Pseudoaneurisma de la arteria femoral profunda secundario a trauma penetrante: reporte de caso / Deep femoral artery pseudoaneurysm secondary to penetrating trauma: case report

Resumen Objetivo: El objetivo del trabajo es presentar una opción terapéutica adecuada para los pseudoaneurismas de la femoral profunda secundarios a trauma penetrante, así como realizar una revisión de la literatura sobre el manejo en estas patologías. Caso clínico: Paciente masculino de 21 años quien 5 meses previos a su valoración sufre una herida por arma punzocortante en el muslo izquierdo, desarrollando aumento de volumen el sitio de la lesión, dolor y limitación al movimiento. Se diagnostica un pseudoaneurisma de la arteria femoral profunda de 2,3 cm x 2,1 cm x 2,7 cm y un hematoma adyacente de 13,5 cm x 12,6 cm x 23 cm. Se realiza exclusión del pseudoaneurisma mediante cirugía endovascular con coils, posteriormente se evacúa el hematoma adyacente. Resultados: El paciente egresa al tercer día posoperatorio con mejoría de la sintomatología, antibioticoterapia y analgesia. Discusión y Conclusión: En el caso presentado la exclusión del pseudoaneurisma mediante coils facilitó el control de éste y la evacuación del hematoma adyacente, disminuyendo el riesgo de sangrado. Por lo que consideramos adecuada esta conducta terapéutica en pseudoaneurismas de la femoral profunda.

Aim: The aim of this paper is to present a case of a deep femoral artery pseudoaneurysm secondary to a penetrating trauma in the left thigh, its management and a literature review. Clinical Case: 21-year-old male referred to the emergency department of our institution 5 months after he was injured with a knife on his left thigh, with severe local swelling, local pain, and difficulty to the mobilization of the left leg. A 2.3 cm x 2.1 cm x 2.7 cm deep femoral artery pseudoaneurysm was diagnosed with a 13.5 cm x 12.6 cm x 23 cm adjacent hematoma. Endovascular exclusion was made with coils and evacuation of the hematoma with open surgery. Results: The patient was discharged on the third day postop without pain and walking with antibiotics and follow-up to a month did not reveal any complications. Discusion and Conclusion: Exclusion with coils is an adequate management in deep femoral pseudoaneurysms that facilitates the evacuation of the hematoma lowering the risk of bleeding.

Clinical factors that influence the occurrence of symptomatic pseudoaneurysms and arteriovenous fistulas after partial nephrectomy: multi-institutional study of renal function outcomes after one year of selective arterial embolization

ABSTRACT Purpose: Renal artery pseudoaneurysms (RAPs) and arteriovenous fistulas (AVFs) are rare but potentially life-threatening complications after partial nephrectomy (PN). Selective arterial embolization (SAE) is an effective method for controlling RAPs/AVFs. We assessed the clinical factors affecting the occurrence of RAPs/AVFs after PN and the effects of SAE on postsurgical renal function. Materials and Methods: Four hundred ninety-three patients who underwent PN were retrospectively reviewed. They were placed in either the SAE or the non-SAE group. The effects of clinical factors, including R.E.N.A.L. scores, on the occurrence of RAPs/AVFs were analyzed. The influence of SAE on the estimated glomerular filtration rate (eGFR) during the first postoperative year was evaluated. Results: Thirty-three (6.7%) patients experienced RAPs/AVFs within 8 days of the median interval between PN and SAE. The SAE group had significantly higher R.E.N.A.L. scores, higher N component scores, and higher L component scores (all, p <0.05). In the multivariate analysis, higher N component scores were associated with the occurrence of RAPs/AVFs (Odds ratio: 1.96, p=0.039). In the SAE group, the mean 3-day postembolization eGFR was significantly lower than the mean 3-day postoperative eGFR (p <0.01). This difference in the eGFRs was still present 1 year later. Conclusions: Renal tumors located near the renal sinus and collecting system were associated with a higher risk for RAPs/AVFs after PN. Although SAE was an effective method for controlling symptomatic RAPs/AVFs after PN, a procedure-related impairment of renal function after SAE could occur and still be present at the end of the first postoperative year.

Coronary involvement in behçet's disease: what are its risks and prognosis? (rare cases and literature review)

Abstract Objective: In our clinic, we aimed to investigate the effect of preoperative risk factors and postoperative complications on reoperation and mortality in cases with Behçet's disease which presents very rare coronary artery involvement. Methods: Thirteen patients with Behçet's Disease who had undergone coronary artery bypass grafting in our center between 2003 and 2015 were analyzed. We evaluated the clinical and laboratory findings, complications and mortality rates of our patients in light of the literature. Results: The mean age was 38.5 (30-55; 3 women). The mean time from onset of Behçet's disease to coronary artery disease was 4,7 (3-11) years. Fifty-four percent of the patients were asymptomatic. Coronary artery disease of these was exposed while peripheral vascular surgery was planned due to complications of Behçet's disease. Symptomatic patients presented angina pectoris (31%), acute coronary syndrome (8%) and arrhythmia (8%). In coronary pathology of patients, distal type obstruction (31%), aneurysm and pseudoaneurysm (31%), proximal segment thrombus (15%), chronic type stenosis and occlusions (31%) were present. Early mortality (15%) was due to acute myocardial infarction while the late mortality (15%) was due to cerebral and gastrointestinal bleeding. Reoperation was due to bleeding in one case on the 1st postoperative day and due to acute pulmonary embolism in another case in the 3rdpostoperative year. Conclusion: In Behçet's disease, coronary artery bypass grafting is a procedure with high mortality, especially in the acute period. The on-pump surgery technique in these cases can be safely performed for multiple bypasses and in patients above 40 years old.

Tratamiento de pseudoaneurisma iatrogénico con compresión ecoguiada / Treatment of iatrogenic pseudoaneurysm with echo-guided compression

Resumen Objetivo: Evaluar la efectividad obtenida con la compresión ecoguiada como primera elección para lograr la trombosis del pseudoaneurisma iatrogénico post estudio o intervencionismo. Material y Método: Estudio retrospectivo observacional de 9 pacientes en quienes se realizó la compresión ecoguiada como primera alternativa de manejo frente a pseudoaneurismas iatrogénicos secundarios a procedimientos diagnósticos o terapéuticos ocurridos entre agosto de 2012 y diciembre de 2015 en el Hospital Regional de Talca. Resultados: De 4.070 procedimientos se presentó la complicación en 9 pacientes, un 0,22%; 7 posterior a procedimientos terapéuticos (0,4%), y 2 en el grupo de diagnósticos (0,08%). La muestra se compone por 6 hombres y 3 mujeres de edad promedio 70 años. El vaso comprometido fue principalmente la arteria femoral con un 77%. Los pseudoaneurismas ocurrieron mayoritariamente posteriores a procedimientos terapéuticos (77%); y el éxito de la compresión ecoguiada se obtuvo en el 67%. No hubo complicaciones asociadas al tratamiento. Conclusiones: La compresión ecoguiada tiene un porcentaje de éxito menor en esta pequeña serie que los obtenidos por otros autores, pero al no presentar complicaciones y por su bajo costo creemos debe mantenerse como primera alternativa.

Objective: To evaluate the effectiveness obtained with echo guided compression as the first choice to achieve thrombosis of iatrogenic pseudoaneurysm after study or interventionism. Material and Method: Retrospective observational study of 9 patients who underwent echo-guided compression as the first management alternative to iatrogenic pseudoaneurysms following diagnostic or therapeutic procedures that occurred between August 2012 and December 2015 at the Regional Hospital of Talca. Results: Of 4,070 procedures the complication was presented in 9 patients, 0.22%; 7 after therapeutic procedures (0.4%), and 2 in the diagnostic group (0.08%). The sample consists of 6 men and 3 women of average age 70 years. The involved vessel was mainly the femoral artery with 77%. Pseudoaneurysms occurred mostly after therapeutic procedures (77%); and the success of the echogenic compression was obtained in 67%. There were no complications associated with treatment. Conclusions : Image guided compression has a lower success rate in this small series than those obtained by other authors, but since there are no complications and because of its low cost, we believe that it should be kept as the first alternative.

Pseudoaneurisma traumático de la arteria temporal superficial, reporte de un caso / Traumatic pseudoaneurysm of the superficial temporal artery, report of a case

Los pseudoaneurismas son una causa infrecuente de masa palpable en cabeza y cuello, habitualmente secundarios a procedimientos intervencionales; trauma e infeccioso son casos aislados. Caso Clínico. Se presenta el caso de un niño de 14 años que luego de haber sufrido un trauma contuso cortante en la región preauricular izquierda intervenido quirúrgicamente, desarrolla al mes un aumento de volumen pulsátil tras un trauma menor en la zona. En la ecografía se aprecia el signo del yin yang, indicador de pseudoaneurisma. Se realiza en pabellón el vaciamiento del pseudoaneurisma y posterior sutura vascular sin incidentes. Discusión. Pese a la baja frecuencia de pseudoaneurisma como causa de masa en cabeza y cuello, se debe considerar como diagnóstico diferencial en el contexto de masas pulsátiles post traumáticas, de horas a días de evolución. El estudio de elección es la ecografía doppler y el Gold Standard del manejo es quirúrgico con sutura vascular.

Pseudoaneurysms are an infrequent cause of palpable mass in the head and neck; usually secondary to invasive procedures; trauma and infectious causes are rare. Clinical Case. We present the case of a 14-year-old boy who, after suffering a blunt contusive trauma in the left preauricular region surgically treated, develops a month later a pulsatile volume increase after a minor trauma in the area. Ultrasound shows the yin yang sign, indicator of pseudoaneurysm. The emptying of the pseudoaneurysm and subsequent vascular suture was performed without incident. Discussion. Despite the low frequency of pseudoaneurysm as a cause of mass in the head and neck, it should be considered as a differential diagnosis in the context of post-traumatic pulsatile masses, from hours to days of evolution. The study of choice is Doppler ultrasound and the Gold Standard treatment is surgery with vascular suture.

Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases / Tratamento endovascular de pseudoaneurisma decorrente de pancreatite crônica: relato de dois casos

Abstract Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.

Resumo O pseudoaneurisma decorrente de pancreatite crônica consiste em complicação rara, porém com alta taxa de mortalidade. Está etiologicamente associado à pancreatite crônica, e seu diagnóstico é feito mais comumente após ruptura, manifestando-se através de sinais clínicos de hemorragia aguda. A tomografia computadorizada desempenha papel importante no diagnóstico; contudo, a angiografia por subtração digital mantém-se como método padrão-ouro para confirmação diagnóstica e direcionamento do tratamento. O presente artigo relata dois casos de pseudoaneurisma em pacientes com pancreatite crônica alcoólica, sendo um da artéria esplênica e outro da artéria gastroduodenal, complicados com sangramento torácico e abdominal respectivamente. Ambos foram submetidos a tratamento endovascular minimamente invasivo com sucesso, através de implante de molas e de stent-grafts.

Post-PCNL renal artery pseudoanurysm

A renal artery pseudoaneurysm is a rare but important complication that can occur after renal trauma, renal biopsy, percutaneous nephrostomy, percutaneous nephrolithotomy [PCNL], and partial nephrectomy. The incidence of this potentially life-threatening complication is less than 1%, but is likely to increase with the increasing popularity of endoscopic renal procedures. We present a case of a 30-year female who underwent right PCNL for a right renal pelvic stone. Two weeks later, she presented with massive hematuria. Renal angiography revealed psuedoanurysm of interlobar artery which was successfully treated with coil embolization

Renal artery pseudoaneurysm / Pseudoaneurisma de artéria rena

Abstract The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT). This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots) inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.

Resumo O pseudoaneurisma de artéria renal constitui-se de uma rara complicação vascular advinda de procedimentos percutâneos, biópsias renais, nefrectomia, traumas penetrantes e mais raramente traumas contusos. A clínica pode variar de acordo com cada paciente, sendo a hematúria o sintoma mais comum. Visto isso, é necessário um alto nível de suspeição clínica para seu diagnóstico, que pode ser elucidado através de exames complementares, como o Ecodoppler colorido e tomografia computadorizada. Neste relato, apresentamos o caso de um paciente submetido à biópsia renal direita percutânea e que, após o procedimento, iniciou com hematúria macroscópica, tenesmo urinário e dor em hipogástrico. O diagnóstico de pseudoaneurisma foi dado após uma semana de evolução, quando o paciente foi internado por hematúria franca, taquicardia, hipotensão e dor em hipocôndrio. Em angiotomografia, foi revelada uma dilatação focal da artéria renal polar acessória inferior à direita, dilatação da pelve renal e de todo trajeto ureteral, com presença de material hiperdenso (coágulos) no interior do terço médio do ureter. O tratamento de escolha para a maioria dos casos é conservador, através da embolização arterial, indicada para aqueles de menores dimensões em pacientes estáveis hemodinamicamente. Entretanto, optou-se inicialmente pelo tratamento clínico com ácido aminocapróico 1 g, com base nos estudos prévios para tratamento da hematúria. O paciente recebeu alta sem evidências de hematúria macroscópica e com ecografia renal normal, seguindo em acompanhamento ambulatorial.

Inusual complicación en procedimiento de cirugía ortognática / Unusual complication in an orthognathicsurgery procedure

Objetivo: presentar un caso de pseudoaneurisma de la arteria maxilar interna, complicación hemorrágica infrecuente mediata al procedimiento de osteotomía sagital mandibular. Caso clínico: El tratamiento consistió en la embolización selectiva del vaso afectado, un procedimiento menos cruento que las maniobras hemostáticas tradicionales, como la ligadura arterial a través de un abordaje cervical. Conclusión: Es posible resolver la hemorragia con un método alternativo pero seguro, que conlleva menos morbilidades asociadas a las maniobras hemostáticas clásicas.

Aim: to report a mediate rare bleeding complication tothe procedure of mandibular sagittal split osteotomy as is thepseudoaneurysm of the internal maxillary artery is.Case report: The treatment consisted of selective embolizationof the affected vessel, which turns out to be a lessinvasive procedure than traditional hemostatic maneuverssuch as arterial ligation through a cervical approach.Conclusion: It is possible to resolve the bleeding withan alternative safe method with lower morbidity than the oneassociated with classical hemostatic maneuvers.

Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo / Las complicaciones del acceso vascular en pacientes sometidos a procedimientos percutáneos en hemodinamia: revisión de escopo / Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review

Resumo OBJETIVO Mapear a produção de conhecimento acerca das complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em Laboratório de Hemodinâmica. MÉTODOS Estudo do tipo revisão de escopo. Elaborou-se estratégia de busca em três etapas, considerando o período entre julho de 2005 e 2015, nas bases de dados PubMed, CINAHL, Scopus e LILACS. Os dados extraídos foram analisados e sintetizados de forma narrativa. RESULTADOS Foram incluídas 128 publicações que permitiram mapear os contextos de estudo das complicações, a ocorrência de acordo com as vias, bem como a compreensão do diagnóstico e manejo clínico. Como síntese da análise identificou-se três categorias temáticas: Complicações; Fatores preditores; e Diagnóstico/tratamento. CONCLUSÃO As complicações no local do acesso vascular são de ocorrência variável conforme a via de acesso utilizada. O conhecimento dos fatores que permeiam a ocorrência destes eventos podem auxiliar no reconhecimento precoce, planejamento e monitorização dos cuidados implementados.

Resumen OBJETIVO Mapear la producción de conocimiento acerca de las complicaciones del acceso vascular en pacientes sometidos a procedimientos percutâneos en el Laboratorio de Hemodinamia. MÉTODOS Estudio de tipo revisión de escopo. Se elaboró la estrategia de búsqueda en tres etapas, considerando el período comprendido entre julio 2005 y 2015, en las bases PubMed, CINAHL, Scopus y LILACS. Los datos extraídos fueron analizados y sintetizados de forma narrativa. RESULTADOS Fueron incluidas 128 publicaciones que permitieron mapear los contextos de estudio de las complicaciones, la ocurrencia de acuerdo con las vías, así como la comprensión del diagnóstico y manejo clínico. Como síntesis del análisis se identificó tres categorías temáticas: Complicaciones, Factores predictores y Diagnóstico/tratamiento. CONCLUSIÓN Las complicaciones en el sitio del acceso vascular son de ocurrencia variable de acuerdo con la vía de acceso utilizada. El conocimiento de los factores que están presentes en la ocurrencia de estos eventos puede auxiliar en el reconocimiento temprano, planeamiento y control de la atención implementados.

Abstract OBJECTIVE To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories. METHODS Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. RESULTS One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. CONCLUSION Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.

Outcomes of surgery for patients with Behcet's disease causing aortic pseudoaneurysm: a shift from open surgery to endovascular repair

OBJECTIVES: Behcet’s disease is a form of systematic vasculitis that affects vessels of various sizes. Aortic pseudoaneurysm is one of the most important causes of death among patients with Behcet’s disease due to its high risk of rupture and associated mortality. Our study aimed to investigate the outcomes of Behcet’s disease patients with aortic pseudoaneurysms undergoing open surgery and endovascular aortic repair. METHODS: From January 2003 to September 2014, ten consecutive patients undergoing surgery for aortic pseudoaneurysm met the diagnostic criteria for Behcet’s disease. Endovascular repair was the preferred modality and open surgery was performed as an alternative. Systemic immunosuppressive medication was administered after Behcet’s disease was definitively diagnosed. RESULTS: Eight patients initially underwent endovascular repair and two patients initially underwent open surgery. The overall success rate was 90% and the only failed case involved the use of the chimney technique to reach a suprarenal location. The median follow-up duration was 23 months. There were 7 recurrences in 5 patients. The median interval between operation and recurrence was 13 months. No significant risk factors for recurrence were identified, but a difference in recurrence between treatment and non-treatment with preoperative immunosuppressive medication preoperatively was notable. Four aneurysm-related deaths occurred within the follow-up period. The overall 1-year, 3-year and 5-year survival rates were 80%, 64% and 48%, respectively. CONCLUSIONS: Both open surgery and endovascular repair are safe and effective for treating aortic pseudoaneurysm in Behcet’s disease patients. The results from our retrospective study indicated that immunosuppressive medication was essential to defer the occurrence and development of recurrent aneurysms.

Seudoaneurisma postraumático de arteria tibial anterior secundario a fractura diafisiaria de tibia. Reporte de caso / Post-traumatic pseudoaneurysm of the anterior tibial artery secondary to tibial shaft fracture. Case report

Resumen: El seudoaneurisma arterial en la extremidad inferior es una entidad poco frecuente, en particular en el segmento infrapoplíteo. Comúnmente se le asocia a reparaciones vasculares o secundario a una lesión arterial localizada, posterior a fractura o a un evento quirúrgico. En México poco se ha documentado sobre esta entidad que afecta la arteria tibial anterior secundaria a proceso traumático y osteosíntesis. El sangrado súbito debido a una ruptura del seudoaneurisma es un posible desenlace catastrófico para la viabilidad del segmento, por lo cual es de suma importancia detectarla y diagnosticarla a tiempo. Las indicaciones en cuanto al tratamiento siguen siendo controvertidas en las publicaciones internacionales. Las opciones resolutivas pueden ser quirúrgicas o endovasculares. Según reportes actuales, la mejor opción terapéutica es el injerto autólogo de vena safena que mantiene el flujo sanguíneo y minimiza el riesgo de isquemia periférica. El objetivo de este trabajo es exponer el caso de un paciente que presentó la complicación descrita previamente y de la misma forma, realizar una revisión de la bibliografía consultada. Es importante indagar más sobre este tema, que bien puede pasar inadvertido en un gran número de casos por su sintomatología silente.

Abstract: Arterial pseudoaneurysm of the lower limb is an infrequent entity, particularly in the infrapopliteal segment. It is commonly associated to vascular repairs or follows a localized arterial lesion, a fracture or a surgical procedure. There is little information in Mexico about this entity in cases involving the anterior tibial artery, and secondary to trauma and osteosynthesis. Given that sudden bleeding due to rupture of the pseudoaneurysm is a possible catastrophic outcome for the viability of the segment, it is important to timely detect and diagnose the pseudoaneurysm. Treatment indications contained in the international literature are controversial. Solution-oriented approaches may be either surgical or endovascular. Current reports show that the best treatment option is an autologous saphenous vein graft, which maintains blood flow and minimizes the risk of peripheral ischemia. The purpose of this paper is to report the case of a patient who sustained the above mentioned complication and provide a literature review. This topic should be further investigated, as this condition may go unnoticed in a large number of cases, given that its symptoms are silent.

Thoracoscopic and endovascular management of retained haemothoarx associated with an intercostal artery pseudoaneurysm.

Intercostal artery pseudoaneurysm (IAP) is a rare entity and may complicate a percutaneous intervention through an intercostal space or follow thoracic trauma. Its rupture into the pleural space can give rise to haemothorax, which if untreated may lead to a retained haemothorax (RH). Traditionally both the IAP and the RH are managed by a thoracotomy. We report a patient who developed an IAP with haemothorax following a trauma. The diagnosis was established by computed tomography. The patient was treated by endovascular embolisation of the IAP followed by thoracoscopic decortications of the RH.

Pseudoaneurisma de la vena porta como una complicación hemorrágica de Ia pancreatoduodenectomy: portal vein pseudoaneurysm as an hemorrhagic complication after pancreatoduodenectomy / Case report: portal vein pseudoaneurysm as an hemorrhagic complication after pancreatoduodenectomy

La pancreatoduodenectomía (cirugía de Whipple) es un procedimiento realizado frecuentemente para el manejo de neoplasias pancreáticas. Las complicaciones hemorrágicas de este procedimiento son bien conocidas, sin embargo, existe escasa información sobre el desarrollo de pseudoaneurisma portal como complicación de esta cirugía. Aquí presentamos un caso de pseudoaneurisma portal en una paciente de 76 años que evoluciona con hemorragia tardía post pancreatoduodenectomía. Se realiza una tomografía computada de abdomen que demuestra el pseudoaneurisma de la vena porta, que se corrobora quirúrgicamente como un desgarro de 2 centímetros en esta estructura. El pseudoaneurisma se desarrolla adyacente a un tubo de drenaje abdominal y en el intraoperatorio se evidencia filtración de la anastomosis, hallazgos también descritos en otro caso de pseudoaneurisma portal post pancreatoduodenectomía, situación que sugiere que estas condiciones pudiesen ser factores de riesgo para el desarrollo de esta complicación.

Pancreaticoduodenectomy (Whipple surgery) is a procedure commonly performed for the management of pancreatic neoplasms. Hemorrhagic complications for this procedure are well known, however, there is little information on the development of portal vein pseudoaneurysm as a complication of this surgery. We present a case of a 76 year old patient with portal vein pseudoaneurysm which formed as a result of lateonset bleeding after pancreaticoduodenectomy. Computed tomography of the abdomen was performed showing the portal vein pseudoaneurysm, which was surgically corroborated as a 2cm tear in this structure. The pseudoaneurysm developed adjacent to an abdominal drainage tube and in the intraoperative anastomotic leakage was evident, findings also described in another case of portal vein pseudoaneurysm after pancreaticoduodenectomy, a situation that suggests that these conditions might be risk factors for the development of this complication.

Spontaneous Obliteration of Right Ventricular Pseudoaneurysm after Blunt Chest Trauma: Diagnosis and Follow-Up with Multidetector CT

Right ventricular (RV) pseudoaneurysm caused by trauma is very rare. We report a case of RV pseudoaneurysm which resolved without surgical treatment in a patient who survived a falling accident. Echocardiography failed to identify the pseudoaneurysm. Electrocardiography-gated CT showed a 17-mm-sized saccular pseusoaneurysm arsing from the RV outflow tract with a narrow neck. Follow-up CT after two months showed spontaneous obliteration of the lesion.