Extrinsic compression Bow hunter’s stroke

Abstract Objective Myelofibrosis is a rare chronic myelolymphoproliferative disease and is associated with increased risk of venous thromboembolism. The objective of this study is to retrospectively evaluate patients with primary myelofibrosis who underwent abdominal US, MDCT and MRI, in order to identify the development of portal thrombosis and its correlation with portal-biliary cavernoma. Methods We evaluated 125 patients with initial diagnosis of primary myelofibrosis and nonspecific abdominal pain who had undergone US with color Doppler. In 13 patients (8 men, 5 females; age: 45–85), US detected portal thrombosis with associated portal-biliary cavernoma. All patients subsequently underwent contrast-enhanced MDCT and MRI and 4 patients MR-cholangiography. The correlation between primary myelofibrosis and portal thrombosis and cavernoma respectively was calculated using χ2 test. Results About 10% of patients with primary myelofibrosis preliminary evaluated with US had partial (8 pts) or complete (5 pts) portal thrombosis associated with portal-biliary cavernoma with a χ2 = 0. In all patients, US detected a concentric thickening of main bile duct (MBD) wall (mean value: 7 mm); color Doppler always showed dilated venous vessels within the thickened wall of the biliary tract. Contrast-enhanced CT and MRI confirmed thickening of MBD walls with their progressive enhancement and allowed better assessment of the extent of the portal system thrombosis. MR-cholangiography showed a thin appearance of the MBD lumen with evidence of ab extrinsic compression. Conclusions The evidence of portal thrombosis and portal-biliary cavernoma in 10% of the patients with primary myelofibrosis indicates a close correlation between the two diseases. In the detection of portal thrombosis and portal-biliary cavernoma, US with color Doppler is the most reliable and economical diagnostic technique while contrast-enhanced MDCT and MRI allow better assessment of the extent of the portal vein thrombosis and of the complications of myelofibrosis.

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Laparoscopic transposition for crossing vessels (vascular hitch) in pure extrinsic pelvic-ureteric junction obstruction: a successful case report of a 2-year-old infant with horseshoe kidney

Surgical Case Reports ◽

10.1186/s40792-021-01190-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Satoshi Ieiri ◽

Kouji Nagata

Keyword(s):

Laparoscopic Surgery ◽

Left Kidney ◽

Horseshoe Kidney ◽

Renal Scintigraphy ◽

Multicystic Dysplastic Kidney ◽

Extrinsic Compression ◽

Dysplastic Kidney ◽

Renal Vessels ◽

The Right ◽

Crossing Vessels

Abstract Background Pediatric hydronephrosis induced by pelvic-ureteric junction obstruction (PUJO) is treated by dismembered pyeloplasty (DP) via open and laparoscopic surgery. The etiology of PUJO involves both intrinsic stenosis and extrinsic compression of crossing vessels (CVs). PUJO owing to CVs is also treated by DP, as there is no consensus concerning this vascular condition. We encountered a 2-year-old infant with pure extrinsic PUJO combined with horseshoe kidney who successfully underwent laparoscopic transposition for CVs (vascular hitch). Case presentation A 2-year-old boy was prenatally diagnosed with left multicystic dysplastic kidney (MDCK) and right hydronephrosis and received a definitive diagnosis after birth. At 6 months old, renal scintigraphy revealed a non-functioning pattern in the left kidney and an obstructive pattern in the right, showing no response to furosemide loading. The patient also had recurrent urinary tract infection, and his right hydronephrosis gradually worsened. We decided to perform surgery for the right PUJO. Preoperative enhanced computed tomography detected three right renal vessels independently branching from the abdominal aorta. The middle renal vessels were located at the ventral side of the pelvis and coincident with the site of PUJO. These vessels were suspected of being CVs. The patient underwent laparoscopic surgery electively. A 5-mm trocar was inserted at the umbilicus for a 5-mm, 30° rigid scope. Two additional ports were then inserted under laparoscope inspection. The dilated right pelvis and CVs were detected after ascending colon mobilization. To confirm the pathogenesis of PUJO, the CVs were dissected and taped. After taping the CVs, an intraoperative diuretic test was performed using furosemide loading. Peristalsis of the right ureter was recognized, and the extrinsic PUJO owing to the CVs was definitively confirmed. We therefore performed transposition for the CVs (vascular hitch procedure). The CVs were mobilized in the cranial direction and those were wrapped by dilated pelvis. The post-operative course was uneventful. The renal scintigraphy findings improved and showed a favorable response of furosemide loading. Conclusions The laparoscopic vascular hitch procedure is minimally invasive and effective for extrinsic PUJO due to CVs. Anastomotic stricture after Anderson and Hynes DP can be prevented by appropriate patient selection.

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Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review

Journal of International Medical Research ◽

10.1177/03000605211010073 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110100

Author(s):

Suqiao Yang ◽

Jianfeng Wang ◽

Jifeng Li ◽

Kewu Huang ◽

Yuanhua Yang

Keyword(s):

Pleural Effusion ◽

Rare Complication ◽

Clinical Manifestations ◽

Pulmonary Vein Stenosis ◽

Pulmonary Artery Stenosis ◽

Heart Catheterization ◽

Tissue Mass ◽

Fibrosing Mediastinitis ◽

Extrinsic Compression ◽

Left Pleural Effusion

Fibrosing mediastinitis (FM) is a progressive, life-threatening disease characterized by extrinsic compression of mediastinal bronchovascular structures, and the clinical manifestations largely depend upon the affected structures. Pleural effusion is rarely reported in patients with FM. We herein describe a 70-year-old man who presented with recurrent breathlessness and refractory left pleural effusion. He was misdiagnosed with and treated for tuberculous pleurisy for several months. Thoracentesis revealed a transudative pleural effusion, and a contrast-enhanced computed tomography scan of the thorax showed an extensive mediastinal soft tissue mass consistent with FM. Pulmonary angiography demonstrated pulmonary artery stenosis on the right side and pulmonary vein stenosis mainly on the left side. After measurement of the pulmonary arterial pressure by right heart catheterization, the patient was diagnosed with pulmonary hypertension associated with FM. He underwent balloon angioplasty and stent implantation of the stenosed pulmonary vessels, which led to long-term improvement in his breathlessness and pleural effusion. Our systematic review of the literature highlights that pleural effusion can be an uncommon complication of FM and requires careful etiological differentiation.

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A rare case of May-Thurner-like syndrome in an elderly lady

Case Reports in Internal Medicine ◽

10.5430/crim.v1n2p19 ◽

2014 ◽

Vol 1 (2) ◽

pp. 19

Author(s):

Kapil Sahnan ◽

Chris Pui Yan Yee ◽

Robert Hywel Thomas ◽

Kaji Sritharan

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Imaging Modality ◽

Lumbar Vertebrae ◽

Kidney Injury ◽

Iliac Vein ◽

Common Iliac Vein ◽

Left Common Iliac Vein ◽

Extrinsic Compression ◽

Duplex Imaging

An elderly lady presented with decreased mobility, sputum production and intermittent confusion. She was treated for chest sepsis, fast atrial fibrillation, and acute kidney injury, and also noted to have a swollen left leg. Venous duplex imaging showed extensive thrombus within the left common iliac, left external iliac and left common femoral veins. A CT Venogram showed compression of the left common iliac vein between an osteophyte at L5 and a calcified ipsilateral common iliac artery. It also showed a pelvic kidney with an extra renal pelvis and large renal cyst which was indirectly contributing to venous compression by splinting the left iliac artery. A decision was made after discussion at the Vascular MDT that the patient was not fit enough for surgery and to manage her medically with anticoagulation. Discussion: Proximal DVT’s are rarer than distal thrombosis, but have similar causes. One of the rarer causes of proximal DVT is May-Thurner syndrome and its variants known collectively as non-thrombotic iliac vein lesions. May-Thurner originally described DVT formation caused by extrinsic compression of the left common iliac vein between the overriding contralateral (right) common iliac artery and adjacent lumbar vertebrae. The best imaging modality is a CT Venogram. Duplex ultrasonography can be used, although it can be difficult to visualize the iliac veins. The mainstay of management is surgical thrombectomy, or thrombolysis, followed by stenting of the affected vessel. However, if intervention is not appropriate, then it can be managed medically with anticoagulation.

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Combination of Superselective Arterial Embolization and Radiofrequency Ablation for the Treatment of a Giant Renal Angiomyolipoma Complicated with Caval Thrombus

Case Reports in Oncological Medicine ◽

10.1155/2016/8087232 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Konstantinos N. Stamatiou ◽

Hippocrates Moschouris ◽

Kiriaki Marmaridou ◽

Michail Kiltenis ◽

Konstantinos Kladis-Kalentzis ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Transarterial Embolization ◽

Vena Cava ◽

Arterial Embolization ◽

Maximum Diameter ◽

Renal Angiomyolipoma ◽

Efficient Treatment ◽

Extrinsic Compression

This is a case of a 78-year-old male patient with multiple angiomyolipomas of a solitary right kidney. The largest of these tumors (maximum diameter: 13.4 cm) caused significant extrinsic compression of the inferior vena cava complicated by thrombosis of this vessel. Treatment of thrombosis with anticoagulants had been ineffective and the patient had experienced a bleeding episode from the largest right renal angiomyolipoma, which had been treated by transarterial embolization in another institution, 4 months prior to our intervention. Our approach included superselective transarterial embolization of the dominant, right kidney angiomyolipoma with hydrogel microspheres, which was combined, 20 days later, with ultrasonographically guided radiofrequency ablation. Both interventions were uneventful. Computed tomography 2 months after ablation showed a 53% reduction in tumor volume, reduced space-occupying effect on inferior vena cava, and resolution of caval thrombus. Nine months after intervention the patient has had no recurrence of thrombosis or hemorrhage and no tumor regrowth has been observed. The combination of superselective transarterial embolization and radiofrequency ablation seems to be a feasible, safe, and efficient treatment of large renal angiomyolipomas.

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Surgical treatment of Dunbar syndrome

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492013000100012 ◽

2013 ◽

Vol 12 (1) ◽

pp. 57-61 ◽

Cited By ~ 2

Author(s):

Luís Henrique Gil França ◽

Carla Mottin

Keyword(s):

Clinical Condition ◽

Epigastric Pain ◽

Celiac Trunk ◽

Celiac Artery ◽

Transluminal Angioplasty ◽

Celiac Artery Compression Syndrome ◽

Extrinsic Compression ◽

Arcuate Ligament ◽

Dunbar Syndrome ◽

Angioplasty And Stenting

Dunbar syndrome or celiac artery compression syndrome is an infrequently described clinical condition with poorly defined diagnostic criteria and an obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. The authors report the case of a 70-year-old male patient presenting with nausea, epigastric pain, and weight loss. An aortography showed a compression of the celiac trunk. A preliminary attempt at percutaneous transluminal angioplasty and stenting proved unsuccessful. The patient became asymptomatic and his clinical condition improved after surgical release of the celiac trunk by partial section of the arcuate ligament of the diaphragm and with resection of the neural, fibrotic, and lymphatic tissues surrounding the aortic and visceral vessels. The purpose of this report is to discuss the indications and the therapeutic options of this syndrome.

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Rotator Cuff Tendinosis in an Animal Model: The Role of Extrinsic and Overuse Factors

10.1115/imece2000-2557 ◽

2000 ◽

Author(s):

S. Thomopoulos ◽

A. Esmail ◽

J. D. Williamson ◽

C. L. Flanagan ◽

J. P. Iannotti ◽

...

Keyword(s):

Animal Model ◽

Soft Tissue ◽

Rotator Cuff ◽

Musculoskeletal System ◽

Soft Tissue Injuries ◽

Rotator Cuff Disease ◽

Extrinsic Compression ◽

In Vivo Animal Model

Abstract One of the most common soft tissue injuries of the musculoskeletal system is injury to the rotator cuff tendons of the shoulder. These injuries are commonly attributed to factors such as overuse activity and extrinsic compression. Previous studies on the rotator cuff have been based on surgical reconstructive or clinical retrospective standpoints and were not designed to test hypotheses related to the causes of rotator cuff tendinosis. Our previous study has identified the rat as an appropriate in vivo animal model in which to study rotator cuff disease based on anatomic and functional similarities [1]. The current study uses this animal model to study the roles of extrinsic compression, overuse, and overuse combined with extrinsic compression, on the development of rotator cuff tendinosis. It was hypothesized that a single injury factor would be insufficient to create persistent tendinosis and a combination of injury factors would be necessary.

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Modern Diagnosis and Surgical Management of Thoracic Outlet Syndrome: A Comprehensive Review

American Journal of Surgical Research and Reviews ◽

10.28933/ajsrr-2021-06-0606 ◽

2021 ◽

pp. 27

Author(s):

Keyword(s):

Upper Extremity ◽

Subclavian Vein ◽

Transverse Process ◽

Venous Hypertension ◽

Cervical Rib ◽

First Rib ◽

Extrinsic Compression ◽

Robotic Resection ◽

Entrapment Syndromes ◽

Neurogenic Tos

Conventionally TOS has been thought to represent a group of diverse disorders that result in compression of the neurovascular bundle exiting the thoracic outlet. Until recently, TOS classification has been based on symptoms, rather than the underlying pathology, with the subgroups consisting of neurogenic (NTOS), venous (VTOS or PSS), and arterial (ATOS). Neurogenic TOS accounts for over 95% of the cases, followed by venous (3–5%) and arterial (1–2%). Neurogenic TOS (NTOS) has been further divided into True NTOS (TNTOS) and Disputed NTOS (DNTOS), with DNTOS reportedly representing 95–99% of all neurogenic cases. In order to decrease confusion and to improve therapeutic results with TOS, the disease should be classified based on the underlying pathologic entity. Acquired and traumatic abnormalities of the clavicle and first rib should be classified separately. Clearly after the more common and objectively supported diagnoses of conditions that result in neurovascular symptoms of the upper extremity, such as cervical spine disease, carpal tunnel disease, and nerve entrapment syndromes, have been ruled out, there remains a group of patients who are suspected of having TOS. In these patients, rather than the more usual classification such as arterial, venous, or neurogenic, the more accurate approach from a diagnostic and therapeutic approach is to classify them as: Cervical Rib Disease: Patients with cervical rib syndrome (CRS) can have complications relating to compression of the subclavian artery (previously referred to as ATOS) and the brachial plexus(previously referred to as True NTOS) secondary to a well-formed cervical rib, or to an incompletely formed first rib, fibrous band associated with a rudimentary cervical rib, or a giant transverse process of C7. Thoracic Outlet Disease or “Subclavian Vein Compression Syndrome”: In these patients an abnormal first rib at its junction with the sternum results in compression of the subclavian vein at the subclavian-innominate junction. Compression of the vein results in venous hypertension in the upper extremity and resultant neurologic symptoms. With prolonged compression of the subclavian-innominate junction, the vein clots giving rise to Paget–Schroetter syndrome. Therefore, patients who have been previously classified as Disputed Neurogenic and Venous TOS represent a variable symptomatic presentation of the same pathologic entity, which affects the subclavian vein. Presently MRA of the thoracic outlet with arm maneuvers is the test of choice in patients suspected of having TOS. This test shows the abnormal bony tubercle on the first rib with extrinsic compression of the subclavian innominate junction, which is exacerbated with elevation of the arm above the shoulder. Robotic resection of the medial aspect of the first rib along with disarticulation of the costo-sternal joint has the best reported results to date.

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