scholarly journals Vertebral erosion due to chronic rupture of aneurismatic abdominal aorta

2019 ◽  
Vol 147 (11-12) ◽  
pp. 762-764
Author(s):  
Nikola Colic ◽  
Dusan Saponjski ◽  
Milica Stojadinovic ◽  
Danilo Jeremic ◽  
Biljana Parapid ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Aneurysm ◽  
Abdominal Aorta ◽  
Psoas Muscle ◽  
Surrounding Tissue ◽  
Arterial Phase ◽  
Lateral Part ◽  
Chronic Rupture ◽  
Threatening Condition ◽  
Life Threatening

Introduction. Extremely rarely, the evolution of abdominal aortic aneurysm (AAA) includes the phase when extravasations of the blood from a ruptured aneurysm is contained by the surrounding tissue, referred to as chronic (contained) rupture of the AAA. Our aim was to call attention to this life-threatening condition, which is always challenging for diagnosis. Case outline. A 58-year-old man reported to the Emergency Center for significant abdominal pain. Ultrasound examination showed an infrarenal aneurysm of the abdominal aorta. A computed tomography scan of the thorax, abdomen, and pelvis with iodine contrast in arterial phase was performed. A free gas collection was observed between the liver and the anterior abdominal wall that is traced to a ruptured inflamed diverticulum on the transversal colon. Immediately distal to the branching sites of the renal arteries, the abdominal aorta extended forward and aneurismatically expanded. Posterior left, along the psoas muscle, a rupture of the aortic wall was seen, with an organized hematoma that accompanied the muscle. Between the hematoma and the aortic aneurysm, erosions of the anterior and lateral part of the vertebral bodies L2 and L3 were discovered. The patient underwent endovascular AAA repair (EVAR) and recovered well. Conclusion. Multidetector computed tomography angiography is a reliable, non-invasive, and necessary examination for localization and evaluation of the size of the AAA form, its chronic rupture, and complications such as vertebral body erosion.

scholarly journals Rolipram Prevents the Formation of Abdominal Aortic Aneurysm (AAA) in Mice: PDE4B as a Target in AAA

Antioxidants ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 460
Author(s):  
Saray Varona ◽  
Lídia Puertas ◽  
María Galán ◽  
Mar Orriols ◽  
Laia Cañes ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Inflammatory Cells ◽  
Progressive Increase ◽  
Phosphodiesterase 4 ◽  
Inflammatory Conditions ◽  
Abdominal Aortic ◽  
Threatening Condition ◽  
Life Threatening ◽  
Effective Therapeutic Strategy

Abdominal aortic aneurysm (AAA) is a common life-threatening condition characterized by exacerbated inflammation and the generation of reactive oxygen species. Pharmacological treatments to slow AAA progression or to prevent its rupture remain a challenge. Targeting phosphodiesterase 4 (PDE4) has been verified as an effective therapeutic strategy for an array of inflammatory conditions; however, no studies have assessed yet PDE4 in AAA. Here, we used angiotensin II (AngII)-infused apolipoprotein E deficient mice to study the involvement of the PDE4 subfamily in aneurysmal disease. PDE4B but not PDE4D was upregulated in inflammatory cells from both experimental and human AAA. The administration of the PDE4 selective inhibitor rolipram (3 mg/kg/day) to AngII-challenged mice (1000 ng/kg bodyweight/min) protected against AAA formation, limiting the progressive increase in the aortic diameter without affecting the blood pressure. The drug strongly attenuated the rise in vascular oxidative stress (superoxide anion) induced by AngII, and decreased the expression of inflammatory markers, as well as the recruitment of macrophages (MAC3+), lymphocytes (CD3+), and neutrophils (ELANE+) into the vessel wall. Rolipram also normalized the vascular MMP2 expression and MMP activity, preserving the elastin integrity and improving the vascular remodelling. These results point to PDE4B as a new therapeutic target for AAA.

PS02.056: TIMELY LIGATION OF THORACIC DUCT IN POST ESOPHAGECTOMY CHYLE LEAK: KEY TO SUCCESSFUL MANAGEMENT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 136-136
Author(s):  
Sanjeev Parshad ◽  
Parvinder Sandu ◽  
Shekar Gogna ◽  
Abhijeet Beniwal ◽  
Rajendra Karwasra
Keyword(s):  
Mortality Rate ◽  
Thoracic Duct ◽  
Conflicts Of Interest ◽  
Surrounding Tissue ◽  
Chyle Leak ◽  
Threatening Condition ◽  
Life Threatening ◽  
Carcinoma Esophagus ◽  
Esophagectomy For Cancer

Abstract Background Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus. Methods From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct. Results Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct. Conclusion Disclosure All authors have declared no conflicts of interest.

scholarly journals Thoracic aortic aneurysm causing aorto-esophageal fistula—our experience with a rare disease

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Aakriti Yadav ◽  
Uttam Krishna Shrestha ◽  
Kajan Raj Shrestha ◽  
Dinesh Gurung
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Sudden Onset ◽  
Massive Hemoptysis ◽  
Esophageal Fistula ◽  
Feeding Jejunostomy ◽  
Intravenous Antibiotics ◽  
Threatening Condition ◽  
Life Threatening ◽  
Upper Gastrointestinal

Abstract Aorto-esophageal fistula is a life-threatening condition, accounting for a small number of cases of upper gastrointestinal bleeding where patients present with one or more features of Chiari’s triad. We present the case of a 43-year-old woman, referred to us with symptoms of central chest pain, sudden onset dysphagia followed by massive hemoptysis. She was diagnosed with an aorto-esophageal fistula due to a ruptured thoracic aortic aneurysm and rushed for an emergency endovascular thoracic aortic stent and feeding jejunostomy with intravenous antibiotics and supportive care. After 6 weeks of surgery, the patient was re-evaluated to plan for an esophageal stent if required. The purpose of this presentation is to make the surgical fraternity aware of the gravity of this disease and novel techniques to manage it.

scholarly journals TEVAR for ruptured descending thoracic aortic aneurysm: case report

2016 ◽  
Vol 15 (4) ◽  
pp. 322-327 ◽  
Author(s):  
Sthefano Atique Gabriel ◽  
Enrico Rinaldi ◽  
Marco Leopardi ◽  
Germano Melissano ◽  
Roberto Chiesa
Keyword(s):  
Case Report ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Thoracic Endovascular Aortic Repair ◽  
High Morbidity ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Descending Thoracic Aortic Aneurysm ◽  
Threatening Condition ◽  
Life Threatening

Abstract A ruptured descending thoracic aortic aneurysm (rDTAA) is a life-threatening condition associated with high morbidity and mortality. Endovascular treatment for rDTAA promotes effective aneurysm exclusion with a minimally invasive approach. The authors report a case of a 76-year-old man with hemodynamically unstable 9-cm-diameter rDTAA treated with emergency thoracic endovascular aortic repair (TEVAR).

scholarly journals Computed tomography angiography findings of abdominal aortic disease: A review of emergencies

2020 ◽  
Vol 73 (11-12) ◽  
pp. 393-400
Author(s):  
Mirela Jukovic ◽  
Aleksandra Mijatovic ◽  
Ivana Stojic ◽  
Ljiljana Drazetin ◽  
Maja Stankov ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Aorta ◽  
Computed Tomography Angiography ◽  
Clinical Manifestations ◽  
Aortic Disease ◽  
Occlusive Disease ◽  
Tunica Media ◽  
Abdominal Aortic ◽  
Wide Range ◽  
Life Threatening

Introduction. The aorta is a major blood vessel that supplies all segments of the human body. Acute aortic syndrome is a term that implies a life-threatening aortic disease. Due to the speed of examination and widespread availability, computed tomography angiography is a front-line diagnostic modality for emergencies and diseases of the abdominal aorta. The aim of this study was to provide a wide range of potentially life-threatening abnormalities of the abdominal aorta in daily clinical and radiological practice through a series of computed tomography angiography images and three-dimensional virtual reconstruction. Abdominal aortic aneurysm is defined as a 50% increase in diameter more than the normal arterial diameter. One of the most important complications of an aneurysm is a rupture that can be acute or chronic, presenting with various clinical manifestations. Aortic dissections are caused by abnormality of the tunica media layer, forming an intimal-medial flap and two types of lumen. A penetrating aortic ulcer may erode through the internal elastic lamina of the aortic wall and allow formation of hematoma within the tunica media. Occlusive disease of the abdominal aorta may refer to the late stage of chronic aortoiliac occlusive disease, whereas the acute and/or subacute form occurs due to sudden thrombosis or occlusion. Conclusion. The recognition of specific radiological signs of abdominal aortic disease using computed tomography angiography contributes to optimal treatment of patients and reduces mortality.

scholarly journals Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience

2019 ◽  
Vol 7 ◽  
pp. 232470961986557
Author(s):  
Asim Kichloo ◽  
M. Zatmar Khan ◽  
El-Amir Zain ◽  
Navya Sree Vipparla ◽  
Farah Wani
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Abdominal Aortic Aneurysm ◽  
Case Report ◽  
Aortic Aneurysm ◽  
Abdominal Aorta ◽  
Abdominal Aortic Aneurysm Repair ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Abdominal aortic aneurysm (AAA) is one of the important pathologies involving the abdominal aorta, as it can have adverse consequences if it goes unnoticed or untreated. AAA is defined as an abnormal dilation of the abdominal aorta 3 cm or greater. Endovascular abdominal aortic aneurysm repair (EVAR) has recently emerged as a treatment modality for AAA. It does have a few inherent complications that include endoleak, endograft migration, bleeding, ischemia, and compartment syndrome. This case report discusses a patient who came in with abdominal pain and a pulsatile mass, which raised concerns regarding endoleak. The patient had a 9.9-cm AAA, which was repaired in the past, as was made evident by computed tomography findings of the stent graft in the aneurysmal segment. This case stands out because it highlights the importance of comparing the size of the AAA at the time of the EVAR to the current scenario where the patient presents with abdominal pain of unknown etiology. Also, this case report highlights the importance of computed tomography and other imaging forms in following-up with patients who have EVAR for AAAs.

Gastropericardial fistula: A rare etiology of chest pain

2017 ◽  
Vol 25 (2) ◽  
pp. 106-109
Author(s):  
Amine Ghalem ◽  
Mehdi Berrajaa ◽  
Kamal Ahsayan ◽  
Mohammed Aabdi ◽  
Imane Boutahar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Wedge Resection ◽  
Unusual Condition ◽  
Gastropericardial Fistula ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Esophagogastric Surgery

Gastropericardial fistula is an abnormal communication between the stomach and the pericardium. It is a rare, life-threatening condition that has numerous etiologies. We report the case of a 53-year-old male patient, with a history of wedge resection for gastrointestinal stromal tumor, who presented to the emergency department for epigastric and chest pain along with lethargy leading to the uncommon diagnosis of gastropericardial fistula with pneumopericardium. Through this case, we would like to draw clinicians’ attention to gastropericardial fistula as a differential diagnosis in patients presenting for epigastric and/or chest pain with a history of esophagogastric surgery, emphasizing on the key role of computed tomography in this regard, and underscore the management basics of this unusual condition.

scholarly journals The chest pain in neurological practice. Non deesset...

2019 ◽  
Vol 10 (2) ◽  
pp. 91-96
Author(s):  
Elena V. Shirshova ◽  
O. Y. Annenkova ◽  
E. V. Ekusheva ◽  
V. N. Petrov
Keyword(s):  
Chest Pain ◽  
Aortic Aneurysm ◽  
Clinical Manifestations ◽  
Routine Clinical Practice ◽  
Aortic Aneurysms ◽  
Aorta Aneurysm ◽  
Thoracic Aortic Aneurysms ◽  
Threatening Condition ◽  
Life Threatening ◽  
Thoracic Aorta Aneurysm

Chest pain can be a “mask” of a life-threatening condition, which the practitioner must remember. One of such life-threatening condition is aortic aneurysm, which diagnosis presents significant difficulties in routine clinical practice. Clinical manifestations of thoracic aortic aneurysms are extremely variable and non-specific and are mainly depends on the size of the aneurysmal sac, its localization and extent, as well as the etiology of the disease. Here we present a clinical case report of a 48 y.o. patient who died because of the acute cardiac tamponade as a complication of dissecting thoracic aorta aneurysm. The lack of symptoms and clinical instrumental data, initially suggesting the presence of life-threatening disease did not allow the physician to suspect aortic aneurysm and urgently take action regarding it.

scholarly journals Management of a Mycotic Thoracoabdominal Aortic Aneurysm Involving the Celiac Artery

2016 ◽  
Vol 43 (6) ◽  
pp. 528-530 ◽  
Author(s):  
Ahmet Dolapoglu ◽  
Kim I. de la Cruz ◽  
Joseph S. Coselli
Keyword(s):  
Aortic Aneurysm ◽  
Rare Case ◽  
Mycotic Aneurysm ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Celiac Artery ◽  
Threatening Condition ◽  
Visceral Arteries ◽  
Life Threatening ◽  
In Situ Repair

A mycotic aneurysm that also involves the visceral arteries is a life-threatening condition. Surgical management typically consists of débridement and in situ repair with a Dacron graft and reimplantation of the involved visceral branches. We report a rare case of a mycotic saccular thoracoabdominal aortic aneurysm involving the celiac artery, with Streptococcus pneumoniae as the responsible organism. Successful repair of the aneurysm and concomitant revascularization of the celiac artery were achieved.

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