32 Congenital Arteriovenous Malformation of The Breast Associated with Giant Hairy Naevus: A Case Report

Introduction An arteriovenous malformation (AVM) is defined as an abnormal connection between arteries and veins, bypassing the capillary system. AVM of the breast is a rare clinical entity, with limited evidence to guide management. We present the case of a congenital AVM of the breast in an otherwise healthy woman, with an interesting presenting complaint. Case Description A 38-year-old female presented with a ‘buzzing’ sensation and mastalgia in her left breast. Examination revealed a visible pulsatile linear abnormality with a bruit on auscultation. Duplex ultrasonography demonstrated mixing of the arterial and venous flow, consistent with an AVM. Operative management entailed ultrasound guided identification, ligation and excision of all aneurysmal segments. Histopathologic evaluation demonstrated an AVM with no malignant features. At one year postoperatively, the patient reported complete symptom resolution. Literature review identified nine case reports, including two cases of congenital breast AVM, both treated surgically. Seven cases of iatrogenic AVM were identified, with diagnosis based on duplex ultrasonography and management by surgical ligation in all except one, which resolved spontaneously. Conclusions ongenital AVM of the breast is a rare clinical entity. Diagnosis can be established using duplex ultrasonography, while CT and MRI may be useful for preoperative planning. Endovascular management alone is associated with high recurrence rates and surgical excision is the favoured approach where technically feasible without major aesthetic or functional compromise.

Cerebral Autoregulation during Postural Change in Patients with Cervical Spinal Cord Injury—A Carotid Duplex Ultrasonography Study

Patients with a spinal cord injury (SCI) frequently experience sudden falls in blood pressure during postural change. Few studies have investigated whether the measurement of blood flow velocity within vessels can reflect brain perfusion during postural change. By performing carotid duplex ultrasonography (CDU), we investigated changes in cerebral blood flow (CBF) during postural changes in patients with a cervical SCI, determined the correlation of CBF change with presyncopal symptoms, and investigated factors affecting cerebral autoregulation. We reviewed the medical records of 100 patients with a cervical SCI who underwent CDU. The differences between the systolic blood pressure, diastolic blood pressure, and CBF volume in the supine posture and after 5 min at 50° tilt were evaluated. Presyncopal symptoms occurred when the blood flow volume of the internal carotid artery decreased by ≥21% after tilt. In the group that had orthostatic hypotension and severe CBF decrease during tilt, the body mass index and physical and functional scores were lower than in other groups, and the proportion of patients with a severe SCI was high. The higher the SCI severity and the lower the functional score, the higher the possibility of cerebral autoregulation failure. CBF should be assessed by conducting CDU in patients with a high-level SCI.

Detection of Cavernous transformation of the portal vein in a 22-year-old male with upper gastrointestinal bleeding and anemia by Abdominal Duplex Ultrasonography. A Case Report.

Cavernous transformation of the portal vein (CTPV) is a rare condition characterized by the formation of multiple tortuous tiny blood vessels within and around a portal vein which has been occluded by thrombus. Early diagnosis of CTPV is relevant for timely intervention which could save the liver from non-reversible damage

Superficial venous aneurysm of the great saphenous vein: a case report

Superficial venous aneurysms are rare clinical entity. They can remain asymptomatic to be detected incidentally or can present with pain. They can be readily diagnosed by duplex ultrasonography or discovered only during surgical exploration. The objective of this clinical case report is to highlight this rare occurrence and avoid misdiagnosis. A 69-year-old male presented at our tertiary care hospital with complaints of pain and swelling which was gradually increasing in size. Initially it was misdiagnosed to be femoral hernia, and the diagnosis of Great Saphenous Vein aneurysm was made following duplex ultrasonography. Following which, the patient underwent successful surgical excision.

Duplex ultrasonography as prognostic tool of acute ischemic stroke patients

Background Cerebral stroke is a major source of mortality and morbidity. Duplex ultrasonography is used to evaluate carotid and cerebral arteries. The objectives of this work are to study the correlation between carotid duplex parameters with risk factors of ischemic stroke and evaluate duplex parameter as prognostic tool of ischemic stroke. Methods The study was conducted on 100 patients presented by acute ischemic stroke submitted to history taking, medical, and neurological examination. Neurological deficit was assessed by National Institute of Health Stroke Scale (NIHSS); the functional state of the patients was assessed by modified Rankin scale (mRS). Brain CT and/or MRI, routine laboratory investigations, extracranial, and transcranial duplex (TCD) were done. Results The end diastolic velocities (EDVs) and peak systolic velocities (PSVs) of common carotid arteries (CCA) were significantly decreased in smokers and hypertensive (P<0.05). Smoking and hypertension were positively correlated with resistive index (RI). In 80 patients, PSV in the symptomatic middle cerebral artery (MCA) did not exceed 70 cm/s within averaged 50.7 ± 4.6 cm/s. EDV was 12.0 ± 3.0 cm/s, RI was 0.78 ± 0.05, and pulsativity index (PI) was 1.61 ± 0.09. There was significant difference in all hemodynamic parameters in comparison with the asymptomatic side. Conclusion Patients who have risk factors of stroke should be evaluated with duplex ultrasonography. Duplex parameters can give informative data about prognosis and outcome.

Physical Examination and Ultrasound Evaluation of Patients with Superficial Venous Disease

Systematic and standardized evaluation of superficial venous disease, guided by knowledge of the various clinical presentations, venous anatomy, and pathophysiology of reflux, is essential for appropriate diagnosis and optimal treatment. Duplex ultrasonography is the standard for delineating venous anatomy, detecting anatomic variants, and identifying the origin of venous insufficiency. This article reviews tools and techniques essential for physical examination and ultrasound assessment of patients with superficial venous disease.