Pulsatile Swelling Research Articles

1588 A Rare Case of Arteriovenous Malformation Following TMJ Arthroscopy: A Case Report and Review of The Literature

Abstract Patients undergo temporo-mandibular joint (TMJ) arthroscopy as part of the diagnosis and management of chronic pain in the TMJ. Known complications of the procedure include bleeding within the joint spaces, lacerations of the external auditory canal and local nerve damage. We present the case of a 25-year-old woman who developed an arteriovenous fistula in the right pre-auricular region secondary to TMJ arthroscopic examination. She had presented with ongoing TMJ pain necessitating further investigation with arthroscopy. Following her procedure her TMJ symptoms improved, however she developed right pre-auricular swelling of gradual onset, right-sided headaches, and pulsatile tinnitus. Due to her pregnancy of around 16 weeks this was originally linked to expansion in plasma volume and hyperdynamic circulation; however, this was later diagnosed as an extremely rare, post-operative complication of TMJ arthroscopy. Her examination revealed a pre-auricular pulsatile swelling measuring approximately 1.5 cm. Blood tests including ESR and CRP were within normal limits excluding temporal arteritis. An ultrasound scan revealed an AV fistula of the right superficial temporal artery; Her MRI confirmed single vessel supply. Following discussion in the vascular anomalies MDT, she underwent embolisation with PHIL and surgical excision via a preauricular approach. The procedure was successful, and the patient made a full recovery. The literature reports very few cases of iatrogenic arterio-venous fistulas resulting from TMJ arthroscopic surgery. Our case emphasises the importance of a multidisciplinary approach in combining embolisation with surgical excision resulting in the successful management of a rare post-operative complication.

Traumatic Common Carotid-jugular Fistula In A 6-year-old Child: Rare Cause Of Pulsatile Neck Mass

Background: Traumatic common carotid artery-jugular vein fistula is an uncommon clinical entity that may follow penetrating neck injury. It is rarely seen in children. It usually presents with a pulsatile neck mass following a history of trauma to the neck. It may present with pulsatile mass, thrill on palpation and murmurs on auscultation. There may be a neurologic deficit, which may vary from hemiparesis to hemiplegia. We present a case of traumatic arteriovenous fistula that presented as pulsatile anterior neck swelling in a school child. Case Presentation: A 6 year old male child, presented with a 3 days history of penetrating gunshot injury to the right side of the neck, as a result of accidental discharge from a gun during a marriage ceremony. The patient said to have bled profusely from the site of injury and had transient loss of consciousness. Examination revealed a healing wound and a slight swelling on the right side of the neck just anterior to the anterior border of the sternocleidomastoid muscle. The mass was pulsatile, with palpable thrill and bruit on auscultation. Colour doppler ultrasound demonstrated an abnormal connection with abnormal blood flow from the right common carotid artery to the right internal jugular vein. He was successfully treated surgically by neck exploration, excision of the fistula, and repair of defects in both vessels. Conclusions: Traumatic carotid-jugular fistula following gunshot injury is rarely seen in children. Guns should not be used or left unattended to in crowds so as to forestall future occurrence of accidental discharge that could lead to avoidable injuries. We recommended strict adherence to the rules and regulations guarding the use of firearms by civilians.

Ten-year follow-up of direct interposition graft repair of persistent sciatic artery aneurysm.

A 58-year-old woman had presented with a pulsatile swelling in the left gluteal region and pain in the limb on the same side in 2010. Magnetic resonance angiography was performed, which revealed a type 2 persistent sciatic artery (PSA) with an aneurysm in the gluteal region (A). She underwent direct endoaneurysmorrhaphy with an interposition polytetrafluoroethylene (PTFE) graft through a posterior gluteal approach. The patient was placed in the lateral decubitus position, and the aneurysm sac was approached after dividing the overlying gluteal muscles.

Outcomes of Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers Managed at a Tertiary Care Center.

ObjectivesThe aim of this study was to assess the effects of ligation and excision of femoral artery pseudoaneurysm without revascularization in intravenous drug abusers presenting in the tertiary care center.MethodsThis was a retrospective study conducted at Shaheed Mohtarma Benazir Bhutto Institute, Karachi, Pakistan, and included 119 patients admitted for vascular injuries of the groin between June 2016 and June 2020. Data collected from the hospital's medical records included all intravenous drug addicts presented with mass near or at groin area only, while other pseudoaneurysm locations secondary to vascular trauma, arteriovenous fistula, and hemodialysis were excluded. SPSS Version 20.0 (IBM Corp., Armonk, NY, USA) was used for data analysis.ResultsThis study included 119 patients, all of whom presented and admitted to the Accident and Emergency Department, with a mean age of about 32 years ± 11.34 years and a mean duration of addiction of 2.47 years ± 1.37 years. Males constituted 83.2% of the patients, while females constituted 16.8%. The left femoral artery was affected more commonly than the right femoral artery, with an average of 75.6% and 24.4%, respectively. The most common presentation was bleeding from ruptured pseudoaneurysm (76.5%) and oozing with pulsatile mass (17.6%), while infected pulsatile swelling and misdiagnosis were uncommon. After surgical intervention, limb salvage was 95.8%, whereas mortality and amputation rate were 2.5 % and 1.7%, respectively.ConclusionThe optimal management of femoral artery pseudoaneurysm in intravenous drug addicts is ligation and excision of the pseudoaneurysm without revascularization.

A fatal case of right subclavian artery aneurysm due to takayasu's arteritis presenting as brachial plexopathy

A 36-year-old lady presented with insidious onset, gradually progressive neuropathic pain, sensory loss, and weakness of the right upper limb. Her brachial, ulnar, and radial pulses were not palpable on the right side and feeble on the left. She had an irregular, ill-localized 8 cm × 6 cm pulsatile swelling in the right supraclavicular region with thrill on palpation and bruit on auscultation. Motor system examination revealed grade 4 power with wasting of thenar muscles. Nerve conduction studies were suggestive of pan-brachial plexus involvement. Computed tomography angiogram images revealed thickening of the aortic arch, irregular narrowing of the descending aorta, and aneurysm of the right subclavian artery. She was diagnosed to be suffering from right brachial plexopathy due to compression by aneurysm of the right subclavian artery secondary to Takayasu's arteritis. The case is rare as no such presentation has been reported earlier.

Ruptured True Common Femoral Artery Aneurysm and Operative Management

An 81-year-old male with past surgical history significant for right common femoral to posterior tibial artery bypass as well as aortic aneurysm repair using endograft presented with painful pulsatile right groin swelling. Ultrasound imaging revealed a fluid collection and concern for ruptured right common femoral artery aneurysm with expanding hematoma. The patient underwent prompt aneurysm excision with graft interposition complicated by wound dehiscence for which he subsequently underwent wound exploration, revision of proximal anastomosis and sartorius myoplasty. Our case illustrates a rare form of femoral artery rupture and operative management of a true common femoral artery aneurysm.

Outcome of Extracranial Carotid Pseudoaneurysm Surgery: A Retrospective Study

Introduction Extracranial carotid pseudoaneurysm (ECPA) is commonly associated with blunt or penetrating trauma and can result in thromboembolic event, cranial nerves palsies, rupture and hemorrhage. Due to the limited number of large studies, safety and efficacy of surgical and interventional management of ECPA is not well characterized. Open surgery with resection of pseudoaneurysm with end-to-end anastomosis or interposition graft is currently the preferred method of management. The aim of this study is to study the demographics, etiopathogenesis, presentation and outcome after surgical intervention of ECPA at our center.
 MethodsAll patients who underwent surgery for carotid pseudoaneurysm form June 2012 to December 2019, at Department of Cardiothoracic and Vascular Surgery were included in this retrospective chart review study after evaluation of the hospital record book and electronic medical record. Patients who had stroke or cranial nerve injury before surgery, were excluded from this study.
 ResultsFifteen patients met the inclusion criteria. Male to female ratio was 11:4. Mean age of presentation was 38.17±18.98 years. All patients presented with tender and pulsatile neck swelling. Common carotid artery involvement was more common. Three patients suffered from stroke postoperatively, and all of these patients died, however, one patient with stroke died due to reasons not related to pseudoaneurysm. Two patients suffered cranial nerve injury and ten patients had no other disabling complications.
 ConclusionECPA is an uncommon but a serious disease and ischemic stroke after surgery is associated with high mortality.

Outcome of Extracranial Carotid Pseudoaneurysm Surgery: A Retrospective Study

Introduction: Extracranial carotid pseudoaneurysm (ECPA) is commonly associated with blunt or penetrating trauma and can result in thromboembolic event, cranial nerves palsies, rupture and hemorrhage. Due to the limited number of large studies, safety and efficacy of surgical and interventional management of ECPA is not well characterized. Open surgery with resection of pseudoaneurysm with end-to-end anastomosis or interposition graft is currently the preferred method of management. The aim of this study is to study the demographics, etiopathogenesis, presentation and outcome after surgical intervention of ECPA at our center. Methods: All patients who underwent surgery for carotid pseudoaneurysm form June 2012 to December 2019, at Department of Cardiothoracic and Vascular Surgery were included in this retrospective chart review study after evaluation of the hospital record book and electronic medical record. Patients who had stroke or cranial nerve injury before surgery, were excluded from this study. Results: Fifteen patients met the inclusion criteria. Male to female ratio was 11:4. Mean age of presentation was 38.17±18.98 years. All patients presented with tender and pulsatile neck swelling. Common carotid artery involvement was more common. Three patients suffered from stroke postoperatively, and all of these patients died, however, one patient with stroke died due to reasons not related to pseudoaneurysm. Two patients suffered cranial nerve injury and ten patients had no other disabling complications. Conclusion: ECPA is an uncommon but a serious disease and ischemic stroke after surgery is associated with high mortality.

Endovascular management of internal carotid artery pseudoaneurysms: Retrospective observational study

Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) are caused by multiple etiological factors and can involve any segment. There are no clear guidelines to select treatment options in managing these cases. A retrospective review of all patients treated for ICA PSAs by endovascular treatment was conducted. Details of clinical presentations, imaging modalities, angiographic findings and endovascular treatment were noted. Four male (57%) and three female (43%) patients were treated. Their ages ranged from ten months to 52 years old. Five patients had cervical ICA PSAs, and one patient each had PSA of petrous and paraclinoid ICA segment. Five patients had traumatic etiology, one patient had post-infective mycotic and one patient had iatrogenic PSA. The most common presentation was pulsatile neck swelling (n = 5). Two patients (n = 2) presented with massive bleeding, one patient had stroke with aphasia and transient limb weakness, while the patient with petrous PSA had tinnitus and ear pain. Parent artery occlusion (PAO) was performed in six patients (n = 6). In three patients (n = 3), we used stent grafts to trap the ICA. Two patients (n = 2) underwent PAO with coils. In one patient, we used liquid embolic agent (Histoacryl) for PAO. An aneugraft pericardium covered stent was used in one patient. All patients experienced good angiographic results, without any neurological complication. There was no re-canalization of the aneurysm on follow ups. Endovascular approach is a feasible treatment option, with multiple alternative occlusion techniques and a low complication rate. PAO still remains a simple, safe, effective treatment in selective patients.

‘Spontaneous graft pseudoaneurysm presenting a decade after carotid-subclavian bypass’: an extremely rare complication detected on CT

A 61-year-old man who had undergone a right carotid-subclavian bypass with saphenous vein homograft for symptomatic right ostio-proximal subclavian artery (SCA) occlusion 10 years ago, presented with gradually progressive pulsatile...

Non-traumatic Dorsalis Pedis Artery Aneurysm

A true dorsalis pedis artery aneurysm is a very rare find. This is a case presentation of a patient with an asymptomatic non-traumatic dorsalis pedis artery aneurysm. A 49-year-old man was referred to the vascular lab for evaluation of an asymptomatic non-traumatic pulsatile lump on the dorsal aspect of his left foot. The patient reported that the lump had been present for at least 4 years. Color flow duplex ultrasound was used to evaluate the lump. Color flow duplex ultrasound examination of the lump demonstrated a dilatation of the dorsalis pedis artery, measuring approximately 1.05 cm by 1.35 cm. Mural thrombus is noted in gray scale image. Normal Doppler flow was noted in the dorsalis pedis artery, proximal, and distal to the aneurysm. The patient was referred to a vascular surgeon. Subsequently, he underwent a lower extremity arteriogram confirming the diagnosis of a dorsalis pedis artery aneurysm, with good distal blood flow to the toes. The patient underwent resection of the dorsalis pedis artery aneurysm. Reverse great saphenous vein was used as an interposition graft. Follow-up graft scans demonstrated good flow in the graft and in the native artery, distal to the graft. True dorsalis pedis artery aneurysms are very rare finding. When left untreated, the patient is at risk for embolization to the digits. Color flow Doppler is a very useful tool in diagnosing and assessing these aneurysms.

Pulsatile Swelling of Umbilicus in a Cyanotic Neonate

Pulsatile Swelling of Umbilicus in a Cyanotic Neonate

Solitary plasmacytoma of occipital bone

We report a case of a 35-year-old male who presented with a pulsatile swelling in the posterior parieto-occipital area. CT and MRI revealed an extra-axial mass. Gross total resection was performed. Histologically it was found to be a plasmacytoma. No recurrence has been noted in the last 48 months of follow up.

Degenerated Conduit Post–Tetralogy of Fallot Repair Presenting as Pulsatile Subcutaneous Swelling

Degenerated Conduit Post–Tetralogy of Fallot Repair Presenting as Pulsatile Subcutaneous Swelling

Case of Mycotic Pseudoaneurysm of the Common Carotid Artery due to Salmonella typhi Bacteremia

Aneurysm of the extracranial carotid artery is a rare disease, mycotic pseudoaneurysms being even less common. They are a life-threatening complication of systemic infection and atherosclerosis. Immunocompromised people, including patients with HIV, uncontrolled diabetes melltus, those on immunosuppressants like high-dose steroids, and chemotherapy, are at a higher risk for development of mycotic pseudoaneurysms. Due to the high risk of potential complications like rupture and thromboembolic events, mycotic aneurysms always require surgical management. Early detection followed by restoration of blood flow is critical to minimize a fatal outcome. Here we report the case of a 52-year-old man with a past history of hypertension and dyslipidemia who presented with a pulsatile painful neck swelling. On evaluation, the patient was diagnosed to have Salmonella typhi bacteremia, HIV infection, and a mycotic aneurysm of the left common carotid artery.

Arteries gone astray: Adult presentation of arterial tortuosity syndrome

Arterial tortuosity syndrome (ATS) is a rare genetic arteriopathy with tortuosity of large- and medium-sized arteries, transmitted in an autosomal recessive fashion. Over the years, better cross-sectional imaging has heightened the chances of diagnosing this entity. So far, less than hundred cases have been reported in literature. Most of these are seen in infants and children. A 36 year old lady presented to us with a pulsatile swelling in the right supraclavicular region. She was diagnosed to have ATS based on her imaging characteristics. As she had no significant vascular compromise, she was reassured and advised yearly follow-up.

Giant aneurysm of the ileocolic artery presenting as abdominal mass

An aneurysm of the abdominal splanchnic artery is a relatively rare vascular disorder. Since it is characterized by nonspecific clinical manifestations, an aneurysm in this uncommon location is usually diagnosed following complications. A 55-year-old female presented with a pulsatile lump in her right iliac fossa. Contrast-enhanced computerized tomography diagnosed it as aneurysm of the superior mesenteric artery (SMA). However, on exploration, SMA was found to be free, and the aneurysm was seen to be arising from the ileocolic artery ending in the appendicular branches. Ligation followed by excision of the sac along with the cecum and appendix was done followed by ileoascending anastomosis. Isolated aneurysms of the SMA branches are rare. Most cases are diagnosed after the occurrence of complications. Due to the high risk of rupture and ligation, they can interrupt the circulation to the target organs, and therefore, surgery is indicated even in the absence of complications.

Challenges of Management of Arteriovenous Malformation of the Pinna in a Low Resource Setting: A Case Report

Arteriovenous Malformation (AVM) is a lesion of vascular development characterized by an abnormal communication between an artery and a vein without an intervening capillary bed. AVM of the pinna is very rare with very few reported cases in Africa. Management of an AVM is often daunting, most especially in a resource challenged centre like ours where facilities for super selective embolization are not available. We present the case of a 17-year-old female with a pulsatile swelling of the left pinna since childhood. Clinical and radiological diagnosis of arteriovenous malformation was made. She was managed surgically with left external carotid artery ligation, partial auricular resection and postauricular scalp rotation flap cover of the cartilage remnant. The aetiopathogenesis, clinical presentation, diagnostic confirmation and treatment options are discussed. We also discuss the challenges of managing AVM in poor resource settings like ours.

Pulsatile Temporal Swelling—Successful Removal of a True Superficial Temporal Artery Aneurysm

True superficial temporal artery aneurysms are rare, while pseudo-aneurysms are more common. We report the case of a 43-year-old gentleman who had a pulsatile swelling in the right pre-auricular region with no history of trauma. He underwent an uneventful and curative surgical excision of the aneurysm.

Mycotic Aneurysm of Brachial Artery Secondary to Infective Endocarditis

IntroductionThis case describes a brachial artery mycotic aneurysm (BAMA) secondary to infective endocarditis caused by Enterococcus faecalis. BAMAs are rare and potentially limb or life threatening. A literature review revealed 61 cases since 1950, primarily caused by intravenous drug use, with Staphylococcus aureus being the most common causative bacteria.ReportA 71 year old man with known infective endocarditis presented with pulsatile swelling in his right antecubital fossa. A BAMA was confirmed on duplex scan. The patient underwent prompt extra-anatomic bypass with an ipsilateral cephalic vein graft.DiscussionBacterial endocarditis should be acknowledged as a cause of BAMA. Prompt diagnosis and intervention are essential.