Osteochondroma of the scapula associated with a subclavian artery pseudoaneurysm: Case report

Osteochondromas rarely induce vascular complications by mechanical compression. We present the case of a subclavian artery pseudoaneursym caused by an osteochondroma of the scapula in a 67-year-old male. The diagnosis was based on a previous history of multiple exostoses, computed tomography and magnetic resonance imaging, as well as the local vascular clinical status of the lesion. Surgical treatment consisted of vascular and orthopaedic intervention. First, the vascular surgeon implanted a bypass of the subclavian artery from the ventral aspect, enabling the orthopaedic surgeon to resect the osteochondroma from the dorsal aspect. The patient recovered with full function. Vascular pseundoaneurysms should be taken into consideration in patients with osteochondromas, especially with a known history of multiple hereditary exostoses.

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Controlled Trial of Nebulized Albuterol in Children Younger Than 2 Years of Age With Acute Asthma

PEDIATRICS ◽

10.1542/peds.89.1.133 ◽

1992 ◽

Vol 89 (1) ◽

pp. 133-137 ◽

Cited By ~ 1

Author(s):

Lea Bentur ◽

Gerard J. Canny ◽

Michael D. Shields ◽

Eitan Kerem ◽

Joseph J. Reisman ◽

...

Keyword(s):

Oxygen Saturation ◽

Acute Asthma ◽

Controlled Trial ◽

Arterial Oxygen Saturation ◽

Clinical Status ◽

Previous History ◽

Clinical Score ◽

Arterial Oxygen ◽

Recurrent Wheezing ◽

History Of

To determine the response to nebulized β2 agonist, 28 children younger than 2 years of age who visited the emergency department during an episode of acute asthma were studied. Each subject had a previous history of recurrent wheezing episodes. They were randomly assigned to receive two administrations of either nebulized albuterol (0.15 mg/kg per dose) or placebo (normal saline) with oxygen, 1 hour apart. After two nebulizations, the albuterol-treated patients had a greater improvement in clinical status (respiratory rate, degree of wheezing and accessory muscle use, total clinical score, and arterial oxygen saturation) than the placebo group. None of the patients in the albuterol group experienced a decrease of arterial oxygen saturation of ≥2%. It is conduded that a trial of nebulized β2 agonists is warranted in the treatment of acute asthma in infants and young children.

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Co-Occurrence of Rarest Type of Dysphagia Lusoria (Type N-1) and Eosinophilic Esophagitis in a Cognitively Disabled Individual

Case Reports in Medicine ◽

10.1155/2019/2890635 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Kishore Kumar ◽

Jasbir Makker ◽

Hassan Tariq ◽

Ariyo Ihimoyan ◽

Chime Chukwunonso ◽

...

Keyword(s):

Subclavian Artery ◽

Eosinophilic Esophagitis ◽

Previous History ◽

Food Allergies ◽

Aberrant Right Subclavian Artery ◽

Food Impaction ◽

Diagnostic Challenge ◽

Dysphagia Lusoria ◽

Extrinsic Compression ◽

History Of

Dysphagia is an expressive symptom, described by an individual as “difficulty in swallowing.” Dysphagia due to esophageal compression from an aberrant right subclavian artery is rare, and it is termed as “dysphagia lusoria.” We present a rare case of co-occurrence of dysphagia lusoria with esophageal eosinophilia in a patient with cognitive disability which portends a case with diagnostic challenge and treatment dilemma. A 31-year-old man with intellectual disability, cerebral palsy, previous history of feeding difficulty, and esophageal food impaction presented with esophageal foreign body impaction. He has no known history of atopy and food allergies. There was no laboratory evidence of peripheral eosinophilia. The IgE-mediated allergic test was unremarkable. His prior presentation revealed a diagnosis of eosinophilic esophagitis. The imaging studies showed proximal esophageal dilatation with extrinsic compression at the level of the upper esophagus. The foreign bodies were removed successfully through the help of upper endoscopy. Subsequent evaluation revealed a rare type of dysphagia lusoria (type N-1) due to an aberrant left subclavian artery arising from the right-sided aortic arch. The patient’s family refused further management of artery lusoria. Prolonged stasis of secretions and food in the esophagus can also lead to increased esophageal eosinophils. In our case, it remains undetermined whether increased number of esophageal eosinophils resulted from primary eosinophilic esophagitis or due to prolonged food stasis from esophageal compression caused by an aberrant subclavian artery. However, food impaction right above the compression site makes dysphagia lusoria the likely etiology.

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Stent erosion after treatment of coarctation of right-sided aorta and successful surgical management

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz281 ◽

2019 ◽

Vol 57 (5) ◽

pp. 1007-1008

Author(s):

Andreas Rukosujew ◽

Raluca Weber ◽

Bernd Kasprzak ◽

Angelo Maria Dell’Aquila

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Septal Defect ◽

Artery Bypass ◽

Previous History ◽

Second Step ◽

Descending Aorta ◽

History Of ◽

Aorta Replacement ◽

The Right

Abstract We present a case of surgical treatment of a pseudoaneurysm of the right-sided aortic arch after stent implantation for primary coarctation in a 36-year-old woman with a previous history of ventricle septal defect closure in early childhood. As a first step, she underwent a left carotid to subclavian artery bypass for an aberrant left subclavian artery and as a second step a ‘beating heart’ aortic arch and descending aorta replacement via resternotomy. The postoperative course was uneventful.

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Popliteal artery pseudoaneurysm due to femur exostosis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492317703837 ◽

2017 ◽

Vol 27 (1) ◽

pp. 39-41

Author(s):

Wahid Syed ◽

Mohd Akbar Bhat ◽

Hakeem Zubair Ashraf ◽

Farooq Ganie ◽

Feroze Ahmad

Keyword(s):

Popliteal Artery ◽

Vascular Complications ◽

Surgical Excision ◽

Left Thigh ◽

Lower Limbs ◽

Patch Repair ◽

Medial Aspect ◽

Artery Pseudoaneurysm ◽

Multiple Exostoses ◽

Popliteal Artery Pseudoaneurysm

Vascular complications of femur exostoses are rare, with popliteal pseudoaneurysm being the most common. After establishing the diagnosis, surgical treatment is mandatory. A 35-year-old woman presented with a painful pulsatile swelling in the lower medial aspect of the left thigh. Investigations revealed a pseudoaneurysm arising from the left popliteal artery adjacent to femur exostoses. Skeletal survey revealed multiple exostoses involving the upper and lower limbs. Surgical excision of the pseudoaneurysm was followed by ePTFE patch repair of the defect and excision of the exostoses. The patient was discharged after 5 days and followed up for 6 months with excellent results.

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Role of ethnicity in thrombotic and hemorrhagic complications of myeloproliferative neoplasms.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18555 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18555-e18555

Author(s):

Andrew Peseski ◽

Antoine Saliba ◽

Hamid Sayar

Keyword(s):

Myeloproliferative Neoplasms ◽

Philadelphia Chromosome ◽

Previous History ◽

Multivariate Logistic Regression Analysis ◽

Vascular Complications ◽

Bleeding Complications ◽

Vascular Events ◽

Hemorrhagic Complications ◽

History Of ◽

Caucasian Patients

e18555 Background: Philadelphia-chromosome negative myeloproliferative neoplasms (MPN) are a group of hematologic malignancies with known complications of hemorrhage and thrombosis. Age and a previous history of thrombosis are well-documented risk factors for future vascular events. Variations in the rates of these complications among ethnicities and sexes have not been extensively explored. Methods: Our retrospective analysis included 301 adult patients with a diagnosis of MPN without a history of thrombosis or hemorrhagic event seen at the Indiana University Simon Cancer Center between 1992 and 2019. Relationships between ethno-racial backgrounds and vascular complications and disease outcomes were evaluated using multivariate logistic regression analysis and Cox regression models. Results: Two hundred seventy-one patients (90.0%) were Caucasian and 30 patients (10.0%) were non-Caucasian. Non-Caucasian patients were comprised of African America, Asian, and Middle Eastern ethnicities. Median age at diagnosis was 56 years, and 43.9% were male. No association was found between the incidence of thrombotic complications and ethnicity using the log-rank test ( p 0.68). The incidence of hemorrhagic events was significantly increased in non-Caucasian patients (OR = 4.33; 95% CI [1.15 – 16.36], p 0.03). Patients with higher hemoglobin concentration at diagnosis were at a significantly lower risk of bleeding complications (OR = 0.79; 95% CI [0.65 – 0.95], p 0.01). Non-Caucasian patients were at 2.98 times (95% CI [1.19 – 7.44], p 0.02) higher risk when vascular complications were pooled together. Our models also showed that male sex (OR = 0.14; 95% CI [.02 – .98], p 0.048) and a higher platelet count at the time of diagnosis (OR = 0.99; 95% CI [.993 –.999], p 0.03) had a marginally significant association with decreased rate of progression to acute myeloid leukemia. Conclusions: This study suggests that in patients without a history of thrombosis or bleeding, non-Caucasian ethnicity was associated with an increased adjusted risk of hemorrhagic complications in patients with MPN. This observation may inform future studies to further characterize those disparities in outcomes at the genetic or socioeconomic level.

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Endovascular Treatment of Left Subclavian Artery Pseudoaneurysm after Clavicle Fracture in an Elderly Adult with a 40-Year History of Behçet’s Disease

Annals of Vascular Diseases ◽

10.3400/avd.cr.15-00082 ◽

2015 ◽

Vol 8 (4) ◽

pp. 328-330 ◽

Cited By ~ 4

Author(s):

Kengo Nishimura ◽

Takafumi Hamasaki ◽

Shuichi Yamamoto ◽

Tsuyoshi Kawai ◽

Kimihiko Sugiura

Keyword(s):

Endovascular Treatment ◽

Subclavian Artery ◽

Behcet’S Disease ◽

Behçet's Disease ◽

Left Subclavian Artery ◽

Clavicle Fracture ◽

Elderly Adult ◽

Artery Pseudoaneurysm ◽

Behcet's Disease ◽

History Of

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Acute popliteal pseudoaneurysm rupture secondary to distal femoral osteochondroma in a patient with hereditary multiple exostoses

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221590656 ◽

2012 ◽

Vol 94 (3) ◽

pp. e134-e136 ◽

Cited By ~ 13

Author(s):

IS Vanhegan ◽

KN Shehzad ◽

TS Bhatti ◽

TS Waters

Keyword(s):

Bypass Graft ◽

Vascular Complications ◽

Hereditary Multiple Exostoses ◽

Pseudoaneurysm Formation ◽

Multiple Exostoses ◽

Acute Rupture ◽

Vein Bypass ◽

History Of ◽

Vein Bypass Graft ◽

Saphenous Vein Bypass Graft

A 21-year-old man with known hereditary multiple exostoses presented with a 24-hour history of atraumatic bruising and swelling of the posterior thigh. A leaking popliteal pseudoaneurysm was diagnosed on ultrasonography and an emergency saphenous vein bypass graft procedure performed. The patient required a post-operative blood transfusion but otherwise made a full recovery. Vascular complications from osteochondromas are rare and include vessel displacement, stenosis, occlusion, arteriov-enous fistulas and pseudoaneurysm formation. Pseudoaneurysms usually present as an enlarging mass behind the knee. Acute rupture of an occult popliteal pseudoaneurysm caused by a distal femoral exostosis has not been reported previously.

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Delayed Subclavian Artery Aneurysm Following Fixation of a Clavicular Fracture

Vascular and Endovascular Surgery ◽

10.1177/1538574418770105 ◽

2018 ◽

Vol 52 (6) ◽

pp. 459-462 ◽

Cited By ~ 1

Author(s):

Scott John Charles Pallett ◽

Isabelle Singh ◽

Neveen Rady ◽

Hemprakesh Goshai

Keyword(s):

Primary Care ◽

Subclavian Artery ◽

Plate Fixation ◽

Delayed Diagnosis ◽

Vascular Complications ◽

Artery Aneurysm ◽

Subclavian Artery Aneurysm ◽

Life Threatening ◽

History Of ◽

Rare Phenomena

Aneurysms of the subclavian artery are rare phenomena that have the potential for limb and life-threatening complications. Delayed diagnosis increases the risk of life-threatening complications or at the very least may result in a detrimental effect to both functional capacity and quality of life; primary care offers a vital opportunity to screen for such rare vascular complications and should be a consideration in all patients with evolving peripheral nerve or vascular symptoms with a history of localized clavicular trauma. We present the case of a left subclavian artery aneurysm with radial artery thrombotic sequelae following an injury and screw–plate fixation of his left clavicle. This required a 2-stage surgical approach to treatment and provides useful learning considerations for identifying rare vascular anomalies early in a primary care setting.

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An unusual cause of hemoptysis due to leaking subclavian artery pseudoaneurysm secondary to trauma

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175750 ◽

2017 ◽

Vol 6 (1) ◽

pp. 359

Author(s):

Yugandhar Bhatt ◽

Waseem Md Abdul ◽

Misba Zahera

Keyword(s):

Subclavian Artery ◽

Case Reports ◽

Proximal Part ◽

Blunt Injury ◽

Lobe Bronchus ◽

Complete Evaluation ◽

Artery Pseudoaneurysm ◽

History Of ◽

The Right ◽

Resection And Anastomosis

Pseudoneurysms of the subclavian artery after blunting thoracic trauma presenting with a complication of hemoptysis are rare, most of which occur early, within days of trauma and represent a challenging surgical problem. Only a few scattered case reports are found in the literature. Here, we present the case of a 36-year-old male, with a history of blunt injury to the chest with right clavicular fracture, a few years back, who presented with cough, hemoptysis and shortness of breath of five days duration. On complete evaluation it was found that these complaints were due to a sub clavian artery pseudo aneurysm in the proximal part, which is compressing on the right upper lobe bronchus and blood leaking into the parenchyma and airways producing the symptoms. He was managed conservatively and stabilized. Later aneurysm resection and anastomosis was done electively. The patient is now asymptomatic and healthy.

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