Thoracic Manifestations of the Angiobehçet

2019 ◽  
Vol 6 ◽  
Author(s):  
Lamiyae Senhaji ◽  
Badr Alami ◽  
Bouchra Amara ◽  
Mohammed El Biaze ◽  
Mohamed Chakib Benjelloun ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Lower Limbs ◽  
Vascular Involvement ◽  
Hepatic Veins ◽  
Venous Involvement ◽  
Cardiac Thrombus ◽  
Arterial Involvement ◽  
Type Size

Introduction: Vascular involvement in Behçet's disease affects 5 to 40% of patients. All vessels regardless of their type, size or location can be affected. This impairment is serious and can be life-threatening.Patients and methods : We collected 12 cases from January 2010 to January 2017. These were 11 men and 1 woman with an average age of 32.5 years. The venous involvement involved 11 patients with thrombosis of the upper vena cava (VCS) in 6 patients, thrombophlebitis of the lower limbs in 5 patients and thrombosis of the lower vena cava and hepatic veins in 1 patient. The arterial involvement affected 9 patients (75%) with aneurysm of the pulmonary arteries in 5 patients and a pulmonary embolism in 5 others. The cardiac involvement concerned half of the patients with pericarditis type in 3 patients and intra-cardiac thrombus in 4 patients.Conclusion: Thoracic involvement of the angiobehçet is frequent and severe, requiring rapid diagnosis and intense specific therapy to improve its prognosis.

scholarly journals Vascular Involvements in Cholangiocarcinoma: Tips and Tricks

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3735
Author(s):  
Roberta Angelico ◽  
Bruno Sensi ◽  
Alessandro Parente ◽  
Leandro Siragusa ◽  
Carlo Gazia ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Vena Cava ◽  
High Volume ◽  
Vascular Reconstruction ◽  
Ex Situ ◽  
Vascular Involvement ◽  
Hepatic Veins ◽  
Hepatic Artery Resection ◽  
Artery Resection

Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.

scholarly journals The Utility of Preoperative Vascular Grading in Patients Undergoing Surgery First for Pancreatic Cancer: Does Radiologic Arterial or Venous Involvement Predict Pathologic Margin Status?

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Neha Goel ◽  
Jimson W. D’Souza ◽  
Karen J. Ruth ◽  
Barton Milestone ◽  
Andreas Karachristos ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Margin Status ◽  
Ductal Adenocarcinoma ◽  
Preoperative Imaging ◽  
Vascular Involvement ◽  
Grading System ◽  
Positive Margins ◽  
Venous Involvement ◽  
Arterial Involvement ◽  
Surgery First

Controversy exists on accurately grading vascular involvement on preoperative imaging for pancreatic ductal adenocarcinoma. We reviewed the association between preoperative imaging and margin status in 137 patients. Radiologists graded venous involvement based on the Ishikawa classification system and arterial involvement based on preoperative imaging. For patients with both classifications recorded, we categorized vascular involvement as “None,” “Arterial only,” “Venous only,” or “Both” and examined the association of vascular involvement and pathologic margin status. Of 134 patients with Ishikawa classifications, 63%, 17%, 11%, and 9% were graded as I, II, III, and IV, respectively. Of 96 patients with arterial staging, 74%, 16%, and 10% were categorized as stages i, ii, and iii, respectively. Of 93 patients with both stagings, 61% had no vascular involvement, 7% had arterial only, 14% had venous only, and 17% had both involved. Ishikawa classification was strongly associated with a positive SMA and SMV margin (p<0.001). However, for arterial staging, there was no association with SMA or SMV margin. Overall, Ishikawa grading was more predicative of arterial involvement and remained significant on multivariate analysis. The use of diagnostic imaging in predicting positive margins is more accurate when using a venous grading system.

scholarly journals Mesoatrial shunt in Budd-Chiari syndrome

2009 ◽  
Vol 66 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Darko Mirkovic ◽  
Nebojsa Stankovic ◽  
Miodrag Jevtic ◽  
Miroslav Mitrovic ◽  
Milan Jovanovic
Keyword(s):  
Computed Tomography ◽  
Vena Cava ◽  
Factor V Leiden ◽  
Lower Limbs ◽  
Portal System ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Factor V Leiden Mutation ◽  
Chiari Syndrome ◽  
The Right

Background. Budd-Chiari syndrome (BCS) represents partial or total occlusion of the hepatic veins with or without simultaneous obstruction of vena cava inferior (VCI). The symptoms of BCS are abdominal pain, hepatomegaly, ascites, varices of the abdominal wall, sometimes bleeding from the upper part of gastointestinal tract (GIT), lower limbs swelling and jaundice. Primary BSC is a relatively rare condition occurring in one per 100 000 of the population worldwide. Case report. A male patient, 25-year-old, facing tooth postextraction complications, was presented with acute BCS. On admission, physical examination revealed pale-grayish complexion, more pronounced veins over the thorax and abdomen, ascites, enlarged liver rising 8 cm below the right costal arch and having a minor pleural effusion by the right side. The patient was submitted to Doppler sonography and computed tomography (CT) that verified the right leg deep veins thrombosis, as well as the presence of a thrombus in the intrahepatic portion of the VCI. Multislice computed tomography (MSCT) showed occlusion of hepatic veins (Budd-Chiari syndrome) and thrombosis of the VCI in the retrohepatic part 6 cm long. Also, increased values of transaminases and gamma GT and reduced values of albumines and serum ferrum were registered. Molecular examination revealed Factor V Leiden mutation - heterozygote. After preoperative preparations a mesocaval shunt was made using Gore- Tex ring graft of 12 mm. Intraoperatively, the blue enlarged liver was found with almost black zones of tense capsule. After a graft making, liver congestion decreased followed by the change of colour and volume. Within postoperative course metabolic and synthetic liver functions were obvious. Conclusion. In patients with BCS medicamentous treatment does not yield adequate results, but even causes worsening of general condition. Surgical therapy in the presented patient was performed timely regarding the stage of the disease due to which irreversible liver changes were prevented while decompression of the portal system provided time overbridging up to liver transplantation.

scholarly journals Whole-body MRI: comprehensive evaluation on a 48-channel 3T MRI system in less than 40 minutes. Preliminary results

2012 ◽  
Vol 45 (6) ◽  
pp. 319-325 ◽  
Author(s):  
Mateus de Andrade Hernandes ◽  
Richard C. Semelka ◽  
Jorge Elias Júnior ◽  
Saraporn Bamrungchart ◽  
Brian M. Dale ◽  
...  
Keyword(s):  
Image Quality ◽  
Comprehensive Evaluation ◽  
Inflammatory Diseases ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Observer Agreement ◽  
Whole Body ◽  
Hepatic Veins ◽  
Single Shot ◽  
New Generation

OBJECTIVE: To evaluate a comprehensive MRI protocol that investigates for cancer, vascular disease, and degenerative/inflammatory disease from the head to the pelvis in less than 40 minutes on a new generation 48-channel 3T system. MATERIALS AND METHODS: All MR studies were performed on a 48-channel 3T MR scanner. A 20-channel head/neck coil, two 18-channel body arrays, and a 32-channel spine array were employed. A total of 4 healthy individuals were studied. The designed protocol included a combination of single-shot T2-weighted sequences, T1-weighted 3D gradient-echo pre- and post-gadolinium. All images were retrospectively evaluated by two radiologists independently for overall image quality. RESULTS: The image quality for cancer was rated as excellent in the liver, pancreas, kidneys, lungs, pelvic organs, and brain, and rated as fair in the colon and breast. For vascular diseases ratings were excellent in the aorta, major branch vessel origins, inferior vena cava, portal and hepatic veins, rated as good in pulmonary arteries, and as poor in the coronary arteries. For degenerative/inflammatory diseases ratings were excellent in the brain, liver and pancreas. The inter-observer agreement was excellent. CONCLUSION: A comprehensive and time efficient screening for important categories of disease processes may be achieved with high quality imaging in a new generation 48-channel 3T system.

scholarly journals Late cardiovascular complication after varicose vein endovascular ablation

2020 ◽  
Vol 30 (5) ◽  
pp. 785-787
Author(s):  
Antonio Fiore ◽  
Mariantonietta Piscitelli ◽  
Costin Radu ◽  
Thierry Folliguet
Keyword(s):  
Varicose Vein ◽  
Venous Insufficiency ◽  
Foreign Bodies ◽  
Varicose Veins ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Cardiovascular Complication ◽  
Lower Limbs ◽  
Current Guidelines ◽  
Endoluminal Treatment

Abstract Venous insufficiency of the lower limbs is one of the most common vascular disorders affecting millions of people worldwide. Endovascular techniques are considered by current guidelines as simple, safe and effective. Persistence or even migration of foreign bodies after varicose vein endovascular surgery is a rare and unfeared complication. Herein, we present the case of a 39-year-old woman who underwent endoluminal treatment of varicose veins &gt;2 years ago and she was admitted to our department for late cardiovascular complication caused by catheter or guidewire rupture and the dissemination of its fragments in the inferior vena cava, right heart chambers, liver and pulmonary arteries. A systematic verification of the length and integrity of the devices should be performed at the end of every endovascular procedure.

Characterization and clinical implications of peripheral arterial involvement in transthyretin cardiac amyloidosis cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stamatelopoulos ◽  
D Delialis ◽  
D Bampatsias ◽  
M.E Tselegkidi ◽  
I Petropoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Significance ◽  
Vascular Involvement ◽  
Control Group ◽  
Peripheral Vascular ◽  
Cvd Risk Factors ◽  
Wave Reflections ◽  
Cvd Risk ◽  
Arterial Involvement ◽  
Peripheral Arterial

Abstract Background The sporadic form of transthyretin amyloidosis cardiomyopathy (ATTR-CM) is underdiagnosed but its prevalence is increasing due to the aging population. Given the poor prognosis of ATTR-CM understanding the underlying pathophysiologic mechanisms of the disease is imperative in order to improve strategies for early diagnosis and risk stratification and to develop new effective therapeutic options. ATTR-CM is associated with hypotension and there is preliminary experimental evidence of vascular involvement but its presence and clinical significance remains unknown. Purpose To characterize peripheral arterial involvement and explore its clinical role in ATTR-CM. Methods We consecutively recruited 28 previously untreated patients with newly diagnosed ATTR-CM and 34 elderly controls &gt;70 years old, without ATTR-CM or heart failure. In both groups, flow-mediated dilatation (FMD) and intima-media thickness (IMT) in the carotid arteries were measured by high-resolution ultrasonography as markers of peripheral vascular reactivity and of subclinical atherosclerosis, respectively. Carotid-femoral pulse wave velocity (PWV) was measured as a marker of arterial stiffness. Aortic blood pressure (BP) and augmentation index (AI) using applanation tonometry were measured as markers of arterial wave reflections, peripheral arterial resistance and central hemodynamics. Echocardiography was performed in all ATTR patients. All cardiovascular (CV) measurements were performed before administration of any ATTR-specific therapy. Results ATTR patients were older and had lower prevalence of hypertension and male gender (p&lt;0.05 for all) than the control group. Aortic and peripheral BP (p=0.016–0.088) and AI (p=0.003) were lower in ATTR patients. IMT in the common (cc) and internal carotid (ic) as well as in the carotid bulb (cb) were significantly higher in ATTR patients (p=0.001–0.042). After multivariable adjustment for traditional CV disease (CVD) risk factors, the ATTR group was independently associated with AI and IMT in cc, cb and ic (p&lt;0.05 for all). In a subgroup of subjects with similar age between groups (n=13 and n=33 and 74.5±2.9 vs. 75.6±3.6 years, for ATTR vs. controls, respectively) differences in AI and cbIMT remained significant. Interestingly, AI was strongly and inversely associated with interventricular wall thickness (IVwt) in ATTR patients (spearman rho=−0.651, p=0.001). After adjustment for traditional CVD risk factors this association remained significant. Conclusion ATTR-CM is associated with lower aortic wave reflections, which correlate with more advanced structural cardiac disease, as assessed by IVwt. Further, ATTR-CM patients present accelerated subclinical carotid atherosclerosis as compared to elderly control subjects. These findings suggest that in ATTR-CM there is disease-specific peripheral vascular involvement in parallel to cardiac involvement. The clinical significance of these findings merits further investigation. Funding Acknowledgement Type of funding source: None

Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome

2021 ◽  
pp. 153857442110020
Author(s):  
Reza Talaie ◽  
Hamed Jalaeian ◽  
Nassir Rostambeigi ◽  
Anthony Spano ◽  
Jafar Golzarian
Keyword(s):  
Inferior Vena Cava ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Inferior Vena ◽  
Vena Cava ◽  
Portosystemic Shunt ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Chiari Syndrome ◽  
Intrahepatic Portosystemic Shunt ◽  
The Right

Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails.1-3 Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation.

Budd-Chiari Syndrome in Childhood Secondary to Inferior Vena Caval Obstruction

PEDIATRICS ◽  
1979 ◽  
Vol 63 (5) ◽  
pp. 808-812
Author(s):  
Arvind Taneja ◽  
S. K. Mitra ◽  
P. D. Moghe ◽  
P. N. Rao ◽  
N. Samanta ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Budd Chiari Syndrome ◽  
Venous Outflow ◽  
Massive Ascites ◽  
Inferior Vena Caval ◽  
Uncommon Disease ◽  
Chiari Syndrome ◽  
Hepatic Venous Outflow

Budd-Chiari syndrome is an uncommon disease caused by an obstruction to hepatic venous outflow either at the level of the hepatic veins or in the hepatic part of the inferior vena cava. Clinically, it presents with ascites, abdominal pain, hepatomegaly, edema, and occasionally jaundice. The syndrome was first recognised by Lamboran1 in 1842 and later described by Budd2 in 1846 and Chiari3 in 1899. The syndrome is caused by obstruction to the hepatic veins. In the Fig 1. Photograph showing massive ascites and dilated superficial abdominal veins. majority of cases, the obstruction is ascribed to obliterative thrombophlebitis of unknown cause.4

Treatment with doxorubicin-based protocol in cardiac involvement diffuse large B-cell lymphoma: A case report

2021 ◽  
pp. 107815522110351
Author(s):  
Atakan Tekinalp ◽  
Taha U Kars ◽  
Hatice Z Dikici ◽  
Pınar D Yılmaz ◽  
Sinan Demircioğlu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
B Cell ◽  
Cardiac Involvement ◽  
Cell Lymphoma ◽  
Vena Cava ◽  
Standardized Uptake Value ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Introduction Cardiac involvement in diffuse large B-cell lymphoma is a rare entity in non-Hodgkin lymphomas. Symptoms are usually related to heart failure. Patients who are severely symptomatic due to cardiac mass could be considered treatment as soon as possible. In this report, we present a patient diagnosed with diffuse large B-cell lymphoma with cardiac involvement. Case Report A 61-year-old female patient was admitted to our unit with gastric biopsy diffuse large B-cell lymphoma. Computerized tomography of the chest and positron emission tomography/computed tomography demonstrated a neoplastic mass in the intra-atrial septum extended to inferior vena cava (5 × 4 cm in size and standardized uptake value maximum 24.6). She was in stage III and in the high-risk group. Because of pronounced heart failure findings associated with the mass-specific chemotherapy was planned early. Management & Outcome Although a fraction of ejection was 60% by echocardiography before the treatment, she had a cardiac risk for doxorubicin due to being over 60 years old and hypertension. Complete remission was achieved after three cycles of rituximab–cyclophosphamide–doxorubicin–vincristine and methylprednisolone protocol including doxorubicin. Treatment was completed with six cycles and she was followed up for three months. Discussion Because of the cardiotoxicity of doxorubicin-based protocols, patients should be evaluated according to cardiac functions before and during the chemotherapy.

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