ABSTRACT
We report the findings in a 75-year-old woman who was given diagnosis of rupture of the internal thoracic artery (ITA) and was successfully treated by coil embolization. The patient suddenly felt chest pain, and a chest CT revealed a mediastinal hematoma. She was suspected to have an acute aortic dissection, and therefore transferred to our hospital. Upon careful examination, a CT showed a hematoma in the superior mediastunum and the extravasation of the left internal thoracic artery. Emergency coil embolization was thus performed to stop the bleeding. After the embolization, no further hemorrhaging was observed. The patient was uneventfully discharged in a healthy state 2 weeks later. Rupture of the internal thoracic artery is rare. However, it is important to include this potential disease in the differential diagnosis when encountering a patient presenting with an atraumatic mediastinal hematoma.
ABSTRACT
We describe our surgical experience of inflammatory abdominal aortic aneurysm (IAAA) in a 54-year-old man. Computed tomography (CT) with contrast enhancement revealed an infrarenal abdominal aortic aneurysm with marked thickening of the aneurysmal wall (mantle core sign) and left hydronephrosis. The left ureteral stenting was performed. Preoperative laboratory findings showed high levels of serum IgG4. The IAAA was removed and replaced with a woven-Dacron graft <i>in situ</i>. Histological examination revealed the IgG4 positive plasma cell, and demonstrated IAAA associated with IgG4. The postoperative serum IgG4 was reduced, but remained high. The postoperative CT revealed new right hydronephrosis, and the ureteral stent was performed. The mantle sign reduced in CT scan after steroid therapy. IAAA with hydronephrosis seems to be associated with IgG4-related sclerosing disease. In this case, the levels of serum IgG4 seems to be a good index for treatment efficacy.
ABSTRACT
A 70-year-old man presented at a nearby hospital with dysphagia, hematemesis, and hemorrhage. After examination by magnetic resonance imaging and gastrointestinal fiberscopy, he was referred to our hospital on the suspicion of an aortoesophageal fistula due to a thoracic aortic aneurysm. Considering the degree of invasion and infection, we planned two operations but were compelled to perform three operations because of esophageal leakage. Aortoesophageal fistula due to thoracic aneurysms are usually fatal, with only 18 reported survivors in the past 22 years. The optimal treatment for this condition is not yet known. We report survival of the first case of aortoesophageal fistula due to thoracic aneurysm complicated by mediastinitis caused by esophageal leakage in which management by two operations was initially planned. From this case many possible strategies to manage aortoesophageal fistula due to thoracic aneurysms arose. Therefore, we report this case together with a review of the literature.