Huge Aneurysm Research Articles

An 18-cm-Large Renal Arteriovenous Fistula Treated by Nephrectomy

Idiopathic renal arteriovenous fistulas are extremely rare. They are believed to occur as the result of congenital renal artery aneurysm that erodes into an adjacent vein. We report a case of a 48-year-old man in whom we discovered fortuitously a painless mass of the right flank. Computed tomography revealed a huge renal artery aneurysm with giant arteriovenous fistula in the absence of any clinical stigmata. Given the size of the fistula and the partial destruction of the renal parenchyma, nephrectomy was successfully performed.

Atypical presentation of an apical pseudoaneurysm in a patient on prolonged left ventricular mechanical support

Prolonged support with left ventricular assist system (LVAS) increases the risk of device-related infection. We experienced a rare complication of LVAS: an infectious aneurysm at the apical cannula, which appeared with atypical presentation. A 27-year-old male, who developed acute aggravation of dilated cardiomyopathy, was placed on extra-corporeal type LVAS. Six months later, the patient suffered from methicillin-resistant Staphylococcus aureus (MRSA) sepsis that lasted for as long as three months despite intensive antibiotic therapy. At 17 months after the implantation, he presented with obstructive ileus. Monthly assessment with transthoracic echocardiography (TTE) did not document any abnormalities around the ventricle. A contrast computed tomographic (CT) scan revealed a huge apical aneurysm protruding into the preperitoneal space. The aneurysm oppressed the transverse colon, resulting in obstructive ileus. Aneurysmectomy was carried out and MRSA was identified from the resected tissue. We reached the precise diagnosis with a CT-scan, although routine assessment with TTE failed to reveal abnormalities. Knowledge of this complication is essential in LVAS management. This is certainly rare, but possibly occurs in all the patients on prolonged LVAS support. Early and accurate diagnosis together with aggressive intervention would bring favorable outcome in such serious cases.

A Case of Popliteal Artery Aneurysm Associated with Popliteal Artery Entrapment Syndrome

Popliteal artery entrapment (PAE) is an uncommon syndrome. Although this phenomenon can cause claudication in younger populations, other clinical features may vary. The present report describes a case of a 48-year-old woman who was referred for treatment of a pulsatile mass in the right popliteal fossa. Computed tomography scan and magnetic resonance imaging demonstrated popliteal aneurysm associated with PAE. Resection of abnormal musculotendinous structures, aneurysmectomy and subsequent revascularization were successfully performed. Although PAE may lead to poststenotic dilatation and aneurysm formation, huge aneurysm without clinical signs of ischemia in a patient with PAE is extremely rare.

Endovascular Treatment for Left-side Cervical Aortic Arch with Huge Aneurysm

Endovascular Treatment for Left-side Cervical Aortic Arch with Huge Aneurysm

Endovascular Treatment for Left-side Cervical Aortic Arch with Huge Aneurysm

Cervical aortic arch (CAA) is an unusual malformation of the aortic arch. CAA with aneurysm formation is very rare. A 67-year-old female patient was admitted with a huge mass on left-side neck and 2 days of dyspnea. Investigations revealed a huge aneurysm on a left-side CAA. The aneurysm was successfully repaired a using thoracic aortic stent-graft. The patient's dyspnea was resolved immediately.

A huge aortic arch aneurysm mimicking massive pulmonary artery embolism

A huge aortic arch aneurysm mimicking massive pulmonary artery embolism

Echocardiographic progression of a subepicardial aneurysm after inferior myocardial infarction

A 62-year-old man presented to hospital with chest oppression. Coronary angiography revealed total occlusion of the right coronary artery and inferior myocardial infarction was diagnosed. He was treated by percutaneous coronary intervention with stenting for myocardial infarction. After four months, echocardiography revealed a huge aneurysm protruding below the inferior surface of the left ventricle. It was considered to be a pseudoaneurysm from the echocardiographic findings. The patient had no symptoms and he refused surgery, so progression of the aneurysm was monitored carefully. At seven months after revascularization, the aneurysm showed a marked increase in size, with a maximal diameter of 48 mm and orifice diameter of 22 mm. Accordingly, the patient agreed to undergo surgical excision. The aneurysm was resected and the defect was closed with a pericardial patch. Pathological examination revealed all of the myocardial elements in the aneurysm wall and thrombus in its lumen. In conclusion, this was a rare case of ventricular subepicardial aneurysm.

Emergency endovascular treatment of a ruptured internal iliac artery aneurysm long after abdominal aortic aneurysm surgical repair

The purpose of this report is to describe the endovascular exclusion of an internal iliac artery (IIA) aneurysm in emergency setting, long after abdominal aortic aneurysm surgical repair. An 85-year-old male presented with a contained rupture of a huge IIA aneurysm, ten years after aortoiliac bifurcated grafting. Because of poor clinical conditions an emergency endovascular treatment was planned. A stent-graft was positioned from the proximal right branch of the bifurcated surgical prosthesis to the distal external iliac artery, covering the hypogastric aneurysm neck. One month after the procedure, CT scan demonstrated the complete exclusion of the aneurysm. Endovascular treatment of IIA aneurysms is an excellent option to reduce perioperative morbidity and mortality in high risk patients, particularly in an emergency setting.

A Case of Coronary Arteriovenous Fistula Associated with Giant Coronary Artery Aneurysm

Introduction Coronary arteriovenous fistula (CAVF) is an infrequent vascular anomaly that establishes a direct link between an epicardial coronary artery and a cardiac chamber, major vessels, or other vascular structures. We describe a case of 76-year-old woman who develop huge coronary artery aneurysm arising from Left main coronary artery and tortuous fistula form proximal right coronary artery drained to aneurysm.

Superior Mesenteric Artery Syndrome Caused by Huge Mycotic Abdominal Aortic Aneurysm

A 92-year-old man who had been hospitalized for dementia developed sudden-onset bilious vomiting accompanied by a fever of 40 degrees C. Physical examination revealed an 8 cm diameter pulsatile mass in the upper abdomen. Computed tomography of the abdomen demonstrated a huge infrarenal saccular aneurysm with a lobulated appearance. We considered this to be a mycotic abdominal aortic aneurysm compressing the third portion of the duodenum and causing proximal duodenal dilatation and superior mesenteric artery (SMA) syndrome.

Ruptur eines Bauchaortenaneurysmas

Abdominal aortic aneurysms, i.e., enlargements of the abdominal aorta > 3 cm, are often the consequence of atherosclerotic vascular changes. Aneurysms of the abdominal aorta are often incidentally detected and asymptomatic. Expansion of the aneurysms are common and associated with an increased risk of rupture, resulting in a life-threatening situation. Here, we demonstrate the case of a 79-year old man being admitted to the hospital for presyncope and repeated hypotension. Before finishing the diagnostic tests, the patient's situation suddenly worsened in the emergency room, due to rupture of a huge infrarenal aneurysm not known until then. Emergency surgery, however, was not successful, confirming the bad outcome for patients in this situation. Early diagnosis and surgical repair where appropriate are essential to affect prognosis of this disease.

Huge Left Ventricular Aneurysm in a Minimally Symptomatic 11-Year-Old Boy

An 11-year-old boy presented with mild shortness of breath and tachycardia and was diagnosed with a huge left ventricular aneurysm ruptured in a secondary pseudoaneurysm. This report highlights the complementary use of echocardiography and cardiac magnetic resonance imaging in the preoperative assessment of this anomaly.

Unusually giant splenic artery and vein aneurysm with arteriovenous fistula with hypersplenism in a nulliparous woman

Although splenic artery aneurysm (SAA) is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein with arteriovenous (a-v) fistula communication between them is a rare entity. Most are <3 cm in diameter. Giant true SAAs are rare and very few lesions >10 cm have been reported. We hereby report a case of an 18 cm x 15 cm size splenic artery and vein aneurysm with a-v fistula in an adult female nulliparous woman who presented with progressively enlarging pulsatile mass in the left upper abdomen with long-standing intractable pancytopenia and splenomegaly. Diagnosis was established by CT (computed tomogram) angiogram and laboratory tests. Laparotomy demonstrated huge well-defined aneurysm of splenic artery and vein with splenic a-v fistula, extending in all except the right lower and inferior quadrants of the abdomen along with splenomegaly. Aneurysmectomy with splenectomy was done.

흉부 대동맥류와 연관된 일측 성대마비 1예

Paralysis of the left recurrent laryngeal nerve as a complication of various types of heart disease is a well known clinical entity. It is a recognized complication of a number of conditions including arterial septal defect, patent ductus arteriosus, primary pulmonary hypertension, Eisenmenger’s syndrome and aortic aneurysm. We report a case of left recurrent laryngeal nerve palsy associated with a huge thoracic aortic aneurysm in an old man with a history of hypertension. (J Clinical Otolaryngol 2008;19:235-238)

Living donor liver transplantation for hepatitis C virus cirrhosis with a huge portal vein aneurysm

Received November 25, 2007; accepted January 20, 2008.A57-year-oldfemalewasdiagnosedwithhepatocellularcarcinoma associated with hepatitis C virus–related cir-rhosis. She underwent ablation therapy several times,including 4 repeated courses of percutaneous ethanolinjection, and was finally referred to our hospital forliver transplantation. During the preoperative evalua-tion, a huge extrahepatic portal vein aneurysm (PVA)and mural thrombosis were detected on computed to-mographic angiography and magnetic resonance imag-ing angiography (Fig. 1). Massive ascites and a recana-lized umbilical vein were also noted. She underwentliving donor liver transplantation using her daughter’sright lobe graft. During surgery, the confluence of thesuperior mesenteric vein and splenic vein seemed to benormal and intact, so the whole PVA was resected, andthe mural thromboses were removed. Thereafter, directend-to-end anastomosis between the recipient portalvein and graft portal vein was successfully accom-plished without tension. The postoperative course wasuneventful until she developed portal vein thrombosisdue to anastomotic stenosis 1 year after the transplan-tation. The complication was successfully reversed bysystemic thrombolytic therapy using recombinant tis-sue plasminogen activator combined with subsequentpercutaneous transhepatic balloon dilatation. Sincethen, the patient has been doing well with normal liverfunction for the past 2 years.Abnormality of the portal vein is often observed inliver transplant candidates but mainly as stenosis orthrombosis in chronic diseases.

Cardiac compression by massive hematoma due to aneurysm rupture of the descending thoracic aorta

Fig. 2. Computed tomographic scan (A; axial slice, B; sagittal reconstruction) revealed a huge aneurysm of the descending thoracic aorta with a maximum diameter of approximately 9.0 cm, which was ruptured just above the diaphragm. The heart was compressed anteriorly by massive hematoma in the posterior mediastinum in a manner resembling cardiac tamponade. The massive hematoma extended to the bilateral thoracic cavity.His physical examination revealed a neck vein dilatation. The blood pressure was 85/ 54 mmHg with a pulse of 114 beats/min. Heart sounds were diminished and the electrocardiogram showed a sinus tachycardia with low voltage. * Corresponding author. Tel.: +81 58 246 1111; fax: +81 58 248 3805. E-mail address: 44870@gifu-hp.jp (Y. Matsuno).

Severe Vertebral Erosion by Huge Symptomatic Pulsating Aortic Aneurysm

Aortic abdominal aneurysm rarely has been reported as causing osteolytic lesions of the spine. It may produce back and radiating pain patterns similar to those of several commonly encountered neurosurgical processes. We report a uncommon complication of huge pulsating aortic aneurysm causing severe vertebral erosion with incapacitating back and radiating pain.

A Case of Bronchial Artery Aneurysm with Bronchiectasis and Successful Coil Embolization

Bronchial artery aneurysm (BAA) is a rare entity that requires early diagnosis and immediate treatment due to the possibility of a life-threatening massive hemorrhage through rupture. The standard treatment is a surgical resection of the aneurismal artery. However, various embolization techniques, including coil embolization, are currently used as the optimal treatment because they are less invasive. A 65-year-old woman was referred for the treatment of intermittent hemoptysis. A chest CT scan showe d an approximately 2 cm sized vascular mass with strong contrast enhancement originating from the right bronchial artery on the bronchiectatic parenchyma. On the angiogram, the inferior portion of the bronchial artery with a hypertrophic aspect and a huge bronchial artery aneurysm was detected on the left side branch. The bronchial artery aneurysm was embolized successfully with coils at the proximal and distal portion of the aneurysm. After coil embolization, the selective bronchial angiogram confirmed complete occlusion. We report this case of a bronchial artery aneurysm that was treated successfully with coil embolization. (Tuberc Respir Dis 2008;65:546-549)

The imaging of huge pulmonary artery aneurysm associated with Taussig–Bing anomaly

The imaging of huge pulmonary artery aneurysm associated with Taussig–Bing anomaly

An Aneurysmal Left Circumflex Artery-to-Right Atrium Fistula in a Patient with Ischemic Symptoms: Accurate Diagnosis with Dual-Source CT Angiography

In this report, we present a 55-year-old female patient with a left circumflex artery-to-right atrial fistula associated with a huge saccular aneurysm. She had undergone conventional angiography due to ischemic symptoms. In conventional angiography, a very dilated and tortuous vessel originating from the circumflex artery and continuous with a huge saccular aneurysm was visualized but the drainage site could not be demonstrated. With dual-source CT coronary angiography, the exact anatomy of this fistula was demonstrated and surgery was planned.