Multislice Computed Tomography Angiography Research Articles

Analysis of 41 cases of myocardial infarction in children with coronary artery lesion after Kawasaki disease

Objective: To analyze the clinical characteristics,diagnosis and treatment of pediatric myocardial infarction (MI) patients with coronary artery lesions (CAL) after Kawasaki disease (KD). Methods: Clinical data including baseline characteristics, KD and CAL information, clinical symptoms at MI onset, electrocardiogram (ECG) and imaging findings, MI treatment, and clinical outcomes of 41 MI patients with CAL after KD admitted to the Children's Hospital of Fudan University from January 2017 to August 2024 were analyzed retrospectively. Results: (1) Demographic characteristics: a total of 41 patients were included (36 males and 5 females). The age at MI was 4.6 (2.3, 5.7) years, and time from KD onset to MI was 397 (50, 1 095) d. (2) Treatment of acute KD: only 15 patients (37%) received standard initial treatment within 10 days of KD onset with intravenous immunoglobulin 2 g/kg. The other 26 cases (63%) received non-standard treatment or no treatment. (3) Treatment of CAL before MI: the time from KD onset to CAL was 14 (10, 116) d, with CAL not identified before MI onset in 15 patients. Among the 26 cases diagnosed with CAL prior to MI, 9 cases received only single or dual antiplatelet drug, of which 7 cases received oral dipyridamole. The remaining 16 cases received antiplatelet drug combined with warfarin, but only 1 case achieved the target international standardized ratio of 1.5-2.5. Out of all 41 cases, only 1 case (2%) received standard antithrombotic treatment before MI onset. (4) Clinical symptoms of MI: at MI onset, 32 patients presented with different clinical symptoms, with typical MI symptoms such as chest tightness, chest pain, precordial discomfort in 18 cases, and cardiopulmonary arrest accompanied by syncope or convulsions in 10 cases. Other non-specific symptoms included abdominal pain, nausea, vomiting and pallor. Nine patients were asymptomatic and were found to have silent MI on follow-up. (5) ECG and imaging findings: ECG showed ST-T changes in 33 cases, and abnormal Q waves, and arrhythmias in the remaining patients; echocardiography indicated coronary artery aneurysm with thrombosis in 27 cases, reduced left ventricular ejection fraction in 18 cases, abnormal wall motion in 15 cases, and ventricular aneurysm in 3 cases. Thirty-seven patients underwent coronary angiography and (or) multi-slice spiral CT angiography, with 39 occluded vessels and 3 severe stenosis (≥75%), all of which were caused by giant aneurism with thrombus formation. (6) Treatment of MI: of the 32 patients with acute MI, 9 patients received successful cardiopulmonary resuscitation, 7 patients received intravenous thrombolysis, and 1 patient underwent percutaneous coronary balloon angioplasty. All of these patients received dual antiplatelet drugs and low-molecular-weight heparin at therapeutic doses following MI treatment. Sixteen patients received coronary artery bypass graft (CABG) treatment, all of which were successful. (7) Outcomes: the follow-up time was 994 (215, 1 832) d. Thirty-one patients showed improvement, 5 patients experienced disease progression or no change, 1 patient died, and 4 patients were lost to follow-up. Conclusions: MI in children with CAL after KD often occurs within 1 year after the onset of KD. MI can present with atypical clinical symptoms in children. CABG is the main treatment option in children severe CAL after KD who developed MI.

036. Sclerotic Therapy as The Management Of Arteriovenous Malformation on Hand: A Case Report

Background: An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. There are a number of consequences associated with this illness, such as bleeding and neurological impairments. The situation is complex, which emphasizes the necessity for individualized treatment plans. This case report a 18 years old female with AVM condition. Case: A 18 years old female was admitted to to Prof. IGNG Ngoerah General Hospital with a chief complaint of lump on the left finger. The lump on the left finger has been felt since >10 years ago. The lump appeared suddenly and went bigger each day. Complaints worsened until the patient felt pain in the left finger. On examination of the local status, multiple masses were found on third and fourth digits of the left hand, with unclear border and vein ectasis. MSCT Angiography of the left superior extremity found a soft tissue image of hemangioma on the palmar aspect and interdigiti III-IV to the palmar-dorsal aspect of digit III and the palmar aspect of digiti IV of the left hand and multiple non-suspicious lymphadenopathy in the left axilla region. The scleroterapy treatment was performed and 3 months results shown decreased size of the masses without any complication. Conclusion: An arteriovenous malformation (AVM) of the left hand fingers is a rare case found in Prof Ngoerah Hospital. The sclerotic therapy found to be an effective management for this case.

Coronary bypass surgery guided by multislice computed tomography angiography in a low surgical risk population

Abstract Background In patients with three-vessel disease and/or left main disease, selecting revascularization strategies based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography(ICA).(1) Purpose The FASTTRACK CABG trial aims to assess the feasibility and safety of using CCTA and FFRCT as guidance for planning and performing CABG in patients with 3VD and/or LMCAD. Methods In this multicentre study, coronary artery bypass grafts (CABG) were planned and performed based on CCTA without knowledge of ICA. CABG strategy was recommended by a central Core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular events (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals(CI) for feasibility ≥75%.(2) Results The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX Score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Three patients did not undergo CABG due to the patient’s preference for percutaneous treatment (n=1) or lack of graft material. Unblinding ICA was required in one case, yielding a feasibility of 99.1% (95%CI: 95.2%-100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Team was 82.9% with a moderate kappa of 0.58 (95%CI:0.50-0.66). The concordance and agreement in revascularization planning between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95%CI:0.53-0.68). The 30-day follow-up CCTA was performed in 102 (91.9%) of the 111 operated patients, which showed an anastomosis patency rate of 92.6%. At 30 days, the incidence of MACCE was 7.2% whereas major bleeding was 2.7%. Conclusions CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.

Early Experiences of Serbian Surgeons Using No-Touch Technique for Vein Conduits in CABG Patients: A Follow-Up Study with Multi-Slice CT Angiography.

Background and Objectives: The saphenous vein graft (SVG) remains the most frequently used conduit worldwide, despite its common disadvantage of early graft failure. To solve the problem and reduce the SVG damage, Souza implemented a new technique where a vein is harvested with surrounding fascia and fat tissue (the so-called no-touch technique). Materials and Methods. A prospective study conducted from February 2019 to June 2024 included 23 patients who underwent myocardial revascularization using a no-touch vein, with follow-up control examinations using computed tomographic angiography to detect graft stenosis or occlusion. Results. Of the entire patient group, 17 (73.9%) were male, with a mean age of 67.39 ± 7.71 years. The mean follow-up period was 25 months. There were no major adverse cardiovascular or cerebrovascular events (MACCEs) during hospitalization, although one patient died in the hospital. Another patient died due to malignancy, but no MACCEs occurred during the follow-up period. According to multi-slice CT coronary angiography, the results were impeccable, with an astonishing 100% patency observed in all 20 IMA grafts and 58 no-touch SVGs examined. Conclusions. The excellent patency rate during the early follow-up period confirmed that the no-touch technique is a good option for surgical revascularization.

Behavioral, Clinical, and Coronary Artery Calcium Screening for Prevention and Treatment of Subclinical Atherosclerosis: Implications for Health Education

ABSTRACT Background In the USA, heart disease is the leading cause of death for women and men. Coronary artery disease (CAD) is the most common type of heart disease. Purpose To investigate the association between behavioral and non-behavioral risk factors associated with subclinical atherosclerosis. Methods Patients referred for a CT angiography completed a demographic/behavioral questionnaire and medical history interview for CAD risk factors. Risk factor data were correlated with CAD subclinical atherosclerosis scores for 521 participants. Results Frequency among four levels of CAD revealed: no disease 38%, mild atherosclerotic 20%, moderate atherosclerotic 30%, and severe atherosclerosis 12%. Significant (p ≤ .05) demographic variables were as follows: age, race, marital status, and employment status. Significant predictive behavioral variables were as follows: tobacco use, daily water intake, sodium consumption, exercise days per week, and junk food consumption. Risk factors significantly associated with subclinical CAD included hypertension, diabetes, sleep apnea, and abnormal coronary calcium score. Discussion Multi-slice CT angiography allows early reliable evaluation of subclinical atherosclerosis and correlation with behavioral/non-behavioral risk factors with level of CAD, instrumental to primary and secondary CAD prevention, limiting tertiary CAD treatment. Translation to Health Education Practice Study results have implications for Health Educators with regard to intervention research planning, implementation, and evaluation.

Subclavian artery pseudoaneurysm after penetrating chest trauma: A case report

Introduction: Subclavian artery pseudoaneurysm is a rare entity with significant mortality and morbidity. Most injuries were related to iatrogenic manipulations, but in some cases, this injury has been described as secondary to a chest trauma. This case report presents a case of a subclavian artery pseudoaneurysm caused by a chest stabbing trauma. Case description: This case is the report of a twenty-four-year-old man with a chief complaint of a painful and pulsating mass on the right shoulder 3 months before admission at the scar on his chest after having penetrating chest trauma; he also complained about weakness on the right arm. An evaluation with thorax MSCT and CT angiography supports the diagnosis of the right subclavian artery pseudoaneurysm. Intraoperative, we found a fistula from the right subclavian artery with hematomas. From the post-operative evaluation, the patient showed motoric improvement in the right arm and no pain. The patient was discharged from the hospital on the ninth day after surgery. Conclusion: Prompt and accurate diagnosis is crucial in subclavian artery pseudoaneurysm for determining the appropriate therapeutic approach, both in surgical preparation and intraoperative focus.

Coronary Bypass Surgery Guided By Multislice Computed Tomography Angiography In A Low Surgical Risk Population

Coronary Bypass Surgery Guided By Multislice Computed Tomography Angiography In A Low Surgical Risk Population

Open reconstructive surgery for renal artery aneurysm

THE OBJECTIVE was to evaluate the immediate results of open reconstructive operations for renal artery aneurysm.METHODS AND MATERIALS . From March 2019 to September 2023, 55 patients with visceral artery aneurysms were operated at the Department of Vascular Surgery at the Pavlov University. 4 patients with renal artery aneurysms were operated on by open surgical method and 5 patients underwent endovascular operation. There are two clinical cases of open reconstruction of renal artery aneurysm in situ and one ex vivo. In all cases, the indication for the operation was the presence of a symptomatic aneurysm. For in situ reconstructions, a retroperitoneal thoracophrenopararectal access to the tenth intercostal space on the left side with the opening of the left pleural cavity and partial diaphragmatic cavity and a transverse laparotomy of «chevron» type were used. Autovena was used as a bypass. For surgery of the renal artery ex vivo laparoscopic nephrectomy with autotransplantation of the kidney was performed. In the near postoperative period, we made the assessment of the patency of the reconstruction zone using MSCT angiography, the analysis of indicators of renal function.RESULTS . All the observations noted satisfactory near-term results – the reconstruction zone is unobstructed, indicators of renal function without negative dynamics, absence of clinical manifestations of this pathology. Long-term results (observed for more than 4 years) were traced in one patient. During this period, normal renal function and adequate functioning of the reconstruction zone are maintained.CONCLUSION . Open reconstructive surgery in the surgical treatment of renal artery aneurysm remains relevant due to the inability in some cases to perform its endovascular correction without high risk of ischemic damage to the parenchyma of the kidney.

Pulmonary, aorta, and coronary arteries post-arterial switch in transposition of great arteries: intermediate-term surveillance utilizing conventional echocardiography and cardiac multislice computed tomography

BackgroundArterial switch operation (ASO) is the standard surgical choice for D-transposition of great arteries (D-TGA). However, the implications of ASO on pulmonaries, coronaries, and aorta have not been adequately investigated. The current study evaluates arterial morphologic changes post-ASO at intermediate-term surveillance.MethodsFrom May 2021 to May 2022, patients with D-TGA who underwent ASO for more than six months were recruited. Preoperative and operative data were collected. Patients were assessed using echocardiography (ECHO) and multislice CT angiography (MSCT) to evaluate pulmonary, coronary, and aortic arterial anatomy.ResultsTwenty patients were included with median age of 11 (10-23.25) days at ASO and 14 (7.25–32.75) months on last follow-up. Neo-aortic regurgitation was detected in 12(60%) and neo-pulmonary regurgitation in 3 (15%). Using ECHO, complete evaluation of pulmonary arteries (PAs) was not achieved in 35% and incomplete coronaries assessment in 40% of cases. No stenosis was detected in coronaries using MSCT, although coronary anomalies were found in 9/20 (45%). Dilated Aortic annulus was detected in 16/20 (80%), dilated aortic root in 18/20 (90%), and dilated sinotubular junction in 70%. Right PA stenosis was diagnosed in 10/20 (50%) and left PA(LPA) stenosis in 7/20 (35%). Although Z-score of PAs did not correlate with aortic data, LPA bending angle was positively correlated to neo-aortic root diameter and Z-score (rho = 0.65,p = 0.016; rho = 0.69,p = 0.01), respectively.ConclusionEchocardiography alone is not a conclusive surveillance tool for detecting late post-ASO anatomic changes in D-TGA patients. Cardiac MSCT should be considered for comprehensive evaluation on the intermediate-term follow-up post-ASO to accurately track morphologic abnormalities in the aorta, pulmonary, and coronary arteries.

Multi-slice CT angiography of a ruptured MCA bifurcation berry aneurysm: Clinical images

Multi-slice CT angiography of a ruptured MCA bifurcation berry aneurysm: Clinical images

Hybrid treatment of recurrent venous mesenteric thrombosis with small intestinal necrosis

The article presents a clinical case of a 39-year-old patient with thrombosis and postoperative rethrombosis of the superior mesenteric vein. The disease was complicated by the small intestine necrosis and abdominal surgical infection. Successful thrombectomy and bowel resection made it possible to restore mesenteric blood supply, to stabilize the patient’s condition and to perform an enteroenteroanastomosis. Due to antithrombin III deficiency, rethrombosis in the early postoperative period was complicated by anastomotic leak, unformed intestinal fistula and peritonitis. A hybrid treatment (surgical, parasurgical and conservative) was performed, which included selective infusion of a thrombolysis activator at the superior mesenteric artery mouth. The patient recovered.Clinical and laboratory manifestations of superior mesenteric vein thrombosis, in contrast to acute circulatory disorders in the arteriomesenteric system, are nonspecific and do not always allow timely diagnosis of intestinal ischemia. MSCT angiography identifies venous mesenteric thrombosis in most cases. The ineffectiveness of anticoagulant therapy against the background of antithrombin III deficiency caused superior mesenteric vein thrombosis and rethrombosis. The treatment of the small intestine critical postoperative ischemia included an increase in the volume of antithrombin III and frozen plasma intravenous infusion and selective administration of a thrombolysis activator (actilyse) into the superior mesenteric artery, which made it possible to restore the arteriolovenular intramural blood flow of the small intestine and to prevent another stem rethrombosis of the superior mesenteric vein. Laparostomy using a silicone plate made it possible to constantly monitor the course of the abdominal infectious process and to make timely decisions about the next intervention if medically required. The vacuum assisted design provided permanent lavage of the abdominal cavity without trauma to the soft tissues of the abdominal wall and presenting intestinal loops.

Body mass index and long-term survival following acute pulmonary embolism: insights from machine learning models

Abstract Funding Acknowledgements None. Introduction Body mass index (BMI) has been associated with long-term survival in the setting of acute pulmonary embolism (PE) [1,2]. The non-linear pattern of this association proves to be challenging for frequentist statistical analyses. Contemporary machine learning models offer superior handling capabilities of datasets with non-linear data distributions. Purpose To examine the predictive power of BMI expressed as a continuous variable in a dataset of patients with pulmonary embolism (PE) using the extreme gradient boosting (XGBoost) machine learning framework. Methods All consecutive patients with confirmed PE admitted to the two tertiary teaching Clinical Hospitals in the metropolitan area from November 2013 until November 2018 were included in the study. The diagnosis was established by multislice computed tomography angiography. Machine learning models were investigated using the LightGBM variant of XGBoost. We allocated 80% of the dataset for model training and the remaining 20% for testing. Two models were tested: (1) a model with 20 variables tailored according to the Cox proportional hazards model in the initial publication; (2) a model with 11 independent predictors of outcome. Results The study population is described in detail in previous publications [1,2]. In brief, a total of 761 patients were included in the study. The population was predominantly female (57.4%), aged 73 (61-81). The median overall follow-up was 675 days (114-1331). There were 335 (44.0%) cases of death recorded at follow-up. A Cox proportional hazards model with 19 covariates significantly predicted death during follow-up (χ2 = 595.5, p<0.001). The first BMI quartile was an independent predictor of death (hazard ratio 1.66, 95% confidence interval 1.31-2.10). However, when expressed as a continuous variable, BMI failed to enter the model. In both XGBoost models, BMI expressed as a continuous variable proved to be a feature with high predictive power, second only to pulmonary embolism severity index score (Figure 1 and 2). The models showed high accuracy, with an area under curve of 0.840 and 0.864 respectively. Conclusion In the XGBoost analysis, a machine learning framework with superior handling of non-linear data, BMI expressed as a continuous variable emerged as the second strongest predictor of outcome among 761 PE patients.Figure 1Figure 2

Off-label use of muscular VSD device for closure of a rare congenital portosystemic shunt

BackgroundCongenital portosystemic shunt (CPSS) is a vascular malformation in which portal blood drains toward the systemic circulation, leading to pulmonary hypertension.Case presentationA 10-year-old patient was brought for evaluation because of dyspnea on exertion. Echocardiography revealed a pulmonary hypertension of 75 mmHg, and multi-slice CT angiography revealed the presence of a CPSS. Closure was finally implemented using a muscular ventricular septal defect device. Follow-up of the patient revealed a gradual decline in pulmonary hypertension.ConclusionsCPSS is an overlooked cause of reversible pulmonary hypertension (PH). Closure of such lesions and reversal pulmonary hypertension are possible via catheterization. The preferred device type depends largely on the intervening team. Plugs are the first choice for interventional radiologists, while ventricular and atrial septal occluder devices and duct occluders are preferred by pediatric cardiologists.

NONINVASIVE DIAGNOSTICS OF EXTRACRANIAL ARTERIES TORTUOSITY

Deformations of carotid artery – deviation, tortuosity, coiling, hold the 2nd placeamong other carotid pathologies. They are the cause of 10-17% of cerebrovasculardisorders. It should also be noted that this pathology is common for a relatively youngage. It is considered that in the elderly carotid deformation is an acquired lesion mostcommonly seen in patients suffering from arteriosclerosis and hypertension, while inchildren and younger patients, the kinks and coils are congenital. For diagnostics ofdeformations of magistral arteries, highly efficient non-invasive methods are applied:ultrasound duplex-scanning, MR angiography, and multi-slice CT angiography. We havestudied deformations of magistral carotid and vertebral arteries in cases of isolatedatherosclerosis, isolated arterial hypertension, and a combination of atherosclerosisand hypertension. Out of 205 patients we diagnosed deformations of carotid arteriesin 93 (30%) cases, and deformations of vertebral arteries in 64 (21%) cases. Bilateraldeformation of carotid arteries was diagnosed in 43 (17%) cases. C- or S-shaped deformationsin 55 (81%) cases were located in proximal or medial parts of CCA or ICA. 76%of patients with this pathology had arterial hypertension. In the case of C- or S-typedeformation rate amounted to 30%, in the case of coiling increase of flow it reached50%, and in the case of kinking – exceeded 60%. In the case of C- or S-type elongation,flow volume (Q) is practically within the normal range - 488±38 ml/min. In the case ofspiral shape elongation, it showed the tendency of decrease -402±22 ml/min, which ismore obvious in the case of kinking - 332±22 ml/min. The frequency of elongations ispractically the same in the case of isolated atherosclerosis or hypertension, however,in the case of their combination the frequency increases. In order to study the impactof the deformation of magistral arteries on intracranial hemodynamics, we examined84 patients without any hemodynamically significant atherosclerotic pathology of carotids.We found a total of 91 elongations: In the case of C- or S-shaped deformation,flow parameters remain within the normal range, as in the case of spiral elongation orcoiling. In the case of kinking, there is an obvious tendency for a decrease in flow rate – the average flow rate is 20% below the normal value. Our data correspond to similar data of other authors, who revealed the tendency of a 20-35% decrease of flow rate in the ipsilateral middle cerebral artery, in case of significant tortuosity or kinking of the carotid artery.

Assessment of Plaque Vulnerability in Diabetic and Non-Diabetic Patients with Coronary Artery Disease Using Multi-slice CT Angiography

Assessment of Plaque Vulnerability in Diabetic and Non-Diabetic Patients with Coronary Artery Disease Using Multi-slice CT Angiography

A young woman with acute coronary syndrome and antiphospholipid syndrome. Is it the antiphospholipid syndrome or COVID-19 vaccination or classical risk as the risk factor? a case report

BackgroundAcute coronary syndrome (ACS) in young women is poorly understood due to underdiagnosis and undertreatment. One of the possible risk factors for ACS in young women is antiphospholipid syndrome (APS). Coronavirus disease 2019 (COVID-19) vaccination also emerged as one of the possible risk factors for ACS during the COVID-19 pandemic.Case presentationOur patient, a 39-year-old Batak woman with dyslipidemia and family history of cardiovascular disease, experienced chest pain slightly improved at rest accompanied by autonomic symptoms. She was diagnosed with non-ST-elevation myocardial infarction (NSTEMI) based on her clinical features, dynamic electrocardiogram changes, troponin elevation, and multislice computed tomography angiography confirmed with diagnostic catheterization. The patient was managed by percutaneous coronary intervention with implantation of drug-eluting stents. On follow-up, the patient was diagnosed with APS based on history of preeclampsia with severe features in the first and third pregnancy, spontaneous abortion in the second pregnancy, history of transient ischemic attack, moderately positive lupus anticoagulant on two occasions with an interval of 12 weeks, and ACS. Further investigation revealed a history of COVID-19 vaccination with Sinovac four and six weeks before presentation. The patient was recommended for lifelong warfarin and short-term dual antiplatelet (aspirin and ticagrelor).ConclusionsYoung women are not completely immune to ACS as evident in this case of ACS in a young woman with classical risk factors (dyslipidemia and family history of cardiovascular disease) and APS. Further studies are required to fill the knowledge gap on whether COVID-19 vaccination had any contribution to the ACS in the young woman.

Multi-slice CT Angiography “Triple Rule Out technique” in the Evaluation of Emergency Department Patients with Acute Chest Pain Having Low to Intermediate Risk for Acute Coronary Syndrome

Multi-slice CT Angiography “Triple Rule Out technique” in the Evaluation of Emergency Department Patients with Acute Chest Pain Having Low to Intermediate Risk for Acute Coronary Syndrome

Миграция эмболизирующей спирали из гастродуоденальной артерии в просвет двенадцатиперстной кишки после остановки кровотечения из дуоденальной язвы

The rationale for the study. The study of long-term results, errors, dangers and complications of endovascular embolization in gastroduodenal bleeding. The purpose of the study. The probability of migration of the embolizing coil from the target vessel after stopping gastroduodenal bleeding. Methods. The patient is 76 years old, with a clinic of gastrointestinal bleeding caused by the migration of an embolizing coil installed 5 years ago into the gastroduodenal artery with active ulcerative bleeding. Verification of the diagnosis using EGDS, MSCT, and selective angiography. Results. The treatment used endoscopic extraction of the migrated coil in combination with conservative treatment of peptic ulcer disease. The result is recovery. Conclusion. There is a possibility of migration of embolizing coils. This complication is rare. Currently, it is necessary to develop recommendations to eliminate this complication. In this regard, the expediency of such clinical observations is obvious. Surgical tactics in each case should be individual.

Clinical case of 9-month observation of orbital venous varicose with intraluminal thrombus using radiologic methods

A rare clinical case of thrombosis of varicose superior ophthalmic vein in combination with a unilateral venous anomaly of the subcortical region of the brain with successful antithrombotic therapy is presented. Varicose veins of the superior ophthalmic vein are rare (2% of all orbital formations) and are a risk factor for thrombosis.Material and methods. A 41-year-old patient with verified thrombosis of unilateral orbital venous varicose veins was observed for 9 months. Initially, MSCT of the brain and MSCT angiography were performed, then dynamic monitoring was carried out by performing MRI of the brain and MR venography, and finally an ultrasound examination of the orbit was performed.Description of a clinical case. The clinical presentation consisted of a slight non-pulsatile unilateral exophthalmos, mild ptosis, periorbital soft tissue edema, subconjunctival hemorrhage, paraorbital hematoma, and venous dysfunction in the fundus. MSCT and MSCT angiography revealed a thrombus inside the sac of orbital venous varicose veins. The disease was probably secondary in nature, given that it was combined with venous angioma of the subcortical region on the same side. During 9 months of observation, to monitor the effectiveness of therapy, MRI was performed three times before and after contrast enhancement, which showed a gradual decrease in exophthalmos, the size of the thrombus and the varicocele sac, which was accompanied by a gradual improvement in the clinical picture until subjective recovery.Conclusion. MRI was as good an imaging modality as MSCT, and, in our opinion, more preferable due to the absence of radiation exposure and the need for iodine contrast agent.

True aneurysms of the inferior phrenic arteries in celiac trunk compression syndrome and surgical treatment of three patients

The Objective was to pay attention to the rare combination of a true aneurysm of the inferior phrenic artery and the syndrome of compression of the celiac trunk, its open decompression and elimination of aneurysms in three patients.Methods and Materials. From September 2018 to December 2022, in 5 patients with celiac trunk compression syndrome (three men; mean age 49.4 years, from 18 to 72 years) out of 182, according to MSCT angiography and during surgery, an aneurysm of the right inferior phrenic artery was detected in two and left for three. These arteries originated from the post-stenotic moderately dilated part of the celiac trunk.Results. On average, its diameter at the site of stenosis was 1.9 mm and the degree was 58 %, the trunk was 8.6 mm and the aneurysm was 6.8 mm, and its length was 8 mm. In 4 cases, the aneurysm originated from the ostium of this artery and in one case, 5 mm from it, without involvement of the celiac trunk. All 5 aneurysms were concentric sac-shaped, including a funnel-shaped variant in two of them. Three out of 5 patients successfully underwent open decompression of the celiac trunk and immediately resection of the aneurysm in two with the imposition of a lateral suture and ligatures on the artery, respectively, and exclusion in one with a purse-string suture.Conclusion. An aneurysm of the inferior phrenic artery originating from the celiac trunk may be one of the specific manifestations of its long-term significant diaphragmatic compression. With such a combination of lesions, the expediency of decompressing the celiac trunk and removing the aneurysm from the bloodstream, regardless of its size, should be considered.