A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

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Exceptional life threatening complication 19 years after Ravitch correction of pectus excavatum.

10.22541/au.162046982.25357609/v1 ◽

2021 ◽

Author(s):

Krzysztof Greberski ◽

Radoslaw Jarzabek ◽

Bartłomiej Perek ◽

Pawel Bugajski

Keyword(s):

Adverse Event ◽

Cardiopulmonary Bypass ◽

Pectus Excavatum ◽

Late Complication ◽

Ascending Aorta ◽

Post Discharge ◽

Postoperative Course ◽

Life Threatening ◽

Life Threatening Complication

Ravitch technique of chest correction has been considered, although invasive, as safe and efficacious surgical method. We describe a case of 35-year-old woman with cardiac tamponade and in cardiogenic shock due to exceptional late complication after pectus excavatum reconstruction by means of classic Ravitch technique 19 years earlier. This very late adverse event was caused by broken metal sternal wire that injured the wall of the ascending aorta. Patient underwent salvage repair of this segment of aorta in cardiopulmonary bypass. Postoperative course and post-discharge 3-year follow-up have been uneventful.

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Infected Anastomotic Pseudoaneurysm after Aortic Valve Replacement with Annular Enlargement

The Heart Surgery Forum ◽

10.1532/hsf.2379 ◽

2019 ◽

Vol 22 (3) ◽

pp. E252-E255

Author(s):

Runqian Sui ◽

Jie Zi ◽

Liangong Sun ◽

Decai Li ◽

Anbiao Wang

Keyword(s):

Computed Tomography ◽

Rare Case ◽

Ascending Aorta ◽

Anastomotic Pseudoaneurysm ◽

Computed Tomography Scans ◽

Infected Pseudoaneurysm ◽

Life Threatening ◽

Important Means ◽

Anastomotic Line

Anastomotic pseudoaneurysm remains one of the main life-threatening complications of cardiac and thoracic aorta surgery. We report a rare case of infected pseudoaneurysm at the anastomotic line found during follow-up. Blood culture results suggested Enterococcus faecium infection. Transthoracic echocardiography and computed tomography scans revealed the presence of a pseudoaneurysm of the ascending aorta. The pseudoaneurysm was resected and the ascending aorta was reconstructed with an artificial vascular patch without complications. Reducing the anastomotic tension, with complete hemostasis at the anastomotic incision, is the most important means of preventing the formation of pseudoaneurysm.

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Penetrating Atheromatous Ulcer As A Precursor Of Aortic Dissection: A Case Report

10.21203/rs.3.rs-47460/v1 ◽

2020 ◽

Author(s):

Priya Shah ◽

Erik Polan

Keyword(s):

Case Report ◽

Aortic Dissection ◽

Ulcer Patient ◽

Intramural Hematoma ◽

Ascending Aorta ◽

Penetrating Aortic Ulcer ◽

Ct Angiogram ◽

Acute Aortic Syndromes ◽

Life Threatening

Abstract Background: Acute aortic syndromes include a range of life-threatening conditions with the most familiar entity being aortic dissection. However, variants of aortic dissection also include intimal tear without hematoma, aortic intramural hematoma, and lastly penetrating aortic ulcer (PAU), which will be the focus of this case report. Most PAUs are located in the descending thoracic aorta (85-95%), but they can also occur in the ascending aorta or arch as in the current case. Case Presentation: We report a case of a 77 year old male who presented with chief complaint of intermittent right-handed weakness associated with no numbness or mental status changes. Patient was admitted for stroke workup with unrevealing findings on CT (computed tomography) for acute abnormalities or any hemodynamically significant stenosis on carotid ultrasound. CT angiogram of head/neck revealed a penetrating aortic ulcer of the lateral aspect of the mid to distal ascending aorta. Patient was then transferred for further evaluation to a center of higher level care for further management. Conclusions: Patient was evaluated for surgical repair of penetrating ascending aortic ulcer. Patient underwent serial imaging throughout hospital course which showed grossly similar findings to prior examination and thus no surgical intervention was needed at that time. Patient was recommended to have follow up CT scan in one month to monitor progression of aortic ulcer, however patient lost to follow-up thereafter. Penetrating aortic ulcers are rarely located in the ascending aorta and are considered precursors of life-threatening aortic dissections.

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Anterior Mediastinal Paraganglioma Mimicking Thymoma

The Heart Surgery Forum ◽

10.1532/hsf98.20111173 ◽

2012 ◽

Vol 15 (3) ◽

pp. 170

Author(s):

Hee Moon Lee ◽

Dong Seop Jeong ◽

Pyo Won Park ◽

Wook Sung Kim ◽

Kiick Sung ◽

...

Keyword(s):

Mediastinal Mass ◽

Aortic Wall ◽

Anterior Wall ◽

Ascending Aorta ◽

Anterior Mediastinal Mass ◽

Arterial Reconstruction ◽

Ct Evaluation ◽

One Year ◽

Mediastinal Paraganglioma

A 54-year-old man was referred to our institution with hemoptysis and hoarseness of 1 year's duration. A computed tomography (CT) scan showed an anterior mediastinal mass (2.5 cm x 1.0 cm), which was diagnosed as thymoma. The tumor was resected under a sternotomy. The tumor had invaded the anterior wall of the ascending aorta. With the patient under cardiopulmonary bypass, the aortic wall invaded by the mass was resected, and arterial reconstruction was performed with patch material. The tumor was revealed to be a tumor of neuronal origin. The patient's postoperative course was uneventful. The patient was discharged on postoperative day 9. One year after the operation, a follow-up chest CT evaluation showed no specific complications or recurrence.

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Back-Table Modified Stent-Graft for Endovascular Repair of Ascending Aorta

Journal of Endovascular Therapy ◽

10.1177/15266028211028201 ◽

2021 ◽

pp. 152660282110282

Author(s):

Juan Shi ◽

Ligang Liu ◽

Xiang Wei ◽

Mingjia Ma

Keyword(s):

Endovascular Repair ◽

Survival Rates ◽

Ascending Aorta ◽

Cerebellar Infarction ◽

Type Ia ◽

Risk Patients ◽

Aorta Replacement ◽

Aortic Dissections ◽

Event Rates

Objectives To investigate the effectiveness of modified stent-grafts (SGs) for the management of ascending aortic pathologies. Materials and Methods From January 2015 to December 2019, 31 individuals were treated by ascending aortic endovascular repair with a back-table modified SG for acute (n=4) or chronic (n=1) type A aortic dissections, penetrating aortic ulcers (n=18), pseudoaneurysms (n=2), anastomotic fistula (n=1), and endoleaks after thoracic endovascular aortic repair (TEVAR) (n=5). The commercially available thoracic aortic SGs were modified with a fenestration or truncation technique on the back-table according to aortography during the operation. Results The 30-day mortality and aorta-related mortality rates were 12.9% and 6.5%, respectively. There were 2 strokes, 3 respiratory insufficiencies, and 6 endoleaks during hospitalization. During a mean follow-up of 28.8±16.6 months, the overall survival rates at 1 year and 3 years were both 80.6%. Free from adverse event rates at 1 year and 3 years were 88.9% and 84.7%, respectively. There were 2 deaths during follow-up: One patient died of cachexia 1 month after discharge, and the other patient died of acute myocardial infarction 3 months after discharge. One patient with a pseudoaneurysm underwent open ascending aorta replacement 3 months after discharge for a type Ia endoleak. Another patient suffered from cerebellar infarction 17 months after discharge. Conclusion The modified SG for endovascular repair of the ascending aorta is a practicable alternative and presents acceptable outcomes in high-risk patients.

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Intra-Peritoneal Pseudocyst as a Rare Complication After Peritoneal Dialysis: The Use of a Staged Surgical Approach in Management

The American Surgeon ◽

10.1177/00031348211047465 ◽

2021 ◽

pp. 000313482110474

Author(s):

Ahmad Kharsa ◽

Kayla Colvill ◽

Heather Stevenson ◽

Jeffrey Fair ◽

Rupak Kulkarni ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Surgical Approach ◽

Rare Case ◽

Diagnostic Laparoscopy ◽

Rare Complication ◽

Cyst Excision ◽

Neoplastic Processes ◽

Life Threatening ◽

Pseudocyst Formation

Despite its numerous benefits, peritoneal dialysis (PD) can rarely result in dangerous and even life-threatening complications, including peritonitis, hernias, encapsulating peritoneal sclerosis (EPS), and rarely peritoneal pseudocysts. Herein, we present a rare case of a giant intra-peritoneal pseudocyst that presented four months following the discontinuation of a 5-year course of complicated PD. Despite the initially successful drainages, the patient’s symptoms continued to recur, and the imaging findings were concerning for underlying neoplastic processes. As such, a staged surgical approach was performed, starting with a diagnostic laparoscopy and was subsequently followed with cyst excision and marsupialization to the peritoneal cavity. While previous reports of such rare pseudocyst have been documented in the literature as a complication of PD, to our knowledge, this is the second case of pseudocyst formation to occur months after the discontinuation of PD therapy. This case emphasizes the importance of close follow-up in PD patients and showcases how a staged surgical approach can be utilized to accurately diagnose and manage such complicated cases.

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Bowel ischemia caused by a giant thrombus in the ascending aorta. A case report

Vascular ◽

10.1177/1708538114553286 ◽

2014 ◽

Vol 23 (6) ◽

pp. 641-644 ◽

Cited By ~ 2

Author(s):

Hua-Dong Li ◽

Tu-Cheng Sun

Keyword(s):

Rare Case ◽

Rare Condition ◽

Ascending Aorta ◽

Bowel Ischemia ◽

Synthetic Graft ◽

Aortic Thrombosis ◽

Coagulation Therapy ◽

Aortic Thrombus ◽

Organized Thrombus

Although an ascending aortic thrombus is a rare condition, it can cause serious complications of thromboembolism. Here we present a rare case of a patient who was hospitalized due to ileal arteries embolization caused by emboli from a giant thrombus in the ascending aorta. After 10 days anti-coagulation therapy, we performed a surgery to replace the ascending aorta containing the strip organized thrombus with a synthetic graft. During two years of postoperative follow-up, no recurrence of aortic thrombosis was found. Although the exact cause of this thrombus remains unclear, we believe that it is important to perform a surgery as soon as the presence of an ascending aortic thrombus is confirmed, which could help preventing the major recurrent embolic events.

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Penetrating aortic ulcer

ESC CardioMed ◽

10.1093/med/9780198784906.003.0619 ◽

2018 ◽

pp. 2602-2604

Author(s):

Arturo Evangelista ◽

José Rodríguez-Palomares

Keyword(s):

Open Surgery ◽

Aortic Rupture ◽

Imaging Techniques ◽

Large Field ◽

Intramural Haematoma ◽

Acute Aortic Syndrome ◽

Penetrating Aortic Ulcer ◽

Rapid Enlargement ◽

The Media

Penetrating aortic ulcer is a disease of the intima produced by an ulceration of atherosclerotic plaque penetrating to the media of the aortic wall. Although diagnosis can be made by all imaging techniques, computed tomography is the most useful technique due to its high spatial resolution and large field of view. Natural evolution is completely different if penetrating aortic ulcer is diagnosed in the contest of an acute aortic syndrome or incidentally. The presence of pain, rapid enlargement of the ulcer size, and intramural haematoma have been considered predictors of serious complications. In these cases, open surgery or endovascular treatment should be indicated to prevent aortic rupture. In stable and asymptomatic cases, control of blood pressure and close follow-up by imaging techniques is recommended.

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Giant Retrorectal Epidermoid Cyst Masquerading as a Perianal Swelling

Case Reports in Surgery ◽

10.1155/2020/5750382 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Reem Al-Shoura ◽

Haifaa Malaekah ◽

Waddah Al Bassam

Keyword(s):

Magnetic Resonance Imaging ◽

Epidermoid Cyst ◽

Rare Case ◽

Perianal Abscess ◽

Resonance Imaging ◽

Pelvic Magnetic Resonance Imaging ◽

Incision And Drainage ◽

Postoperative Course ◽

Embryonic Tissues

A retrorectal epidermoid cyst is an uncommon congenital lesion that arises from the remnants of the embryonic tissues. This type of cyst is difficult to diagnose before surgery. In this study, we report a rare case of a giant retrorectal epidermoid cyst in a 30-year-old woman. Initially, the condition was diagnosed as a perianal abscess and treated with incision and drainage. Since the abscess recurred, a pelvic magnetic resonance imaging was ordered, which revealed an 8.2 cm perianal cyst with appearance not compatible with an abscess. Postsurgical histologic analysis confirmed a retrorectal epidermoid cyst. Postoperative course was uneventful, and the woman was discharged on postoperative day 3. She was doing well at 4 months of follow-up. This report suggests that retrorectal cysts should be considered in cases of recurrent perianal swellings/abscesses.

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Time-Resolved Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography in Patients with Chronic Expanding and Stable Aortic Dissections

Contrast Media & Molecular Imaging ◽

10.1155/2017/5428914 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Michael Trojan ◽

Fabian Rengier ◽

Drosos Kotelis ◽

Matthias Müller-Eschner ◽

Sasan Partovi ◽

...

Keyword(s):

Three Dimensional ◽

False Lumen ◽

Ascending Aorta ◽

Stable Group ◽

Time Resolved ◽

Descending Aorta ◽

Peak Intensity ◽

Contrast Enhanced ◽

Aortic Dissections

Objective. To prospectively evaluate our hypothesis that three-dimensional time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA) is able to detect hemodynamic alterations in patients with chronic expanding aortic dissection compared to stable aortic dissections. Materials and Methods. 20 patients with chronic or residual aortic dissection in the descending aorta and patent false lumen underwent TR-MRA of the aorta at 1.5 T and repeated follow-up imaging (mean follow-up 5.4 years). 7 patients showed chronic aortic expansion and 13 patients had stable aortic diameters. Regions of interest were placed in the nondissected ascending aorta and the false lumen of the descending aorta at the level of the diaphragm (FL-diaphragm level) resulting in respective time-intensity curves. Results. For the FL-diaphragm level, time-to-peak intensity and full width at half maximum were significantly shorter in the expansion group compared to the stable group (p=0.027 and p=0.003), and upward and downward slopes of time-intensity curves were significantly steeper (p=0.015 and p=0.005). The delay of peak intensity in the FL-diaphragm level compared to the nondissected ascending aorta was significantly shorter in the expansion group compared to the stable group (p=0.01). Conclusions. 3D TR-MRA detects significant alterations of hemodynamics within the patent false lumen of chronic expanding aortic dissections compared to stable aortic dissections.

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