Dual Aneurysm Formation in an Occupationally Predisposed Male: Atypical Hypothenar Hammer Syndrome

Hypothenar hammer syndrome is typically described as a chronic repetitive injury to the ulnar artery at the level of hamulus of hamate and shows certain occupational predilection. Our case is an occupationally predisposed patient who had two aneurysm formations from the superficial palmar branch of ulnar artery and the digital branch, respectively, diagnosed and treated surgically. We call it an atypical hypothenar hammer syndrome as the arterial involvement was not typically at the level of hamate bone and only corresponded to the site of recurrent friction. This article also discusses the role of imaging and treatment options.

Angiographic patterns and temporal changes of arterial lesions in Behcet’s disease

Background Behcet’s disease (BD) can entail vascular involvement in various forms including aneurysm. We evaluated the angiographic patterns and changes in arterial lesions over time in BD patients with arterial involvement. Methods We reviewed the medical records of BD patients diagnosed with arterial lesions between 1995 and 2018. Angiographic patterns were categorized as stenosis, occlusion, dilatation, or aneurysm. Patients were divided according to symptom duration (<5, 5–10, >10 years). Cox proportional-hazards model was used to evaluate the risk factors for vascular progression. Results 47 BD patients had arterial involvement in the following patterns: aneurysm ( n = 31), stenosis ( n = 17), dilatation ( n = 13), and occlusion ( n = 8). Aneurysm (70.8%) was the most common pattern in 24 patients with short (<5 years) symptom duration. Stenosis was more common (50.0%) in 12 patients with longer symptom durations (>10 years). In 23 patients with follow-up imaging (median, 5.7 years), eight (34.8%) developed 11 new lesions: stenosis ( n = 5), dilatation ( n = 1), and aneurysm ( n = 5). One stenotic lesion progressed to occlusion, and two dilated lesions progressed to aneurysms. Lower extremity involvement and methotrexate use were associated with arterial progression, with hazard ratios of 5.716 ( p = 0.029) and 0.101 ( p = 0.049), respectively. Conclusion In BD patients with arterial involvement, aneurysm was the most common pattern in earlier stages of BD, while stenosis was more common in later stages of BD. Methotrexate use was associated with lower risk of arterial lesion progression.

MDCT Angiography Evaluation of Arterial Involvement in Carcinoma Gall Bladder: An Institutional Experience

Purpose: Evaluation of pattern of arterial involvement in advance case of gallbladder carcinoma with MDCT Angiography. Method: All CT examinations were performed on a 64- MDCT scanner (Philips Medical System Version 6.4, Extended Brilliance Workspace). Technical features of MSCT were as following 64mm � 1mm collimation, minimum slice thickness of 0.625, gantry rotation time of 320ms, kV of 120, and mAs of 320. CT Angiography was performed with IV administration of nonionic contrast material i.e. omnipaque. The contrast medium and saline solution were injected with a medrad power injector at 4mL/sec through an 18-gauge plastic intravenous catheter placed in an antecubital vein in most of the cases. Contrast medium volumes varied between 100 and 150 mL at 1.5ml/Kg. Images were obtained in triphasic pattern at arterial (20-30 seconds), portal (60-70 seconds), and equilibrium (at 3 minutes) phases. Results: Nearly half of the cases (43.5%) of carcinoma gall bladder showed arterial involvement at the time of diagnosis; most commonly involved artery was found to be cholecystic artery (24.7%) followed by right hepatic artery (14.1%) and replaced right hepatic artery (3.5%). Conclusion: We conclude that nearly half of the patients with carcinoma gall bladder have arterial involvement at the time of diagnosis. The most commonly artery involved was Cholecystic artery followed by right hepatic artery and replaced right hepatic artery. Keywords: MDCT (Multidetector computed tomography); Carcinoma gall bladder; Cholecystic artery; Hepatic artery; Right hepatic artery

Acute limb ischemia in COVID-19 patients: an overview

COVID-19 causes a wide range of clinical symptoms. COVID-19 hematologic and cardiovascular involvement induces thromboembolic symptoms in various organs, most notably venous thromboembolism (VTE); peripheral arterial involvement is uncommon. Acute limb ischemia (ALI) is a vascular emergency known as a dramatic drop in arterial perfusion of a limb that poses a challenge to the limb's viability. Given routine need for thromboprophylaxis, hospitalised COVID-19 patients are at an elevated risk of ALI, limb loss, or even mortality. Understanding the various specific symptoms of COVID-19 patients, especially extrapulmonary manifests, is crucial for both better patient care and the development of adequate infection prevention methods. Although ALI is a complication of COVID-19 in hospitalized patients, it is now being understood that it can arise in patients with mild COVID-19 symptoms, and that ALI can be the first presenting sign of COVID-19 even in the absence of respiratory symptoms. It is recommended that acutely admitted COVID-19 cases should be given pharmacologic thromboprophylaxis with low molecular weight heparin (LMWH) or fondaparinux unless there is a chance of bleeding or contraindicated. Anticoagulant treatment, primarily with LMWH, correlates strongly with an improved prognosis in serious COVID-19 patients who follow sepsis-induced coagulopathy requirements or have significantly elevated D-dimer levels.

Humeral Artery Aneurysm Revealing a Rare Association between Tuberculosis and Behçet’s Disease

The association of pulmonary tuberculosis and Behçet’s disease revealed by an aneurysm of the humeral artery is exceptional with a complicated management. We report a case in which the two conditions occurred concomitantly with the vascular complication, apart from any use of immunosuppressive therapy, something that has never been reported in the literature. We report an extremely rare case of a spontaneous rupture of an aneurysm of the humeral artery of a 29-year-old woman, with no history. The patient underwent axillo-humeral bypass. Investigations concluded the diagnosis of Behçet’s disease associated with pulmonary and lymph node tuberculosis. Anti-tuberculous chemotherapy followed by corticosteroids, immunosuppressants and colchicine have been administrated. Based on this observation, we insist on the necessity of searching the symptoms of Behçet’s disease in the presence of arterial involvement when having a young patient. Therapeutic management must include medical treatment to control inflammation and limit the risk of recurrence. Endovascular or surgical treatment is necessary if the arterial involvement is threatening. The association with tuberculosis complicates management and requires close monitoring.

Effect of cannabis consumption on characteristics and evolution of thromboangitis obliterans

Summary: Background: Thromboangiitis obliterans (TAO) is a distal non atherosclerotic thrombotic vasculitis affecting tobacco smokers. The role of cannabis co-exposure remains controversial. The study aims to assess how cannabis consumption influences clinical presentation and outcome of TAO in tobacco smokers. Patients and methods: TAO patients, according to Papa’s criteria, were included in a retrospective bicentric study between the 1st January 2003 and the 1st march 2020. Clinical characteristics, arterial involvement at TAO diagnosis, vascular event and amputations during follow-up were analyzed according to cannabis consumption. Results: Seventy-three patients with TAO patients were included. Forty-five patients were in Tobacco group (T) and 28 in Tobacco and cannabis group (T&C). Tobacco exposure was less important in T&C group than in T group (19.4±11.3 vs 31.6±16.6 pack-years) (p=0.005) and patients in T&C group were younger at TAO diagnosis than in T group (p=0.008). Patients in T&C group presented more claudication (33.3% vs 8.9%, p=0.01) and less upper limbs resting ischemia (25.9% vs 51.1%, p=0.04) than patients in the T group. No differences were found between groups with regard to arterial distribution. Amputation rate for patients who had at least one major or minor amputation did not differ between T and T&C group (25% vs 14.8%, p=0.38). Conclusions: Cannabis consumption was associated with a younger age of TAO onset. However, it does not affect amputation-free survival, Tobacco exposure is less important in T&C patients; data of this bicentric study suggest that cannabis could be a cofactor of tobacco which accelerates TAO onset.

Pulmonary findings on high-resolution computed tomography in Takayasu arteritis

Objective This study aimed to describe pulmonary high-resolution computed tomography (HRCT) findings in Takayasu arteritis (TA) and to determine possible causes. Methods A total of 243 TA patients were enrolled from a prospective cohort after excluding patients with other pulmonary disorders or incomplete data. Patients were divided into two groups: those with normal lung HRCT and those with abnormal lung HRCT. Clinical characteristics were compared between groups and binary logistic regression analysis was applied to identify possible causes of the lung lesions. Follow-up HRCT (obtained in 64 patients) was analysed to study changes in pulmonary lesions after treatment. Results Of the 243 patients, 107 (44.0%) had normal lung HRCT while 136 (56.0%) had abnormal lung HRCT, including stripe opacity (60.3%), nodules (44.9%), patchy opacity (25.0%), pleural thickening (15.4%), pleural effusion (10.3%), ground-glass opacity (8.1%), pulmonary infarction (6.6%), mosaic attenuation (4.4%), bronchiectasis (3.7%), and pulmonary oedema (2.2%). Patients with abnormal HRCT were significantly more likely to have type II arterial involvement (25% vs. 12.2%, P = 0.04), pulmonary arterial involvement (PAI; 21.3% vs. 5.6%, P &lt; 0.001), pulmonary hypertension (20.6% vs. 8.4%, P = 0.01), and abnormal heart function (27.9% vs. 7.6%, P &lt; 0.001). Logistic regression analysis demonstrated that PAI, worsened heart function, and age were associated with presence of pulmonary lesions. Pulmonary infarction, pleural effusion, and patchy opacities improved partially after treatment. Conclusion Pulmonary lesions are not rare in patients with TA. Age, PAI, and worsened heart function are potential risk factors for presence of pulmonary lesions in TA.