Presence Of Aneurysm Research Articles

Intracavernous Internal Carotid Artery Aneurysm Presenting as Acute Diplopia: A Case Report

IntroductionDiplopia is an uncommon emergency department (ED) complaint representing only 0.1% of visits, but it has a large differential. One cause is a cranial nerve palsy, which may be from a benign or life-threatening process.Case ReportA 69-year-old female presented to the ED with two days of diplopia and dizziness. The physical exam revealed a sixth cranial nerve palsy isolated to the left eye. Imaging demonstrated an intracavernous internal carotid artery aneurysm. The patient was treated with embolization by neurointerventional radiology.DiscussionThe evaluation of diplopia is initially divided into monocular, usually from a lens problem, or binocular, indicating an extraocular process. Microangiopathic disease is the most common cause of sixth nerve palsy; however, more serious etiologies may be present, such as an intracavernous internal carotid artery aneurysm, as in the patient described. Imaging modalities may include computed tomography or magnetic resonance imaging.ConclusionSome causes of sixth nerve palsy are benign, while others will require more urgent attention, such as consideration of an intracavernous internal carotid artery aneurysm.

Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature

BACKGROUNDSplenic artery aneurysm (SAA) and pseudoaneurysm are rare vessel’s lesions. Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma. True SAA is the most common aneurysm of visceral vessels. In contrast to pseudoaneurysm, SAA is usually asymptomatic until the rupture, with high mortality rate. The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability, usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARYWe describe the case of a 35-year-old male patient, with negative past medical history, who presented to the emergency department for massive upper gastrointestinal bleeding, severe anemia and hypotension. An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface, with a visible vessel, but no active bleeding. Endoscopic injection therapy with cyanoacrylate glue was performed. Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect: The radiological examination showed a giant SAA which was adherent to posterior stomach wall, and some smaller aneurysms of the left gastric and ileocolic artery. Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome, the patient underwent immediate open surgery with aneurysmectomy, splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSIONThe management of a ruptured giant SAA into the stomach can be successful with surgical approach.

Idiopathic Intrahepatic Artery Aneurysm Presenting as Acute Hemorrhagic Cholecystitis

Intrahepatic artery aneurysm or pseudoaneurysm is an unusual condition encountered clinically that accounts for a very small part of all visceral artery aneurysm cases. True incidence of primary or spontaneous intrahepatic artery aneurysm is difficult to be verified and has been rarely reported. For intrahepatic artery aneurysm/pseudoaneurysm, the diagnosis and management are challenging owing to the lower incidence and occult or various presentations. Due to the insidious course, patients with such aneurysms often have a higher risk of rupture, sometimes causing a catastrophic bleeding situation. Herein, we present a case of a 20-year-old woman with idiopathic left intrahepatic artery aneurysm with initial presentation mimicking acute hemorrhagic cholecystitis. Following laparoscopic cholecystectomy, intermittent upper gastrointestinal bleeding occurred. At the second radiologic study, left lateral-superior subsegmental hepatic artery aneurysm was detected. After endovascular treatment, the patient recovered without complications. To avoid delayed diagnosis, we suggest that hepatic artery aneurysm/pseudoaneurysm should always be considered when there is no usual cause of upper gastrointestinal tract bleeding.

Pericallosal Artery Aneurysm: systematic review

Background: Pericallosal artery aneurysms, from A2 to A5 segments of anterior cerebral artery, are uncommon (literature states 2.3-9.2% of brain aneurysms). They have a high mortality rate and tend to rupture easily during exposure. This study was done with the intention of pointing out the described presentations of pericallosal artery aneurysms. Materials and Methods: A systematic review related to pericallosal artery aneurysm was performed in the PubMed, MedLine (Ebsco), LILACS and Scielo databases, using as keywords: “pericallosal artery”, “distal anterior cerebral artery” and “aneurysm”. Results: Pericallosal artery aneurysms are present mainly in patients over 50 years of age (2.1:1 female to male). In younger patients (less than 20 years old) the seizure is the most frequent symptom, while in adults (20-59 years old) it is the thunderclap headache. They commonly present with Hunt & Hess Grade (HH) II. However, 69% presented subarachnoid hemorrhage (SAH), presenting mainly with Fisher 4, which increases the chance of vasospasms. Conclusion: Thus, although the distal anterior cerebral artery (pericallosal) aneurysms display common symptoms, they usually have severe bleeding. Nonetheless, more studies are needed to analyze the epidemiological, demographic and clinical aspects of the pericallosal artery aneurysms

Brachiocephalic vein aneurysm: a systematic review of the literature.

Brachiocephalic vein aneurysms are rare lesions with only 36 cases reported in the literature. They usually present incidentally as mediastinal widening on chest X-ray, with thromboembolism or mass effect on adjacent structures, or rupture. Imaging is usually sufficient to identify and characterize the aneurysm, however, certain diagnostic pitfalls can lead to misinterpretation and misdiagnosis. Exploratory surgery is sometimes needed to confirm diagnosis. Brachiocephalic vein aneurysms have been treated both conservatively with watchful waiting, antithrombotic therapy or anticoagulation as well as surgically depending on patient presentation and aneurysm characteristics. Endovascular treatment is also becoming a therapeutic option. Prognosis following surgical treatment is excellent with no reported cases of recurrence. The present systematic review aims to describe the etiology, clinical presentation, diagnosis, management and outcomes of brachiocephalic vein aneurysms.

Endovascular treatment of a small ruptured non-traumatic internal carotid artery aneurysm presenting with repeated massive epistaxis

ObjectiveWe encountered a rare case of massive epistaxis resulting from a small ruptured non-traumatic cavernous internal carotid artery aneurysm associated a bony defect in the wall of the posterior lateral wall of the sphenoid sinus. We presented successful diagnosis and treatment with a balloon-assisted neck-plasty coil embolization. Case PresentationA 74-year-old Japanese man was admitted following recurrent massive epistaxis. There was no history of trauma, surgery, radiotherapy, infection, or tumor. Radiographic imaging demonstrated a bony defect in the wall of the posterior lateral wall of the sphenoid sinus that allowed the aneurysm to ruptured into the nasal cavity rather than intracranially. After rupture, the patient presented with epistaxis that resulted in systemic hypotension. This aneurysm can be managed rapidly using endovascular techniques of a balloon-assisted neck-plasty coil embolization. ConclusionThe present case report highlights the rarity of a small non-traumatic cavernous ICA aneurysm causing massive epistaxis. Clinicians should be aware of this possibility, as a high index of suspicion is required for proper diagnosis. Internal carotid angiography should be performed, particularly in patients with refractory epistaxis. Aneurysms in this location are usually amenable to endovascular treatment. Coil embolization using a microballoon-assisted neck-plasty technique can result in immediate hemostasis, parent artery preservation, and successful long-term aneurysm occlusion.

Patient Education and Engagement Through Multimedia: A Prospective Pilot Study on Health Literacy in Patients with Cerebral Aneurysms

Improving the comprehension and communication of patient education materials could augment patient participation in shared clinical decision making. Inadequate healthcare-oriented educational resources for patients with a newly diagnosed complex disease, such as a cerebral aneurysm, can lead to an insufficient understanding of their ailment. As such, we hypothesized that a PowerPoint-style educational intervention with grade-conscious (i.e., sixth grade level) written material accompanied by visual graphics would help improve patient health literacy and satisfaction. A randomized prospective pilot study was conducted during a 1-year period in 2018. Preclinic encounter knowledge assessment surveys were administered to 52 patients with brain aneurysms (newly diagnosed or during follow-up) presenting for their neurosurgery outpatient clinic visit. The patients were assigned to 1 of 2 cohorts, with 26 each in the educational intervention group and control group, using a quasi-randomization method of alternating the assigned group for each successive patient. At the conclusion of their clinic encounter, all the patients completed a postclinic encounter knowledge assessment and satisfaction survey. Differences in covariates such as gender distribution, age, and family history of aneurysms were analyzed between the control and intervention groups. The overall study cohort had a high baseline knowledge about cerebral aneurysms with an average preclinic encounter score of 5.37 on the 7-question survey. The educational intervention resulted in an upward trend in the patient knowledge scores. No statistically significant difference was detected in the patient satisfaction scores between the intervention and control groups. However, most of the patients receiving the educational intervention reported that the educational material was easy to understand (95.7%), helpful (86.9%), and relevant (87%) to their clinic visit. Overall, in the present prospective study, the use of a multimedia-based educational intervention resulted in an upward trend in knowledge without a statistically significant difference in patient satisfaction scores compared with the control patients. To better measure the effectiveness of multimedia-based patient education interventions, future studies should account for the patients' baseline education level, preexisting educational resources available to study patients, socioeconomic factors, and emotional state.

Giant popliteal artery aneurysm presenting as popliteal mass.

Giant popliteal artery aneurysm presenting as popliteal mass.

Successful Endovascular Repair for Abdominal Aortic Aneurysm Presenting as Aortoduodenal Syndrome.

Aortoduodenal syndrome is a rare duodenal obstruction caused by an abdominal aortic aneurysm. Current treatment involves open aneurysmal repair according to the theory that this procedure releases the duodenum from mechanical compression. However, the mechanism of duodenal blockage remains unclear and reports of endovascular aneurysm repair (EVAR) for aortoduodenal syndrome are quite rare. We report our successful case of EVAR for aortoduodenal syndrome without aneurysmal shrinkage and discuss the mechanism of duodenal obstruction.

A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review

BackgroundRuptured intracranial aneurysms are often associated with subarachnoid or intraparenchymal hemorrhage. However, the prevalence of subdural hemorrhage post aneurysmal rupture is low and rarely reported in scientific studies. Here, we report an unusual case of a ruptured posterior communicating artery aneurysm resulting in an isolated subdural hematoma located in the tentorial and spinal canal without subarachnoid or intraparenchymal hemorrhage.Case presentationIn this case, a 34-year-old woman with no history of trauma or coagulopathy was diagnosed with a subdural hematoma in the tentorium cerebellum tracing to the subdural space of the spinal column. Computed tomography angiography was used to identify the source of the bleeding, which revealed a ruptured left-sided posterior communicating artery saccular aneurysm. The aneurysm was clipped, and the hematoma was evacuated. The patient recovered without any neurological complications.ConclusionsOur results suggest that a diagnosis of ruptured intracranial aneurysm should be considered in patients with nontraumatic subdural hematoma. Prompt diagnostic imaging and interventional diagnostic procedures are required to ensure proper management of these patients and to avoid unnecessary complications.

Hemoptysis as a Rare Presentation of Thoracic Aorta Aneurysm

Hemoptysis is the rarest presentation of thoracic aortic aneurysm (TAA).This critical condition is one of the life-threatening medical emergencies. Even with prompt approaches, TAA can have highly terrible outcomes. Although TAA is an almost asymptomatic condition that is accidentally discovered, imaging with contrast is the most useful modality to diagnosis it.

A178 DIAGNOSIS OF A MYCOTIC AORTIC ANEURYSM USING ENDOSCOPIC ULTRASOUND: A CASE REPORT

Abstract Background The role of endoscopic ultrasound (EUS) has expanded over the last decade. It is a well-established imaging modality in the diagnosis of gastrointestinal and pancreatic lesions as well as in mediastinal lesions. To date, EUS has not been reported in the literature for the diagnosis of mycotic aortic aneurysm after intravesical bacille Calmette-Guérin (BCG) therapy. Aims This case report describes the presentation and diagnosis of a mycotic aneurysm in the context of disseminated Mycobacterium bovis infection. Methods An 86-year-old man with previous intravesical BCG immunotherapy for the treatment of bladder carcinoma presented with weight loss and deconditioning at admission. Based on the patient’s past medical history and age, malignancy was suspected. An endoscopic ultrasound (EUS) revealed a mass at the lymph node station 9 masquerading as a lymphadenopathy. Multiple investigations were completed. Following the second EUS, the diagnosis of mycotic aneurysm was raised. The smear collected with EUS guided fine needle aspiration (FNA) was positive after Ziehl-Neelsen staining. The diagnosis of mycotic aneurysm to Mycobacterium bovis was confirmed. Results Treatment was initiated with rifampin, isoniazid and ethambutol. Despite optimal medical management, the patient presented with new onset fever, and a clinical deterioration with positive mycobacterial blood cultures. Within two months of admission, the treatment was discontinued and the patient died in palliative care. Conclusions Recognition of mycotic aneurysms is critical for institution of appropriate therapy and averting more severe complications, as they are associated with significant morbidity. This case aims to raise awareness to this rare disease after BCG treatment. It also highlights the novel role of EUSin the challenging diagnosis of mycotic aneurysm. Funding Agencies None

Association of Sex With Repair Type and Long-term Mortality in Adults With Abdominal Aortic Aneurysm

Sex-based differences exist in the prevalence and clinical presentation of abdominal aortic aneurysm (AAA). However, it is unclear if sex is associated with AAA repair type and long-term mortality. To investigate whether a sex-related difference exists in mortality risk after AAA repair owing to differences in repair type. This cohort study uses data from the Vascular Quality Initiative, a national clinical registry, and Medicare claims to investigate endovascular and surgical repair procedures performed between January 1, 2003, and September 30, 2015, in patients aged 65 years or older with AAA. The data were analyzed from October 1, 2018, to November 19, 2019. Sex of the patient. Endovascular (EVR) or open surgical AAA repair type and subsequent long-term, all-cause mortality. In this cohort study of 16 386 patients, 12 757 (77.9%) were men and 3629 (22.1%) were women. Women were more likely than men to be older (mean [SD] age, 77 [6.5] years vs 75 [6.6] years; P < .001), active smokers (33% vs 28%; P < .001), and to have smaller aneurysms (mean [SD] diameter, 57 [11.7] mm vs 59 [17.7] mm; P < .001). Surgical AAA repair was performed in 27% (983 of 3629) of women compared with 18% (2328 of 12 757) of men (P < .001). After inverse probability weighting for risk adjustment, women were more likely to receive open surgical repair than EVR repair (risk ratio, 1.65; 95% CI, 1.51-1.80). The 10-year unadjusted survival rate after EVR repair was 14% lower in women than in men (23% vs 37%; log-rank P < .001), but the rates were comparable after open surgical repair (36% in men vs 32% in women; log-rank P = .22). Risk-adjusted analysis showed that women were associated with higher mortality rates after EVR repair (hazard ratio, 1.13; 95% CI, 1.03-1.24), whereas both men and women had a similar risk of death after open surgical repair (hazard ratio, 0.94; 95% CI, 0.84-1.06). After further stratification by symptom severity, higher risk of mortality among women was limited to elective EVR and open surgical repair for ruptured AAA. In this study, women were 65% more likely than men to undergo open surgical repair. After EVR repair, women were 13% more likely to die than men, although no sex-based difference in mortality was found after open surgical repair. The differential treatment benefit of EVR repair in women is concerning given the shift toward an EVR-first approach to AAA repair.

1. Azygous vein aneurysm presenting as a mediastinal mass: A case report

Background: Azygous vein aneurysm is a rare occurrence and presenting as a mediastinal mass is even rarer. Its complications are dreadful as it may lead to rupture and demise if not properly diagnosed and attended. Aims: This report is prepared to present an infrequent ailment, clinical presentation, histopathologic findings and course of the disease. Results: This patient, a 58-year-old female, presented with dyspnoea and chest pain. She was brought to a hospital and showed tachypnoea. Upon admission, chest radiograph was performed displaying a lobulated soft tissue mass in the right suprahilar region which at first was considered as soft tissue mass versus an enlarged lymph node. The patient was transferred to the Philippine Heart Center for definitive management. Computed tomography (CT) of the chest showed a large saccular aneurysm (7.8×7.4×7.7 cm) emanating from the right lateral wall of the superior vena cava (SVC) with thrombus formation within its lumen, extending to the distal SVC. The patient was scheduled for aneurysm repair. Intraoperatively, the SVC was identified and discovered that the aneurysmally dilated vein was the azygous vein instead of the SVC. It was resected and the operation was successful. The specimen consisted of several, tan-gray, rubbery to friable tissues aggregately measuring 6.5×5.5×2.0 cm. Microsections showed vessel wall with fibrosis, myxoid areas within the medial layer and congested vascular channels in the adventitia. Haemorrhage and thrombus were seen. Trichrome stain revealed areas of fibrosis and marked increase in collagen fibres. Elastic stain revealed elastic fibre loss and fragmentation. The final histologic diagnosis was aneurysmal vessel wall with myxoid degeneration of media. Conclusion: Azygous vein aneurysm is rare, probably the first ever reported entity in the Philippines. Proper approach in early detection and keen clinical judgement are necessary to ensure good patient outcomes.

Case report: cystic artery pseudoaneurysm presenting as a massive per rectum bleed treated with percutaneous coil embolization

BackgroundCystic artery pseudoaneurysms are rare. It usually occurs as a complication of laparoscopic cholecystectomy, but can arise uncommonly as a complication of acute cholecystitis. Ruptured cystic artery aneurysms present with haemobilia, intraperitoneal or upper gastrointestinal bleeding. We present an unusual case of cystic artery aneurysm presenting as a massive lower gastrointestinal bleed.Case presentationA 47-year-old man was admitted with a thoracic abscess and was noted incidentally on CT to have acute cholecystitis. Subsequently the patient then presented with massive fresh PR bleeding. This was found on CT to be the result of a cystic artery pseudoaneurysm with associated gallbladder fistulation to the hepatic flexure, secondary to cholecystitis. The patient was treated with coil embolisation of the cystic artery made a full recovery and was discharged with a view to performing an elective cholecystectomy.ConclusionCystic artery pseudoaneurysm is a rare complication of cholecystitis which can present as massive lower gastrointestinal haemorrhage secondary to cholecystocolic fistula. Percutaneous embolization is a safe and effective treatment in the acute phase.

Bilateral Giant Opthalmic Carotid Artery Aneurysms Presenting as Unilateral Diplopia: A Case Report

Introduction: The etiology of giant aneurysms is multifactorial. It becomes symptomatic in 9/100.000, most frequently in the fifth and sixth decades of the life. Intracavernous carotid artery aneurysms (ICAAs) represent less than 1% of intracranial aneurysms and show a slight female predominance. Case-Report: We report an interesting case of bilateral ICAA in 42-year-old female presented as acute diplopia and emphasize the need of a thorough systemic evaluation in young patients with diplopia and treated with endovascular coil embolization. A 42-year-old woman was admitted to the neurology department suffering from the unilateral diplopia. Neurological examination showed the left sixth cranial nerve palsy and had no further general motor or sensory symptoms. Digital Subtraction Angiogram (DSA) showed bilateral ophthalmic artery aneurysm. The patient was treated with endovascular loose packing coil embolization and Derivo 3.5x30mm flow diverter stent. Conclusion: It should be kept in mind that intracavernous carotid artery aneurysms may be bilateral in patients with unilateral cranial nerve symptoms.

Ruptured Sinus of Valsalva Aneurysm Presenting as Acute Coronary Syndrome with Cardiogenic Shock and aVR ST-Elevation - A Case Report.

A ruptured sinus of Valsalva aneurysm can present as a clinical emergency and can lead to progressively deteriorating dyspnea. We describe an unusual case of sinus of Valsalva aneurysm (SOVA) presenting with acute chest pain and dyspnea with electrocardiographic ST-segment elevation in the V1 and aVR leads. Diagnostic angiography and cardiac computed tomography angiography showed contrast enhancement from the aorta to the right ventricle and pulmonary artery. The patient was referred to a cardiovascular surgeon for immediate surgical excision and repair. This case highlights the importance of physical examination and echocardiography, especially in the emergency setting, since the disease can manifest in various presentations. To the best of our knowledge, this report may be the first described case to suggest an acute coronary syndrome with aVR ST-elevation occurring from an acute ruptured SOVA.

A Unique Presentation of Splenic Artery Aneurysm During Pregnancy

Visceral arterial (VAA) and, specifically, splenic arterial aneurysms (SAA) are rare entities often associated with pregnancy. When ruptured, they can be fatal and require emergent management. This case report includes a review of the relevant literature and describes a unique, multidisciplinary approach to managing such an aneurysm. We describe the difficult situation of an already rupturing aneurysm and the careful coordination of obstetric, surgical, vascular, and interventional radiology teams. The distinctiveness of this case continues with the intraoperative finding of metallic coils freely protruding into the peritoneum from a recently coil-embolized ruptured splenic artery aneurysm. Such iatrogenic foreign bodies are a product of the integration of multiple specialities that can provide life-saving care when managing critical surgical disease such as ruptured splenic artery aneurysms. Multidisciplinary approaches should be considered depending upon the resources available at one’s institution.

A rare presentation of combined hepatic artery, celiac trunk and infrarenal aortic aneurysm. Challenges in the surgical treatment

A rare presentation of combined hepatic artery, celiac trunk and infrarenal aortic aneurysm. Challenges in the surgical treatment

P1242 Giant right atrium aneurysm presenting as right heart failure

Abstract Introduction Idiopathic aneurysmal dilatations of the right atrium are rare anomalies. It can be diagnosed at any time between foetal and adult life. This exceptional condition can be confused with other conditions that involve enlargement of right atrium. We report a clinical case of a symptomatic adult who was diagnosed with giant right atrium aneurysm. Case report An 83-year-old female presented with complaints of fatigue, paroxysmal nocturnal dyspnoea, exertional dyspnoea, orthopnoea and cough since last week. There were no history of syncope, convulsions or evidence of thromboembolism. There were a medical history of diverticulosis and atrial fibrillation (warfarin therapy). The principal findings on physical examination included holosystolic murmur at the left middle sternal border, pulmonary rales, jugular venous distension, enlarged liver and peripheral oedema. An electrocardiogram showed an atrial fibrillation with a controlled heart rate response, right axis deviation, right bundle-branch block. A chest radiography posteroanterior view showed a markedly enlarged cardiac silhouette, increased pulmonary vascular congestion, and bilateral pleural effusions. Computed tomography (CT) scan showed aneurysmal dilated right atrium communicating with right ventricle. Right ventricle (RV) and RV outflow tract were dilated with normal pulmonary arteries. Two-dimensional transthoracic echocardiography revealed aneurysmal dilated right atrium measuring 398mL/m2. The tricuspid valve was no displaced. There was severe tricuspid regurgitation and no stenosis. The right atrium was kinetic without any intracavitary thrombus. The intertrial and interventricular septa were intact. The right ventricle and outflow tract were mildly dilated with preserved systolic function. The left atrium and left ventricle were normal. The patient was admitted to the cardiology department with the diagnosis of right heart failure. Conclusion Aneurysm of right atrium is an uncommon condition. It is diagnosed as a disproportionately enlarged right atrium compared to the other cardiac chambers in the absence of other cardiac or hemodynamic abnormalities and must be distinguished from other anomalies causing structural pathology of the right atrium. Approximately, one-half of the patients have no symptoms. Others presented with arrhythmia, palpitations, chest pain, shortness of breath, and fatigue. The major rhythm abnormality is atrial fibrillation or atrial flutter. Our patient presented with symptoms of right heart failure and atrial fibrillation. The right enlargement is usually associated with tricuspid annular dilatation responsible for functional regurgitation, which can be severe in some cases. The diagnosis of right atrium malformation can be established by echocardiography, CT or magnetic resonance imaging. Literature reports various ways to manage these patients. Treatment ranges from conservative to surgical resection specially in the presence of arrhythmias. Abstract P1242 Figure. Aneurysm of right atrium