Cases reported "Aneurysm"

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1/451. Popliteal venous aneurysm mimicking a soft tissue tumour. A case report.

    A case of a giant, thrombosed popliteal venous aneurysm without pulmonary embolism in a 53-year-old woman is reported. Despite thorough preoperative investigation including ultrasound and magnetic resonance imaging, this was misdiagnosed as a benign soft tissue tumour. During the operation the thrombosed venous aneurysm was resected and a vein graft from the contralateral saphenous vein was interposed. Popliteal venous aneurysm is a rare entity, presenting occasionally with local signs and symptoms and more often with pulmonary embolism. The clinician should therefore keep this in mind whenever dealing with a large, soft tissue popliteal fossa mass or looking for the cause of recurrent pulmonary embolism.
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2/451. pulmonary artery aneurysm.

    Main pulmonary artery aneurysm is an exceedingly rare entity. We present a case of main pulmonary artery aneurysm with patent ductus arteriosus in a sixty-year-old woman. The aneurysm was successfully treated with aneurysmectomy and primary anastomosis of the defect of the main pulmonary artery, and the patent ductus arteriosus was divided. The etiology, operative indication and surgical intervention of main pulmonary artery aneurysm are discussed along with a review of the literature.
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3/451. Aneurysms and hypermobility in a 45-year-old woman.

    EDS type IV presents a diagnostic and therapeutic challenge to the primary care physician, surgeon, and rheumatologist. In patients for whom the diagnosis is known, avoidance of trauma, contact sports, or strenuous activities, joint bracing and protection, and counseling on contraception are helpful preventive strategies. In patients presenting with vascular, gastrointestinal, or obstetric complications, a history of hypermobility and skin fragility (easy bruising, abnormal scarring, poor wound healing) should lead to a suspicion of this diagnosis, and to caution in the use of certain invasive diagnostic and operative techniques. Efforts should be made to examine family members. Most importantly, when caring for such patients, the acute onset of headaches, chest pain, shortness of breath, and abdominal pain should arouse suspicion of a potentially catastrophic vascular or visceral event.
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4/451. Aneurysm of the vertebral artery near the atlas arch.

    In this case report, we describe an nontraumatic extracranial aneurysm of the vertebral artery at the V3 segment. Its etiology and pathogenesis could not be clarified completely. The walnut-sized aneurysm was treated surgically by proximal ligation. There were no postoperative complications.
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5/451. Two-stage repair of a combined aneurysm of the descending aorta and the aberrant right subclavian artery.

    In cases of combined aneurysms of the descending aorta and the aberrant right subclavian artery a common surgical strategy has not been clearly elaborated. In this report the case of a 76-year-old male patient with this rare combination of aneurysms is presented. The surgical strategy consisted of a two-stage approach for repairing both aneurysms maintaining the perfusion of the right subclavian and vertebral artery, finally providing an excellent postoperative result even in a patient of this advanced age.
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6/451. Functional, life-threatening disorders and splenectomy following liver transplantation.

    splenectomy (SPL) in cirrhotic patients undergoing liver transplantation (LTx) may resolve specific problems related to the procedure itself, in case of functional and life-threatening clinical situations often occurring as a result of liver cirrhosis and portal hypertension. METHOD: A single-center experience of ten splenectomies in a series of 180 consecutive adult liver transplant patients over a period of 6 yr is reported. The mean patient age was 46.8 /- 9.5 yr (range 25 57 yr). Indications for SPL were post-operative massive ascitic fluid loss (n = 3), severe thrombocytopenia (n = 3), acute intra-abdominal hemorrhage (n = 2), infarction of the spleen (n = 1), and multiple splenic artery aneurysms (n = 1). RESULTS: Extreme ascites production due to functional graft congestion disappeared post-SPL, with an improvement of the hepatic and renal functions. SPL was also effective in cases of thrombocytopenia persistence post-LTx, leading to an increase in the platelet count after about 1 wk. Bleeding episodes related to left-sided portal hypertension or trauma were also resolved. The rejection rate during hospitalization was 0%, and no other episodes were recorded in the course of the long-term follow-up. However, sepsis with a fatal outcome occurred in 4 patients, i.e. between 2 and 3 wk post-SPL in three cases and 1 yr after the procedure as a result of pneumococcal infection in the last case. Fatal traumatic cranial injury occurred 3 yr post-LTx in another case. Five patients (50%) are still alive and asymptomatic after a median follow-up period of 36 months. CONCLUSION: The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.
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7/451. Ganglion of the hip joint--we present a logical approach to the exploration of a mass in the femoral triangle.

    hip joint ganglion is a rare cause of a mass in the femoral triangle. Our patient presented with a swelling in the groin and a history of femoral hernia repair 5 years previously. Pre-operative assessment with ultrasound suggested a possible femoral artery aneurysm. We propose that safe exploration of a mass closely related to the femoral vessels must include vascular control.
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8/451. Inferior mesenteric artery aneurysm. Case report.

    This paper reports a large inferior mesenteric artery aneurysm discovered incidentally during the work-up in a male patient with a thoracoabdominal aortic aneurysm. aortography disclosed an aneurysm in the inferior mesenteric artery with a large marginal artery which filled the branches of the coeliac and superior mesenteric arteries retrogradely. The thoracoabdominal aortic aneurysm was reconstructed by a bifurcated aorto-biiliac Dacron graft while inferior mesenteric artery revascularisation was achieved with a PTFE graft, reconstruction being necessary because of its dominant blood supply to all of the viscera. This case highlights the importance of aneurysmal reconstruction when an anomalous arterial supply to the gastrointestinal tract from a dilated inferior mesenteric artery has been demonstrated on a preoperative angiogram.
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9/451. Gastric pseudotumor.

    The authors present a case report of a pseudotumor of the stomach and a brief discussion about this very unusual entity. A 75-year-old female patient was admitted with melena and a large epigastric tumor; she underwent upper gastrointestinal endoscopy, abdominal ultrasound, magnetic resonance imaging, guided needle aspiration and angiography. Preoperative diagnostic hypothesis included a partially thrombosed aneurysm of the splenic artery, pancreatic cystic neoplasm with gastric invasion and pancreatic pseudocyst complicated with hemorrhage. laparotomy revealed a gastric tumor and the patient was submitted to a radical subtotal Billroth II gastrectomy. Only the pathologic examination revealed the unexpected definitive diagnosis of an organized intramural gastric hematoma. There were no postoperative complications and she remains asymptomatic 10 months after surgery.
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10/451. Symptomatic solitary right renal vein aneurysm: a case report.

    Renal vein aneurysms are very uncommon. Those located in the right side are exceptional. A symptomatic, solitary, voluminous aneurysm of the right renal vein in a 33-year-old man is reported. The lesion was diagnosed preoperatively as a renal tumor. The pathologic study of the nephrectomy specimen disclosed a thrombosed saccular aneurysm measuring 5.5 cm with marked medial atrophy of its wall. Recognition that a mass like this reported is of vascular origin is very important to avoid percutaneous biopsy which could be potentially hazardous; and for undertaking conservative prophylactic surgery. Renal venography is indicated for the diagnosis of these lesions.
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