1/23. Prenatal detection of a giant bilateral thoracic vascular lesion: prognostic evaluation and genetic aspects.We describe a giant bilateral vascular mass in the skin of the chest diagnosed by ultrasound investigation in a fetus of 20 gestational weeks. Ultrasound and colour Doppler investigations detected no signs of early congestive heart failure but rapid and excessive enlargement of the vascular mass. Indications of increased fetal blood volume were found. The fetus had additional minor anomalies. Early in utero manifestation suggests a severe vascular malformation.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/23. Arteriovenous shunting in a giant renal angiomyolipoma. A rare condition.We report a case of a 33-year-old woman with tuberous sclerosis and bilateral angiomyolipomas. She suffered from acute left flank pain due to retroperitoneal haemorrhage. During renal arteriography an arteriovenous shunting was found in the left tumour. angiomyolipoma is a rare cause of angiographically demonstrable arteriovenous shunting.- - - - - - - - - - ranking = 0.8keywords = giant (Clic here for more details about this article) |
3/23. Rare complication of massive hemorrhage in neurofibromatosis with arteriovenous malformation.Neurofibromatosis is rare in the general population. Its clinical manifestations are systemic and variable. The clinical presentation of cutaneous lesions is even more variable. Some patients have giant tumors in the trunk or limbs (so-called "elephant neurofibromatosis"). The pathological findings are diffuse neurofibromatosis of the nerve trunk associated with overgrowth of subcutaneous tissue and skin. The associated vascular malformations make most surgeons hesitant to address them because bleeding to death is possible if the bleeding is not well controlled. According to the authors' experience in treating this complication of neurofibromatosis, they noted that there are three key points to reducing the amount of hemorrhage to a minimal level: (1) hypotensive anesthesia, (2) preliminary sutures around the lesion, (3) ligation of the limited numbers of feeding vessels in the vascular malformation of the neurofibroma. Ligating these pedicles can decrease bleeding during resection of the neurofibroma, as demonstrated in their patient.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
4/23. Transcatheter occlusion of a large pulmonary arteriovenous malformation with use of a Cardioseal device.Large pulmonary arteriovenous malformations (PAVMs) carry a significant risk of neurologic complications and present technical difficulties in transcatheter treatment with use of coils or detachable balloons. A 26-year-old man with a giant PAVM, who had undergone unsuccessful attempted closure with use of a Gianturco-Grifka occlusion device in the past, underwent successful transcatheter embolization with two Cardioseal double umbrella devices designed for occlusion of intracardiac communications. The procedure was technically easy, had no complications, and provided sustained improvement in arterial saturation and exercise tolerance during follow-up. Transcatheter double umbrella device occlusion of large arteriovenous malformations is feasible and should be considered, especially for very large fistulas.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
5/23. Incidentally discovered giant renal arteriovenous malformation.A case is presented of giant renal arteriovenous malformation (AVM). A 61-year-old woman was admitted to the National Defense Medical College Hospital for further evaluation of a renal cyst. Doppler ultrasonography and magnetic resonance imaging revealed a giant renal AVM, although the patient had no history nor clinical sign suggesting an AVM. Under the diagnosis of a right renal AVM, the patient underwent AVM resection.- - - - - - - - - - ranking = 1.2keywords = giant (Clic here for more details about this article) |
6/23. Treatment of a giant orbitofacial vascular malformation and ophthalmic artery aneurysms with intralesion glue injections: case report.We describe a giant left orbital vascular malformation that was treated with both percutaneous and transarterial embolization. Feeder artery aneurysms thrombosed as a result of retrograde reflux of embolic material into the distal ophthalmic artery. In this presentation, we emphasize the efficacy of percutaneous embolization and retrograde thromboses of two intradural saccular ophthalmic artery aneurysms.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/23. proteus syndrome.A 34-year-old male patient was referred with a recalcitrant leg ulcer overlying an extensive vascular malformation, which had led several times to septic soft tissue infections. During his infancy he had been diagnosed to have Klippel-Trenaunay syndrome. Clinical examination revealed asymmetric hypertrophy of the lower extremities, an extensive portwine stain on the more severely affected left limb as well as prominent venous varicosities of both legs. Hands and feet showed striking cerebriform palmoplantar hypertrophy, and macrodactily with syndactily of several fingers. All toes had been amputated in early childhood due to extreme overgrowth and currently the patient walked on his forefeet in a prominent pes equinus deformity. Further symptoms consisted in several lipomas at both arms, another portwine stain at the left hemithorax and a single cafe-au-lait spot at the left scapula. Angio-magnetic resonance imaging scans of both legs showed an extensive venous-lymphatic vascular malformation involving the whole subcutis and infiltrating the muscle. The chronic wound was interpreted as venous stasis ulceration. Local percutaneous sclerotherapy of the dilated veins underneath the ulcer was discussed, but considered to carry a relevant risk of skin necrosis with consecutive progression of the wound. A conventional split-skin graft led to complete wound healing. Since, the patient consequently wears custom-made compression stockings and remained free from recurrences. The syndromatic constellation of palmoplantar overgrowth, multiple lipomas, giant fingers and toes, limb overgrowth, venous-lymphatic malformation and a cafe-au-lait spot led to the diagnosis of proteus syndrome. The possible aetiology, clinical manifestations, differential diagnosis and management of this rare disorder are discussed.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
8/23. Giant spinal perimedullary fistula in hereditary haemorrhagic telangiectasia: diagnosis, endovascular treatment and review of the literature.Hereditary hemorrhagic telangiectasia (HHT, Rendu-Osler-Weber disease) is a vascular disorder with dominant autosomal transmission characterised usually by multiple mucocutaneous and visceral abnormalities. Neurological manifestations due to the primary involvement of spinal cord by vascular malformations are rare. We present a young man with HHT associated with a central nervous system arteriovenous malformation and a giant perimedullary fistula, that was manifested as progressive myelopathy. The diagnosis was made coupling magnetic resonance imaging to selective spinal arteriography. The therapeutic option was endovascular treatment by mechanically detachable coils which resulted in full exclusion of the fistula with full improvement of symptoms. During follow-up a stable clinical and morphological outcome was achieved. Clinical manifestations in HHT, with emphasis on neurological symptoms, are reviewed as well as the therapeutic options to deal with giant perimedullary fistula.- - - - - - - - - - ranking = 0.4keywords = giant (Clic here for more details about this article) |
9/23. Surgical excision of giant cerebellar hemispheric arteriovenous malformations following preoperative embolization. Report of two cases.The authors present two cases of giant cerebellar hemispheric arteriovenous malformation (AVM) managed with staged preoperative embolization and surgical resection. A new embolization technique is described, combining injection of estrogen alcohol and polyvinyl acetate into AVM's by superselective catheterization of feeding arteries. Polyvinyl acetate proved to be an ideal liquid embolic material; because it polymerizes quickly and remains in a gelatinous state after injection, there was no difficulty in cutting and retracting the obliterated AVM during surgery. Intraoperative digital subtraction angiography was useful for confirming complete excision of the large and complex AVM.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/23. Interventional embolization of a giant pulmonary arteriovenous malformation with right-left-shunt associated with hereditary hemorrhagic telangiectasia.A 46-year old woman experienced an episode of arterial desaturation despite administration of 100% oxygen during anesthetization for an elective laparoscopy. Further evaluation revealed a giant pulmonary arteriovenous malformation (PAVM) with right-left shunt associated with previously undiagnosed hereditary hemorrhagic telangiectasia (HHT, Morbus Osler- Weber-Rendu). The PAVM was treated interventionally with an Amplatzer duct occluder. Transcatheter embolization of the PAVM was well tolerated with symptomatic and hemodynamic improvement. CT scan after six months demonstrated correct position of the duct occluder in the left pulmonary artery with nearly complete occlusion of the feeding vessel.PAVMs are rare direct communications between pulmonary arteries and veins, associated with HHT in the majority of cases and often presenting with dyspnea or major neurological complications due to paradoxic embolism. In this case report, we present a rational and stepwise diagnostic workup for this rare medical condition and show that transcatheter embolization is an appropriate treatment for larger malformations.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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