Two Cases of Anomalous Origin of Left Coronary Artery From The Pulmonary Artery

Coronary artery originating from pulmonary artery is a rare congenital vascular malformation, which generally presents corresponding clinical symptoms with the growth of patients' age. Coronary CTA and angiography are important methods for diagnosis of this disease, and provide evidence for treatment strategies of patients.

Incidental Finding of a Persistent Stapedial Artery in a Patient Presenting With Conductive Hearing Loss

A persistent stapedial artery is a congenital vascular malformation that can cause tinnitus and/or conductive hearing loss. Although rare, this case highlights the importance of recognizing aberrant anatomy as a potential cause of patients’ symptoms. It also demonstrates how to recognize and treat patients with a symptomatic persistent stapedial artery.

Case Report: Membranoproliferative Glomerulonephritis, a Rare Clinical Manifestation of Abernethy Malformation Type II

This report describes an 8-year-old male who presented with clinical manifestations including systemic edema, heavy proteinuria, hypoproteinemia, and persistent hypocomplementemia. Arachnoid cysts and focal nodular hyperplasia were also detected. Imaging examination and renal biopsy were performed, and Abernethy malformation type II with immune complex-mediated membranoproliferative glomerulonephritis was considered the diagnosis. Due to the persistence of embryonic vessels, Abernethy malformation is a rare congenital vascular malformation of the splanchnic venous system, which can be classified as type I (end-to-side shunt) and type II (side-to-side shunt). Abernethy malformation with glomerulonephritis remains extremely rare. In the patient described, glomerulonephritis mediated by immune complex with “full-house” positive immunohistochemistry was confirmed on renal biopsy. In addition, he was treated with glucocorticoids and tacrolimus. Whether surgical treatment is necessary should be determined according to the state of the disease in the later stages. The present case reflects the association between the congenital portosystemic shunt and the renal region and, to the authors' knowledge, may be the first report to describe arachnoid cysts as a symptom of Abernethy malformation.

Renal Artery Aneurysm Due to Fenestration of a Branch of the Renal Artery: A Case Study

Artery fenestration is a congenital vascular malformation, often of the intracranial arteries, that causes an aneurysm. However, there have been no reports of artery fenestration causing renal aneurysm. We present the case of a 58-year-old man who developed renin-dependent hypertension. He was aware of heaviness of the head, and his blood pressure was 196/134 mm Hg on 5 mg of amlodipine. Laboratory tests showed hypokalemia, hyperreninemia, and hyperaldosteronemia. An enhanced 3-dimensional computed tomography scan showed a 19-mm renal aneurysm in a branch of the left renal artery, and renal arteriography showed a fenestration in the aneurysm-forming branch. Coil embolization was performed on the central side of the artery forming the aneurysm and fenestration, after which blood pressure, serum potassium, and plasma renin levels improved. The patient in the present case had renin-dependent hypertension as a result of decreased renal blood flow caused by the renal aneurysm and fenestration, which is considered an extremely rare etiology of hypertension.

Giant congenital vascular malformation: diagnostic approach and clinical course

ObjectivesCongenital hemangiomas have been well documented, but there remains relatively little information regarding the workup of large or atypical vascular lesions in neonates beyond history and physical exam.Case presentationWe report a case of a large congenital hemangioma overlying the anterior chest wall of a term male infant. Imaging by ultrasound and computed tomography (CT) scan confirmed the diagnosis of congenital hemangioma, either non-involuting or rapidly-involuting type. Further imaging supported a plan to manage this case conservatively.ConclusionsWe present a case of a giant congenital hemangioma overlying most of the chest wall of a term infant and describe the findings on physical exam and imaging, as well as a work-up of similar lesions.

Infectious stentitis after treatment of coarctation of the aorta: a case report

Background Aortitis is a rare condition that can be caused by inflammatory or infectious aetiologies. The clinical presentation of aortitis includes a heterogeneous range of symptoms and clinical signs. Case summary We present a 53-year-old man whose medical history included presence of a ventricular septal defect, a bicuspid aortic valve, and coarctation of the aorta. The coarctation was treated with percutaneous stent implantation. One and a half years later, he presented to our hospital with complaints of fatigue, night sweats, and shivers. Physical examination revealed a fever, tachycardia, and hypertension. Imaging studies showed no signs of endocarditis. Positron emission tomography–computed tomography (PET–CT) showed an increase in 18F-fluorodeoxyglucose uptake at the distal end of the stent in the descending aorta. Blood cultures revealed a Streptococcus gordonii and antibiotic treatment was adjusted accordingly. The patients’ functional status improved quickly, the fever resolved, and the laboratory markers of inflammation returned to normal. Discussion Aortitis is extremely rare after stent implantation. Risk factors for aortitis include congenital vascular malformation and stent implantation. Computed tomography is currently the imaging study of choice for aortitis, while PET–CT seems ideal for identification of stent infection. Mortality associated with infectious aortitis ranges from 21% to 44%, with generally higher mortality if managed with antibiotics alone. The differential diagnosis of stent infection should be taken into account in patients presenting with fever and chills after previous stent procedures.

Diagnosis and surgical repair of congenital double aortic arch in infants

Objectives Double aortic arch (DAA) is a rare congenital vascular malformation. This study aims to summarize the experience of diagnosis and surgical treatment for congenital double aortic arch. Methods The clinical data of 24 cases with double aortic arch (DAA) from January 2008 to January 2018 in our hospital was reviewed retrospectively. Results A total of 24 cases, including 12 patients with isolated DAA and 12 patients with DAA and associated intracardiac defects were identified. There were 14 males and 10 females, with an average age of 11 months. The associated intracardiac malformations included ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot (TOF), transposition of the great arteries (TGA), pulmonary stenosis (PS), and patent foramen ovale (PFO). Of the 12 patients with DAA and intracardiac malformations, 7 patients underwent intracardiac repair simultaneously, however, 3 patients underwent isolated double aortic arch correction. One patient with DAA and TGA underwent surgical correction of congenital vascular ring at the first stage, and the arterial switch operation was performed at the second stage. The clinical outcomes of 23 patients were promising, however, in one patient, parents decided not to do the surgery due to personal reasons. The average follow-up time was 35 months. Conclusions Tracheal and esophageal compression are commonly seen in patients with DAA, however could be relieved significantly after surgery. In particular cases, the simultaneous intracardiac defects repair could be performed. Misdiagnosis was easily established with isolated echocardiography. Fortunately, the correct diagnosis of DAA and associated intracardiac defects could be established with the use of combined chest computed tomography.

The Applications of Medical Tattooing in the Head and Neck Region

Medical tattooing has been used in various circumstances. In this review, the authors focus on the utilization of medical tattooing in the head and neck region as a minimally invasive alternative to corrective surgeries. It is mostly used to camouflage noticeable surgical scars on scalp, face, and perioral areas. Its use has also been described in cases of concealing depigmentation or hypopigmentation, hair loss, postirradiation telangiectasia, and congenital vascular malformation. These procedures are well-tolerated and safe. Its effects are long-lasting and satisfactory, leading to improvement in self-esteem and increased quality of life in treated patients. The limitations of medical tattooing in such uses include high technical requirement, color fading and alteration, unpredictable outcomes in scarred tissue, and potential cutaneous reactions. It also carries a risk of infection, albeit very low due to standardized sterilization process in a medical setting. The authors conclude that medical tattooing in the head and neck region may serve as an excellent option for patients who seek for cosmetic improvement in their deformities and/or discoloration but would prefer to avoid surgery.

Arteriovenous forms of congenital vascular malformations of extremities: pathogenetic ground for modern approaches in treatment

Purpose of the study. Improvement of the results of treatment of patients with arteriovenous forms (AVF) of congenital vascular malformations (CVM) of the extremities based on the development of the classification scheme of CVM and the study of proliferative activity of the pathology.Materials and methods. The clinical data of 155 patients with AVF of CVM of extremities were analyzed in terms of observation from 1 month to 10 years. Patients of sex of men there were 65 (42%), women – 90 (58%), their correlation – 1 : 1,4; the average age was about 25,1 ± 10,4, children's age group – 53 (34%). The division into clinical-anatomical forms (11 groups) was carried out on the basis of the «working» classification scheme «VASC + T». Expression proliferation markers VEGF and KI-67 woos study were performed by immunoperoxidase method with additional hematoxylin staining.Results and discussion. Pathomorphological (66; 45,8%) and immunohistochemical studies (10; 7%) revealed the presence of proliferative activity of angiomatous tissues and degenerative changes in the walls of the vessels both due to developmental defects and disorders of hemodynamics, while the source of progression of the AVF of CVM there are vessels of the microvasculature.Conclusions. The application of the CVM classification scheme and the step-by-step complex treatment approach, depending on the clinical and anatomical AVF of CVM, led to the absence of major postoperative complications. This tactic made it possible to achieve satisfactory long-term results in 136 (94,4%) cases. Keywords: congenital vascular malformation, arteriovenous forms, proliferative activity, classification, complex treatment.