RESUMO
We report a rare case of spontaneous thrombosis of a ruptured deep femoral artery aneurysm. An 85-year-old man presented two days after onset of acute swelling and pain in the left groin. Computed tomography demonstrated rupture of a deep femoral artery aneurysm and thrombosis of the aneurysm. After 1 month of observation, surgical intervention was performed as the local pain persisted. Opening of the aneurysm sac confirmed that thrombosis was complete. Simple ligation and drainage of the aneurysmal sac was performed. His postoperative course was uneventful.
RESUMO
We report a case of an overlapping ulcerative colitis and aortitis syndrome. A 28-year-old woman with ulcerative colitis in the region from the rectum to the sigmoid colon developed left anterior cervical pain. A cervical contrast-enhanced computed tomography and an arch aortography showed diffuse narrowing of the left common carotid artery and segmental stenosis of the left subclavian artery involving the orifice of the vertebral artery, which defined the diagnosis as aortitis syndrome. HLA was positive for BW 52, which is frequently found in patient with this type of overlapping syndrome. Treatment with prednisolone was begun at an initial dose of 20mg/day, with gradual tapering to 5mg/day at 11 months later, when her symptoms had subsided and laboratory findings of inflammation had disappeared. One year later, she became apathetic in mental activity, and had a poor memory. She also complained of numbness on the left side of her face. Angiography confirmed the progression of the left common carotid narrowing causing the deterioration of her cerebral ischemic symptom. A saphenous vein bypass graft was placed between the right subclavian artery and the left common carotid artery. The postoperative course was uneventful and she had complete symptomatic relief and recovered active ordinary life. Postoperative angiography revealed the well functioning bypass graft.
RESUMO
We report a case of a chronic contained rupture of abdominal aortic aneurysm associated with spinal caries. A giant retroperitoneal mass with bony destruction of the anterior bodies of thoracic and lumber vertebrae was detected on computed tomography in a 72-year-old woman. The patient was asymptomatic but had a history of spinal tuberculosis complicated with cold abcess 44 years earlier. Magnetic resonance imaging suggested the presence of a paravertebral retroperitoneal abscess or organized hematoma. Surgery was performed through median laparotomy and an aortotomy revealed a punched-out defect, 17mm×17mm in size, in the posterior wall of the abdominal aorta, and the large cavity of an aneurysm with an organized thrombus was observed through the defect. The abdominal aorta and common iliac arteries were replaced with a bifurcated graft. The punched-out defect was closed with the anterior wall of the aorta for the purpose of isolating the prosthesis from the aneurysm. The postoperative course was uneventful and there were no signs of prolonged inflammatory reactions. In this case, it was considered that chronic contained rupture of the abdominal aortic aneurysm resulted from spinal tuberculous osteomyelitis eroding into the aorta.
RESUMO
A 60-year-old male was transferred to a critical care medical center with a complaint of sudden back pain. He already had suffered severe back pain 22 years previously when he was 38-year-old), but was not diagnosed then. On admission thoracic CT scan revealed a three-channeled structure in the descending aorta. The preoperative diagnosis was an acute redissection of a DeBakey III b dissecting aortic aneurysm. An emergency graft replacement of the descending aorta confirmed the three-channeled structure of the aorta. The remaining of media of the aorta, which occurred in the re-dissected lumen, was thin and weak. The patient was alive and well twenty-five months following the operation.