MyMedR

A rare case of mycotic pseudoaneurysm in a patient post Rastelli procedure with infective endocarditis

Chua C, Then K, Mohd Khalid KF

Cardiol Young, 2023 May;33(5):827-828.

PMID: 36511131 DOI: 10.1017/S1047951122002931

Mycotic pseudoaneurysm secondary to infective endocarditis is an uncommon complication in CHD with conduit placement. We report a case of late presentation of bacterial infective endocarditis with pseudoaneurysm in an 8-year-old girl with underlying pulmonary atresia with ventricular septal defect, post Rastelli procedure done at the age of 3 years old.

Matched MeSH terms: Aneurysm, False*

Fulltext Novel technique using amplatzer AVP I stent in management for giant renal artery pseudoaneurysm

Sarmukh S, Putera MP, Tan KL, Chew LG

Urol Case Rep, 2021 Mar;35:101515.

PMID: 33318942 DOI: 10.1016/j.eucr.2020.101515

Renal artery pseudoaneurysm (RAP) is an uncommon vascular lesion. Early detection and treatment of renal artery pseudoaneurysm is important because it can rupture and lead to life-threatening hemorrhage. Recent advances in endovascular interventions can prevent potentially challenging open surgery. We describe a case 66 year old patient who presented with a painful abdominal lumbar mass. CT scan show a giant renal artery pseudoaneurysm. We discuss management of giant renal artery pseudoaneurysm, both open surgery and endovascular surgery. Endovascular arterial embolization and stent techniques is feasible. However, open surgical treatment remains to be most effective and radical method in emergency setting.

Matched MeSH terms: Aneurysm, False

Fulltext Acute Shortening and Re-Lengthening (ASRL) in Infected Non-union of Tibia - Advantages Revisited

Baruah RK, Baruah JP, Shyam-Sunder S

Malays Orthop J, 2020 Jul;14(2):47-56.

PMID: 32983377 DOI: 10.5704/MOJ.2007.012

Introduction: A gap non-union in various conditions has been treated successfully by the Ilizarov method. The gap can be filled up either by an acute shortening and re-lengthening (ASRL) procedure or by an internal bone transport (IBT). We compared the functional and clinical outcome of ASRL and IBT in gap non-unions of the infected tibia.

Material and Methods: A retrospective study was conducted in our department from the data collected in the period between 1997 and 2010. There were 86 cases of infected non-union of the tibia, in patients of the age group 18 to 65 years, with a minimum two-year follow-up. Group A consisted of cases treated by ASRL (n=46), and Group B, of cases by IBT (n=40). The non-union following both open and closed fractures had been treated by plate osteosynthesis, intra-medullary nails and primary Ilizarov fixators. Radical debridement was done and fragments stabilised with ring fixators. The actual bone gap and limb length discrepancy were measured on the operating table after debridement. In ASRL acute docking was done for defects up to 3cm, and subacute docking for bigger gaps. Corticotomy was done once there was no infection and distraction started after a latency of seven days. Dynamisation was followed by the application of a patellar tendon bearing cast for one month after removal of the ring with the clinico-radiological union.

Results: The bone loss was 3 to 8cm (4.77±1.43) in Group A and 3 to 9cm (5.31± 1.28) in Group B after thorough debridement. Bony union, eradication of infection and primary soft- tissue healing was 100%, 85% and 78% in Group A and 95%, 60%, 36% in Group B respectively. Nonunion at docking site, equinus deformity, false aneurysm, interposition of soft-tissue, transient nerve palsies were seen only in cases treated by IBT.

Conclusion: IBT is an established method to manage gap non-union of the tibia. In our study, complications were significantly higher in cases where IBT was employed. We, therefore, recommend ASRL with an established protocol for better results in terms of significantly less lengthening index, eradication of infection, and primary soft tissue healing. ASRL is a useful method to bridge the bone gap by making soft tissue and bone reconstruction easier, eliminating the disadvantages of IBT.

Matched MeSH terms: Aneurysm, False

Uterine artery pseudoaneurysm: A case of late intra-abdominal haemorrhage after caesarean section

Soe L, Thidar S, Myat SY, Christine Mui FL, Sue Marie CKP, Tin MN

Med J Malaysia, 2020 05;75(3):298-300.

PMID: 32467549

Uterine artery pseudoaneurysm (UAP) is a rare acquired vascular malformation associated with vaginal bleeding or intraabdominal haemorrhage occurring after pelvic surgery. Pseudoaneurysm may present with delayed, severe haemorrhage after a seemingly uncomplicated initial postoperative period. Treatment is therefore necessary to prevent further complications. We describe here a case of a 32-year-old mother, who presented with abdominal pain and intraabdominal bleeding, 20 days after Caesarean Section. Computerised Tomography (CT) scan showed the presence of haemoperitoneum, suggestive of pseudoaneurysm at the right cervical artery which was successfully managed with emergency angiographic embolisation.

Matched MeSH terms: Aneurysm, False/diagnosis*; Aneurysm, False/surgery

Fulltext Superficial femoral artery thrombosis after midshaft femoral fracture fixation with an intramedullary nail: a case report

Ramachandran Rubenandran, Rampal Sanjiv, Sivalingarajah Prema, Tan Eng Kee, Devaraj Navin Kumar

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):316-318.

MyJurnal

Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dread- ed complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.

Matched MeSH terms: Aneurysm, False

Fulltext A non-surgical management of delayed diagnosis of an oesophageal perforation due to ingestion of okra: a case report

Rosmadi Ismail, Ummi Affah Mahamad, Abdul Aziz Marwan

Malaysian Journal of Medicine and Health Sciences, 2020;16(108):87-89.

MyJurnal

Oesophageal perforation is a not uncommon condition, yet it carries a high mortality rate and has been observed as the most grievous trauma to the digestive tract. Common causes include iatrogenic instrumentation, foreign-body swallowing, and physical injury. This report highlighted a case of oesophageal perforation complicated by formation of proximal descending aorta pseudoaneurysm as a result of okra ingestion. The patient was successfully treated with conservative treatment. The possible mechanism of oesophageal rupture, diagnosis, treatment, and other complica- tion will be further discussed.

Matched MeSH terms: Aneurysm, False

Fulltext Ankle pseudoaneurysm: distal posterior tibial artery pseudoaneurysm in a child following blunt trauma

Aimanan K, Chea CH, Lim KY, Damodaran A

BMJ Case Rep, 2019 May 24;12(5).

PMID: 31129637 DOI: 10.1136/bcr-2018-228255

Pseudoaneurysm of the ankle involving the posterior tibial artery is a rare presentation with only four paediatric cases previously reported in English literature. We report a new case following blunt trauma with the clinical presentation and management strategy. A 6-year-old boy presented with a pulsatile swelling at the medial aspect of ankle following a history of blunt trauma 3 weeks ago. Imaging confirmed pseudoaneurysm involving the distal posterior tibial artery. Excision of the pseudoaneurysm was performed without any complication.

Matched MeSH terms: Aneurysm, False/etiology; Aneurysm, False/surgery*

Fulltext Transposed Basilic Vein Fistula: A Credible Option

Leong BD, Zainal AA, Hanif H, Tajri HM, Govindarajantran N, Pillay K, et al.

Ann Vasc Dis, 2018 Jun 25;11(2):223-227.

PMID: 30116415 DOI: 10.3400/avd.oa.18-00018

Objective: Native fistula creation for hemodialysis in patients who have exhausted all their superficial veins presents a challenge to vascular practice. We review our experience in transposed basilic vein fistula (BVT) creation and its usage for hemodialysis. Materials and Methods: We analyzed the hospital operative registry from January 2009 till June 2012 to identify the total number of BVT created in our center. Medical records of all patients were traced, and patients were interviewed using a standard proforma. In our center, BVT is performed as a two-stage procedure. All patients were routinely assessed with duplex scan preoperatively and postoperatively. Results: Two hundred thirty-nine patients were recruited in the study. Of these patients, 50.6% were male and 49.4% were female. Mean age was 53.4 years. Of these patients, 81.2% had history of other previous fistula creation. Risk factors profile includes diabetes mellitus in 59.8%, hypertension in 86.2%, and smoking in 13.0%. Of these patients, 84.5% had no operative complication. Commonest complication was wound infection, 6.3%, followed by hemorrhage or hemotoma required surgical intervention, 5.9%, and pseudoaneurysm, 1.3%. Primary and secondary patencies were at 84.2% and 86.1% at 1 year and 67.7% and 70.5% at 3 years, respectively. Conclusion: BVT is a credible option for challenging patients with absence of superficial veins for native fistula creation with good patency and low operative complication rate. Preoperative ultrasound assessment improves patient selection and outcome of BVT.

Matched MeSH terms: Aneurysm, False

Fulltext Supraclinoid direct carotid-cavernous sinus fistula

Che Ani MF, Kumar R, Md Noh MSF, Muda AS

BJR Case Rep, 2018 Mar;4(3):20170058.

PMID: 31489208 DOI: 10.1259/bjrcr.20170058

Carotid-cavernous fistulas (CCFs) are vascular shunts between the carotid arterial system with direct drainage into the cerebral venous system, mainly to the cavernous sinus. Direct CCF is a well-recognised complication following head trauma. Classically in direct or traumatic CCF, vessel wall tear occurs at the cavernous segment of the internal carotid artery, between the fixed and free segment. Tears at the supraclinoid segment are rare. We report a case of an internal carotid artery supraclinoid segment pseudoaneurysm, with a direct communication with the cavernous sinus, draining into the superior ophthalmic vein.

Matched MeSH terms: Aneurysm, False

Fulltext Role of Uterine Artery Embolization in Pseudoaneurysm of Uterine Artery: A Rare Cause of Secondary Postpartum Hemorrhage

Subramaniam S, Nadarajan C, Aziz ME

Cureus, 2018 Feb 23;10(2):e2220.

PMID: 29692958 DOI: 10.7759/cureus.2220

Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage, although it carries a high mortality rate. The etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. We present a post-cesarean female who developed delayed hemorrhage and was diagnosed with left uterine artery pseudoaneurysm. Selective transcatheter arterial embolization was performed and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and efficient method of treatment of postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Thus, it should be considered as a treatment option before opting for surgery in favorable cases.

Matched MeSH terms: Aneurysm, False

Fulltext A case report of airway stenting in tracheal compression secondary to right subclavian artery pseudo-aneurysm

Muhammad Naimmuddin Abdul Azih, Aishah Ibrahim, How, Soon Hin, Kuan, Yeh Chunn

International Medical Journal Malaysia, 2018;17(1):141-144.

MyJurnal

We report a 55-year old lady with the presentation of stridor and type II respiratory failure requiring tracheal intubation. She had right Horner’s syndrome associated with pleural effusion. Her chest radiograph revealed right upper zone lobulated opacities and therefore right Pancoast tumor was the initial diagnosis. However, her CECT thorax revealed a huge right subclavian artery pseudoaneurysm with severe tracheal compression. This rare condition imposed a significant diagnostic as well as therapeutic challenge. Vascular surgery is the definitive treatment but it is associated with high risks. The exact role of rigid bronchoscopy for airway stenting is unknown due to limited evidence available. Indeed, this form of central airway obstruction may benefit from temporary tracheal stenting whilst the surgical repair of the lesion is planned. It may facilitate early weaning and allows less complicated airway control.

Matched MeSH terms: Aneurysm, False

Idiopathic Internal Thoracic Artery (ITA) Pseudoaneurysm treated with Endovascular Embolization

Wong WJ, Leong BDK, Mak CH

Med J Malaysia, 2017 04;72(2):144-146.

PMID: 28473685 MyJurnal

A 44-year-old female was diagnosed with an ITA pseudoaneurysm in the right supraclavicular fossa. She was successfully treated with endovascular embolization. The challenges of diagnosis and treatment are discussed.

Matched MeSH terms: Aneurysm, False/diagnosis; Aneurysm, False/therapy*

Fulltext Outcome of Pseudoaneurysm repair: a single tertiary center experience in Pahang, Malaysia

Ahmad Faidzal Othman, Mohamad NorHisham, Azmi Abdul Rahman

International Medical Journal Malaysia, 2017;16(11):18-18.

MyJurnal

Symptomatic arterial pseudoaneurysm is not an uncommon emergent
vascular case presenting to a tertiary hospital. These are mainly associated with
infection, iatrogenic puncture or trauma. The resultant morbidity, limb loss and
mortality present a challenge to the surgeons managing these cases. (Copied from article).

Matched MeSH terms: Aneurysm, False

Fulltext Traumatic right proximal subclavian artery pseudoaneurysm treated with a hybrid procedure: A case report

Zaharudin I, Azizi ZA, Govindarajanthran N

Med J Malaysia, 2016 Aug;71(4):220-222.

PMID: 27770128 MyJurnal

Blunt trauma to the right proximal subclavian artery is uncommon and tends to be associated with pseudoaneurysm formation. We report a patient with right proximal subclavian artery pseudoaneurysm after blunt chest trauma following a motor vehicle accident. The condition was successfully treated with a combined insertion of a covered stent and carotid-carotid bypass as a hybrid procedure. Duplex scans at 6 month and 1 year follow-up documented good stent-graft positioning and no pseudoaneurysm recurrence.

Matched MeSH terms: Aneurysm, False*

Traumatic Pseudoaneurysm of Right Extracranial Internal Carotid Artery: A Rare Entity and Recent Advancement of Treatment with Minimally Invasive Technique

Ong JL, Jalaludin S

Malays J Med Sci, 2016 Mar;23(2):78-81.

PMID: 27547119 MyJurnal

The purpose is to describe a case of traumatic right extracranial internal carotid artery (EICA) pseudoaneurysm, which is a rare entity and the evolution of treatment from surgery to minimally invasive intervention by endovascular stenting and coiling. We reported a case of traumatic right EICA pseudoaneurysm who presented with multiple cranial nerve palsies. Multiple radiological examinations [including magnetic resonance imaging (MRI) with angiogram, computed tomography angiogram (CTA), and digital subtraction angiogram (DSA)] demonstrated right EICA pseudoaneurysm. The pseudoaneurysm was successfully treated with endovascular stenting and coiling. EICA pseudoaneurysm is a rare entity, and open surgery was the gold standard of treatment. Current technology allows endovascular stenting and coiling of pseudoaneurysm as an alternative treatment. It is minimally invasive, associated with lesser complications, better recovery and a shorter hospital stay.

Matched MeSH terms: Aneurysm, False

Fulltext Endovascular stent graft repair of aorto-iliac pseudoaneurysms - Hospital Kuala Lumpur experience

Khang NC, Zainal AA

Med J Malaysia, 2016 02;71(1):17-22.

PMID: 27130738

BACKGROUND: This is a single institutional review of aortoiliac pseudoaneurysm of various aetiologies managed with endovascular stent graft repair.

METHODS: From 2009 to 2014, 16 patients had endovascular stent graft inserted for pseudoaneurysm of the thoracic aorta, abdominal aorta and iliac arteries in Hospital Kuala Lumpur. Co-morbidity, causative agents, in-hospital mortality, complications and outcomes were examined.

RESULTS: The average age was 59.1 years (range 36-77). Comorbidities include hypertension, diabetes mellitus, tuberculosis, prior infection and previous open aneurysmal repair. All patients had raised WBC (>10.0x10(9) /L), ESR or Creactive protein on admission while 50% of patients had fever. Blood cultures were positive in 4 patients. All patients were given antibiotics. Only one in-hospital mortality was noted at day-47 post-procedure. Two patients died of aortoenteric fistula at district hospital eight and 16 months later. One patient died of chronic graft infection two years later. One died of unrelated cause. One patient developed type IB endoleak from internal iliac artery two years later and surgical ligation was performed. The average follow up was 15.8 months.

CONCLUSION: Endovascular stent graft repair for pseudoaneurysm is a viable option compared to open surgery. It is less invasive, has lower operative morbidity and fair outcomes. However, some cases may be due to inflammatory aortitis instead of infective pseudoaneurysm, given the frequent culture-negative results. In order to obtain high yield of bacteria culture for infected pseudoaneurysm, open repair with tissue culture is still the main mode of treatment especially for patients with low comorbidity.

Matched MeSH terms: Aneurysm, False/surgery*

Fulltext Spontaneous resolution of asymptomatic hepatic pseudoaneurysm post radiofrequency ablation

Ch'ng LS, Tazuddin EEM, Young B, Ali AFM

BJR Case Rep, 2016;2(2):20150306.

PMID: 30363592 DOI: 10.1259/bjrcr.20150306

Radiofrequency ablation (RFA) of a hepatic tumour is an established treatment option with an acceptable complication rate. Formation of a pseudoaneurysm after RFA of liver metastasis is an uncommon complication. We report the case of a 69-year-old female patient developing a hepatic pseudoaneurysm after RFA of liver metastasis. On a follow-up CT scan 6 weeks later, there was spontaneous resolution of the pseudoaneurysm. Hepatic pseudoaneurysms are usually treated owing to the risk of rupture. Invasive procedures or conservative management of an asymptomatic hepatic pseudoaneurysm is still the subject of debate. The spontaneous resolution of a hepatic pseudoaneurysm in our patient suggests that an asymptomatic pseudoaneurysm maybe observed for resolution instead of being treated at presentation.

Matched MeSH terms: Aneurysm, False

Early Diagnosis of Intrahepatic Pseudoaneurysm during Radiofrequency Ablation using Contrast-Enhanced Ultrasound

Kumar SK, Oon OK, Horgan P, Leen E

Malays J Med Sci, 2015 Nov;22(6):58-62.

PMID: 28223887

Radiofrequency ablation is one of the more established forms of local treatment in patients with unresectable tumours, including colorectal hepatic metastases. Complications associated with this method of intervention include thermal and mechanical injuries, including vascular insults resulting in haemorrhage or pseudoaneurysm formation. This is the first case demonstrating the detection of post-ablation acute pseudoaneurysm formation identified on the table using contrast-enhanced ultrasound (CEUS) and the subsequent successful management.

Matched MeSH terms: Aneurysm, False

Fulltext Avoiding diagnostic pitfalls in mimics of neoplasia: the importance of a comprehensive diagnostic approach

Samsudin EZ, Kamarul T, Mansor A

Singapore Med J, 2015 May;56(5):e92-5.

PMID: 26034328 DOI: 10.11622/smedj.2015082

Any medical diagnosis should take a multimodal approach, especially those involving tumour-like conditions, as entities that mimic neoplasms have overlapping features and may present detrimental outcomes if they are underdiagnosed. These case reports present diagnostic pitfalls resulting from overdependence on a single diagnostic parameter for three musculoskeletal neoplasm mimics: brown tumour (BT) that was mistaken for giant cell tumour (GCT), methicillin-resistant Staphylococcus aureus osteomyelitis mistaken for osteosarcoma and a pseudoaneurysm mistaken for a soft tissue sarcoma. Literature reviews revealed five reports of BT simulating GCT, four reports of osteomyelitis mimicking osteosarcoma and five reports of a pseudoaneurysm imitating a soft tissue sarcoma. Our findings highlight the therapeutic dilemmas that arise with musculoskeletal mimics, as well as the importance of thorough investigation to distinguish mimickers from true neoplasms.

Matched MeSH terms: Aneurysm, False/diagnosis

Fulltext Intracavernous internal carotid artery pseudoaneurysm

Sridharan R, Low SF, Mohd MR, Kew TY

Singapore Med J, 2014 Oct;55(10):e165-8.

PMID: 25631906

Epistaxis is commonly encountered in otorhinolaryngologic practice. However, severe and recurrent epistaxis is rarely seen, especially that originating from a pseudoaneurysm of the intracavernous internal carotid artery (ICA). We herein present the case of a 32-year-old man who was involved in a motor vehicle accident and subsequently developed recurrent episodes of profuse epistaxis for the next three months, which required blood transfusion and nasal packing to control the bleeding. Computed tomography angiography revealed a large intracavernous ICA pseudoaneurysm measuring 1.7 cm × 1.2 cm × 1.0 cm. The patient underwent emergent four-vessel angiography and coil embolisation and was discharged one week later without any episode of bleeding. He remained asymptomatic after three-month and one‑year intervals. This case report highlights a large intracavernous ICA pseudoaneurysm as a rare cause of epistaxis, which requires a high index of suspicion in the right clinical setting and emergent endovascular treatment to prevent mortality.

Matched MeSH terms: Aneurysm, False/etiology*; Aneurysm, False/surgery

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