Complex aortic-arch pseudoaneurysm with aorto-innominate vein fistula in a case of traumatic chest injury.

A patient in his late 30s presented with issues of retrosternal chest pain and palpitations. He had sustained a splinter injury to the left hemithorax a year ago for which he had been managed with a tube thoracostomy. During subsequent evaluations, he was found to have atrial fibrillations and a CT angiography revealed an arch of the aorta pseudoaneurysm with a fistulous communication with the innominate vein, which being a rare condition has no established treatment protocols. Endovascular salvage of the condition required an aortic Ishimaru zone 2 deployment of the thoracic endovascular aortic repair stent graft to provide an adequate landing zone. The elective left subclavian artery revascularisation was obtained by a left carotid artery to left subclavian artery bypass. Post procedure there was complete exclusion of the pseudoaneurysm sac, and the fistulous aorto-venous communication inflow tract. The patient recuperated well and has returned to full active duties.

T-Acute Lymphoblastic Leukemia Presenting as Bilateral Ovarian Mass in a Toddler.

T-acute lymphoblastic leukemia (T-ALL) generally have nodal presentation while B-cell leukemia and lymphoma may have extra-nodal or visceral involvement. Intra-abdominal presentation of T-ALL is exceedingly rare. Bilateral ovarian involvement at the time of initial presentation of T-ALL has never been described in children, though it may be seen during relapses. The authors describe a toddler with T-ALL who presented with bilateral ovarian mass. Despite complete resolution of ovarian mass post-induction chemotherapy, minimum residual disease in bone marrow was high reaffirming aggressive nature of disease.