review

Authors: K J Edwards, S K Avula, B D H Babu...

INTRODUCTION

Inferior epigastric artery (IEA) pseudoaneurysms are recognised complications of abdominal wall procedures, and a variety of approaches including surgical excision and ligation, percutaneous procedures and conservative management have been employed in treating this rare complication.

METHODS

We describe a case of an IEA pseudoaneurysm diagnosed on computed tomography (CT) angiography, 14 days following a laparoscopic assisted low anterior resection, which was managed successfully with surgical excision and ligation. A review of the literature identified 32 reports of this complication since 1973 with 69% of cases occurring since 2000.

FINDINGS

The main aetiology of IEA pseudoaneurysm was abdominal surgery (n=20); 65% of cases were attributable to abdominal wound closure or laparoscopic surgery. Two-thirds (66%) of patients presented between 11 and 63 days, and all except 1 case presented with discomfort, abdominal mass or haemodynamic instability. Colour Doppler ultrasonography was the imaging modality of choice (n=18), either alone or in combination with computed tomography and/or angiography. Surgical ligation and excision and percutaneous coil embolisation formed the mainstay of attempted treatments (69%), particularly following treatment failure using an alternative technique.

CONCLUSIONS

The incidence of iatrogenic IEA pseudoaneurysms appears to be increasing. Awareness of this rare complication is of clinical importance to avoid excessive morbidity for affected individuals.

Topics: Aneurysm, False; Epigastric Arteries; Humans; Laparoscopy; Postoperative Complications; Tomography, X-Ray Computed

PubMed: 26263930
DOI: 10.1308/003588414X14055925058076

Review

Authors: Young Uk Park, DaeHyun Han, Juho An...

BACKGROUND Arthroscopic surgery is esteemed for its arthroscopic lateral ligament repair to treating ankle ligament injuries, characterized by a low complication rate. Nevertheless, rare complications such as pseudoaneurysms require careful monitoring and a strategic approach to management during the postoperative follow-up period. This case report details a 42-year-old man with chronic instability in his left ankle. The aim of this paper is to present a case report and conduct a literature review on the rare complication of pseudoaneurysm following arthroscopic procedures. CASE REPORT A 42-year-old man with chronic instability in his left ankle was experiencing severe pain and limited motion following arthroscopic lateral ligament repair surgery. He was diagnosed with a pseudoaneurysm of the left anterior tibial artery and an intra-articular hematoma in the left ankle joint, indicated by MRI and Doppler ultrasound findings. Initial conservative management was followed by interventional procedures, including thrombin injection and balloon tamponade. After these interventions proved unsuccessful, surgical intervention for anterior tibial artery reconstruction and hematoma evacuation was performed. The surgical interventions resulted in the closure of the pseudoaneurysm and improvement in the patient's pain. CONCLUSIONS This case underscores the challenges involved in diagnosing and managing pseudoaneurysm and hematoma after ankle surgery, highlighting the necessity for thorough evaluation and a comprehensive treatment strategy.

Topics: Humans; Aneurysm, False; Male; Adult; Arthroscopy; Tibial Arteries; Ankle Joint; Joint Instability; Hematoma; Magnetic Resonance Imaging

PubMed: 40089839
DOI: 10.12659/AJCR.945540

Authors: Pathum Sookaromdee, Viroj Wiwanitkit

Topics: Aneurysm, False; COVID-19; COVID-19 Vaccines; Humans; Rupture, Spontaneous; SARS-CoV-2; Vaccination

PubMed: 34516031
DOI: 10.1111/ans.17224

Review

Authors: Joel Sousa, Diogo Costa, Armando Mansilha...

Visceral arterial aneurysms and pseudoaneurysms are rare entities. Despite infrequent, these lesions are clinically important and potentially lethal, since 22% present as clinical emergencies and 8.5% result in death. As such, early detection and treatment is essential. Through this work, we aim to address both visceral arterial aneurysms and pseudoaneurysms, with particular focus on their epidemiology, etiology and risk factors, as well as report current diagnostic workups and treatment strategies. A full literature review was performed through a comprehensive electronic search of PubMed databases, including articles published until the end of November 2018 and using the following keywords: "visceral aneurysm," "pseudoaneurysm" and "endovascular treatment." From this research, 2043 articles had their abstract assessed, 359 were read integrally, 213 were excluded for not being directly related to the subject and 146 were included, according to the authors preference and scientific relevance in this work's context. Visceral arterial aneurysms and pseudoaneurysms have fairly similar clinical presentations and diagnostic workups. Differences reside mainly in their etiology and indications for treatment, since immediate treatment is recommended for pseudoaneurysms regardless of their size, while true aneurysms have specific treatment cutoffs. Despite a significant improvement on current diagnostic and treatment strategies, these lesions are still frequently diagnosed only upon rupture, with significant mortality rates. Endovascular strategies represent the first line of treatment on the majority of cases, although open surgery continues to play a role in specific conditions. Visceral arterial aneurysms and pseudoaneurysms are rare but potentially fatal and, as such, proper diagnosis and treatment is of capital importance. Due to its minimally invasive nature, endovascular therapies currently represent the standard of care in the majority of situations, although there are still solid indications for open surgery. Technique selection should be performed according to the clinical scenario and baseline anatomy.

Topics: Aneurysm; Aneurysm, False; Arteries; Diagnostic Imaging; Embolization, Therapeutic; Endovascular Procedures; Humans; Risk Factors; Treatment Outcome; Viscera

PubMed: 31284707
DOI: 10.23736/S0392-9590.19.04194-4

Authors: N Nair, M Suhania

A pseudoaneurysm, or false aneurysm, is a haematoma that is formed secondary to a leaking hole in an artery. This haematoma is contained by surrounding fascia. In contrast, a true aneurysm contains all three layers of vessel wall, namely intima. Pseudoaneurysms are scarce and can arise consequential of numerous iatrogenic influences, including but not limited to, blunt or penetrating trauma, orthopedic procedures like tibial nailing or ankle arthroscopy, and sports injury. A thorough history taking focusing on the recent history of trauma or instrumentation and clinical examination should raise the suspicion of a pseudoaneurysm. In doubtful cases, imaging modalities such as an ultrasound and doppler examination of the lower limb can be utilized to confirm the diagnosis. Our case was a 37-year-old gentleman presented with progressive swelling in the anterior aspect of his left leg for the past two weeks. The patient had a atypical presentation, with absence of classic signs of a pseudoaneurysm such as a pulsatile mass, absence distal pulses or a thrill or bruit. However, these injuries albeit rare can be sinister and prompt diagnosis is critical, so that pertinent treatment can be delivered. Our case highlights the importance of sonographic approaches for suspected vascular injuries.

Topics: Adult; Aneurysm, False; Hematoma; Humans; Leg; Male; Tibial Arteries; Wounds, Penetrating

PubMed: 34031347
DOI: No ID Found

Authors: B Brodie, H M Kocher

BACKGROUND

Gastroduodenal artery (GDA) pseudoaneurysm is a serious complication following pancreatic resection, associated with high morbidity and mortality rates. This review aimed to report the incidence of GDA pseudoaneurysm after pancreatic surgery, and describe clinical presentation and management.

METHODS

MEDLINE and Embase were searched systematically for clinical studies evaluating postoperative GDA pseudoaneurysm. Incidence was calculated by dividing total number of GDA pseudoaneurysms by the total number of pancreatic operations. Additional qualitative data related to GDA pseudoaneurysm presentation and management following pancreatic resection were extracted and reviewed from individual reports.

RESULTS

Nine studies were selected for systematic review involving 4227 pancreatic operations with 55 GDA pseudoaneurysms, with a reported incidence of 1·3 (range 0·2-8·3) per cent. Additional data were extracted from 39 individual examples of GDA pseudoaneurysm from 14 studies. The median time for haemorrhage after surgery was at 15 (range 4-210) days. A preceding complication in the postoperative period was documented in four of 21 patients (67 per cent), and sentinel bleeding was observed in 14 of 20 patients (70 per cent). Postoperative complications after pseudoaneurysm management occurred in two-thirds of the patients (14 of 21). The overall survival rate was 85 per cent (33 of 39).

CONCLUSION

GDA pseudoaneurysm is a rare yet serious cause of haemorrhage after pancreatic surgery, with high mortality. The majority of the patients had a preceding complication. Sentinel bleeding was an important clinical indicator.

Topics: Aneurysm, False; Angiography; Embolization, Therapeutic; Endovascular Procedures; Hepatic Artery; Humans; Incidence; Pancreatectomy; Postoperative Hemorrhage; Survival Rate; Time Factors

PubMed: 31832579
DOI: 10.1002/bjs5.50210

Review

Authors: Andrei George Iosifescu, Toma Andrei Iosifescu, Alina Teodora Timisescu...

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