Cases reported "Vascular Diseases"

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1/14. Inferior vena cava hypoplasia with intrahepatic venous continuation: sonographic, angiographic and MR features including MR angiography.

    In cases of inborn or acquired obstacles on the inferior vena cava (IVC), the derived blood flow usually goes through collaterals in the azygos or the hemiazygos venous systems. Exceptionally, a collateral pathway through the portal system or through an anastomosis in between hepatic veins, shunting the IVC interruption, is encountered. In the present paper, the authors describe the fortuitous discovery of a IVC hypoplasia in its retrohepatic segment. MR venography, correlated with fluoroscopic angiography, clearly depicted an intrahepatic collateral circulation consisting of a double aneurysmal communication between an inferior right hepatic vein and the main right hepatic vein.
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2/14. Pancreaticoportal fistula in association with antiphospholipid syndrome presenting as ascites and portal system thrombosis.

    Fistulous communication between the pancreas and the portal venous system is extremely rare and is usually a complication of chronic pancreatitis or pancreatic pseudocysts. A patient who presented with abdominal pain and ascites secondary to a pancreaticoportal fistula and portal system thrombosis is described. The diagnosis was made by endoscopic retrograde cholangiopancreatography and confirmed by immediate postprocedure computed tomographic scanning. Laboratory studies identified concomitant antiphospholipid syndrome. The patient responded favourably to supportive medical therapy.
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3/14. dialysis access-associated steal syndrome: the intraoperative use of duplex ultrasound scan.

    dialysis access-associated steal syndrome (DASS) is an uncommon but serious complication after the creation of an arteriovenous shunt for hemodialysis and is related to an excess perfusion of the fistula. Several surgical options have been described for DASS correction. To achieve an adequate distribution of the blood flow towards the fistula and the hand, intraoperative duplex ultrasound scan monitoring was used in this preliminary communication to control the surgical reduction of volume flow through the fistula. The shunt flow was not estimated with direct insonation of the shunt but calculated from the difference of the bilateral subclavian artery volume flow rates. This new technique has several advantages over a direct shunt evaluation that are discussed in this report. Three patients with DASS are described in whom the technique was successfully applied and led to a normalization of the hand perfusion and to the maintenance of a long-term patency of the fistula.
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4/14. Reversed intrapulmonary right-to-left shunt after banding of the patent ductus venosus.

    Diffuse pulmonary microvascular arteriovenous communication developed in an 8-year-old girl with a patent ductus venosus. Tc-99m macroaggregated albumin (MAA) pulmonary perfusion scintigraphy with total-body imaging demonstrated multiple lung perfusion deficits and abnormal tracer uptake in systemic organs with hepatic radioactivity greater than the kidneys, suggesting the presence of right-to-left shunt and abnormal hepatic hemodynamics. I-123 iodoamphetamine transrectal portal scintigraphy revealed a large portosystemic venous shunt. The follow-up Tc-99m MAA perfusion scans after banding of the patent ductus venosus revealed partial improvement of the perfusion deficits and right-to-left shunt, indicating the possible reversibility of this pulmonary shunt complication.
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5/14. Progressive growth of a pelvic collection five years after endovascular aneurysm repair: an atypical presentation of an asymptomatic contained rupture.

    We report a case of an unusual and late presentation of an asymptomatic contained rupture after modular stent-graft implantation to treat an aortobiiliac aneurysm. Follow-up computed tomography (CT) scans 4 and 5 years after endovascular aneurysm repair showed a homogeneous, nonenhancing, but clearly growing, pelvic collection. CT-guided drainage of the collection was performed, and cultures of the evacuated brown fluid were negative for any infection. Control CT scan after drainage showed a complete collapse of both the collection and the previously excluded iliac aneurysms. A direct communication between the sterile pelvic collection and the excluded iliac aneurysm was suggested on this CT imaging and confirmed afterwards by surgery. From these imaging and surgical findings, this pelvic collection can be considered as an atypical presentation of an asymptomatic contained rupture of the excluded aneurysm.
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6/14. Systemic to pulmonary venous communication in the superior vena caval syndrome.

    A case of superior vena caval obstruction due to bronchogenic carcinoma is presented. upper extremity venography demonstrated shunting of contrast media from systemic veins to the right pulmonary veins. This collateral pathway has been previously described in the superior vena caval syndrome. A proposed mechanism for this flow pattern is discussed.
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7/14. The left ascending lumbar vein: a potential pitfall in CT diagnosis.

    A communication between the left ascending lumbar vein and the left renal vein may be mistaken for a para-aortic mass on abdominal computed tomography due to a localised dilatation at the confluence of these veins. The use of contiguous closely collimated sections and the injection of intravenous contrast medium overcomes this potential pitfall which may be particularly important in the staging of patients with testicular neoplasms.
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8/14. The possibilities of real-time sonography in the diagnostics of peripheral pulsating resistances. Our experiences of some cases.

    Real-time sonography was performed in 5 patients in 7 cases for peripheral pulsating resistances. The change developed in the inguinal fold in one case after arteriography and in 3 patients following a vascular operation. In an additional case, a pulsating mass located in the neck proved to be the kinking of the subclavian artery. After a brief literary review of the ultrasound-diagnostics of the vessels, the authors have found sonography a suitable means for judging the relationship between the vessel or graft and the pseudoaneurysm, the size of the communication and eventual thrombus formation.
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9/14. Tracheoinnominate artery fistula as a complication of radiation therapy.

    Tracheoinnominate artery fistulization is a well-known complication of tracheostomy and of tracheal resection. The first known occurrence of this problem in a patient in whom no transtracheal procedure had ever been performed is reported, and high-dose radiation therapy delivered three years before for a mediastinal malignancy is suggested as the cause. No evidence of tumor was found in or adjacent to the tracheovascular communication. The tracheoinnominate artery fistula must be considered a potential complication of radiation therapy as well as of surgery.
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10/14. Successful management of acute traumatic duodenocaval fistula.

    Acute traumatic duodenocaval fistula is a devastating injury, usually resulting in early exsanguination and death due to lack of retroperitoneal tamponade of vena caval bleeding. Early recognition of possible entericvascular communication and rapid transport to the operating room are prerequisites for successful management of this rare injury.
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