Endovascular Management of Superior Cerebellar Artery Aneurysms: Mid and Long-Term Results.

AIM: Superior cerebellar artery (SCA) aneurysms are uncommon vascular lesions, thus data about their presentation and clinical management are limited. Our aim was to determine clinical presentation, angiographic findings and mid and long-term clinical and imaging results of endovascular treatment of 49 patients with SCA aneurysm. MATERIAL AND METHODS: Forty-nine patients with SCA aneurysms underwent endovascular treatment (25 female, 24 male; mean age 46.7 years; range, 21-79 years) in our institution. Both aneurysms arising at the origin of SCA and peripheral SCA aneurysms were included to our retrospective study. 73.5% of the patients were presented with subarachnoid hemorrhage. Forty-two of 49 (85.7%) aneurysms were located in the origin of SCA. Mean aneurysm size was 6.5 mm (range 2-16 mm). RESULTS: Forty-seven (95.9%) of the aneurysms were coiled with detachable coils. In two peripheral aneurysms, liquid embolic agent was used. Overall control angiographic occlusion rates were as follows: 87.5% (34/40) total occlusion and 12.5% (6/40) dog-ear remnant. All peripheral SCA aneurysms were occluded with the parent artery. Procedure related mortality was seen in one patient (2%) due to the rupture of another aneurysm. There was no procedure related permanent morbidity. CONCLUSION: Endovascular treatment is an effective and safe option in both peripheral and proximal SCA aneurysms.

Flow diverter as a rescue therapy for a complicated basilar angioplasty.

Intracranial atherosclerotic disease is a major cause of ischemic stroke. Stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis was terminated prematurely due to a high stroke and death rate in patients randomized for intracranial stent placement. However, for some patients, angioplasty and/or stent placement remains the best approach. Flow diverters (FDs) are designed to produce a hemodynamic flow diversion by constituting a laminar flow pattern in the parent artery and are mainly used in non-ruptured complex wide-neck aneurysms as well as in ruptured aneurysms. Herein, we present a case where an FD was used in a complicated angioplasty for basilar artery atherosclerosis. A 72-year-old female patient was admitted to our hospital with left side weakness and vertigo. Her diffusion magnetic resonance imaging and magnetic resonance angiography showed right-sided pontine and left-sided occipital acute infarcts with left-sided pontine and right-sided occipital chronic infarcted areas and preocclusive mid-basilar stenosis. The patient was under supervised medical treatment. Despite chronic brain stem and occipital infarcts her modified Rankin Scale was 2. Diagnostic angiography showed no posterior communicating arteries and no pial-pial collaterals and a critical mid-basilar artery stenosis. We decided to perform intracranial angioplasty to increase the perfusion of posterior circulation and reduce the risk of additional embolic infarcts. Angioplasty was complicated with dissection and vessel perforation. We used an FD for rescue therapy to avoid rebleeding. The patient was discharged with good clinical and angiographic results.

The incidence of left atrial diverticula in coronary CT angiography.

PURPOSE: The aim of this study was to characterize the frequency and location of left atrial diverticula by using multidetector computed tomography (MDCT). MATERIALS AND METHODS: Cardiac imaging was performed for 454 patients using 64MDCT. Most patients were being examined for coronary artery disease. All images were interpreted by two radiologists on a three-dimensional workstation using multiplanar reformatting, maximum intensity projection, and volumerendering. Diverticula were characterized by localization and diameter. RESULTS: A total of 207 atrial diverticula were diagnosed in 186 (41%) of the 454 patients in this study. The diameters of left atrial diverticula ranged from 2 mm to 16 mm, with an average diameter of 5.2 mm. Left atrial diverticula were located anterosuperiorly in 166 patients (36.6%), anteriorly in four patients (0.9%), anteroinferiorly in three patients (0.7%), inferolaterally in one patient (0.2%), inferomedially in two patients (0.4%), laterally in two patients (0.4%), posterosuperiorly in one patient (0.2%), and superiorly in seven patients (1.5%). CONCLUSION: Left atrial diverticula are frequently detected during routine cardiac computed tomography angiography examinations. From the Departments of Radiology, and Cardiology, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey.

Massive bilateral renal angiomyolipomatosis and multifocal micronodular pneumocytes hyperplasia associated with tuberous sclerosis: a case report.

Tuberous sclerosis (TS) is an autosomal-dominant disorder characterized by a variety of hamartomatous lesions in various organs. Various organ involvements can be detected with radiology: neurologic involvement (cortical tubers, subependymal nodules and white matter abnormalities), renal involvement (angiomyolipoma) and pulmonary involvement (pulmonary lymphangioleiomyomatosis, multifocal micronodular pneumocyte hyperplasia). Here, we are reporting a case of tuberous sclerosis with multiple organ involvement and massive bilateral AMLs in a 49-year-old female patient.

Are port-wine stain and pneumosinus dilatans associated? A controlled study.

The first case demonstrating the association of a port wine stain with pneumosinus dilatans was reported in 2003 by Dogan B et al. The current study is an extension of that case report, attempting to demonstrate that the association of pneumosinus dilatans and port wine stain is clinically significant and warrants clinical evaluation in patients with port wine stains. We aimed to evaluate the patients with or without facial port wine stains if they had pneumosinus dilatans. Twenty-three patients with port-wine stains, and 20 controls without port wine stains were compared. Facial CT scan were performed on each of the 43 subjects and analysed for radiological evidence of pneumosinus dilatans. A grading system was used to assess the extent of sinus enlargement noted on CT. Statistical analysis was also done. Ten out of 20 controls had minimal enlargement, 22 out of 23 patients with a port-wine stain had minimal to marked enlargement. The differences of having pneumosinus dilatans or not and the severity of enlargement between controls and patients were statistically significant (p=0.001; p=0.00001 respectively) This study showed that the association of port wine stain and pneumosinus dilatans was not a coincidence and the diminished density of peristructural nerves might be the common cause of these two pathological conditions, especially when they are together.

A variant of Poland syndrome associated with dextroposition.

Poland syndrome is characterized by partial or complete absence of pectoralis muscles, ipsilateral syndactyly, and occasionally other malformations of the anterior chest wall and breast. Other associated anomalies, including dextrocardia, renal malformations, and vertebral anomalies, have been reported in rare cases. The condition is more frequent among males, and usually occurs on the right hemithorax in the unilateral form. The syndrome is believed to be caused by a genetic disorder that reduces the embryonal circulation in the subclavian and vertebral arteries. We report a 20-year-old man with Poland syndrome on the left hemithorax, which is rarely associated with dextroposition.

Gadolinium-enhanced 3D MR angiography of pulmonary hypoplasia and aplasia.

OBJECTIVE: The goal of this study was to determine the role of gadolinium-enhanced 3D MR angiography (MRA) in patients with suspected pulmonary hypoplasia and aplasia in a retrospective analysis of MRA and digital subtraction angiography in 11 patients with clinical and/or radiologic suspicion of pulmonary hypoplasia and aplasia. CONCLUSION: Gadolinium-enhanced 3D MRA is capable of diagnosing pulmonary hypoplasia and aplasia rapidly and accurately. Both pulmonary hypoplasia and aplasia can be shown morphologically in a noninvasive manner, obviating digital subtraction angiography.

A case of dyskeratosis congenita with portal hypertension associated with jugular venous anomaly.

Dyskeratosis congenita is an unusual inherited disease characterized by the triad of abnormal skin pigmentation, nail dystrophy and mucosal leukoplakia. Bone marrow failure and various abnormalities including genitourinary, pulmonary, skeletal, neurological, ophthalmic, dental and gastrointestinal have been reported. Portal hypertension is an extremely rare manifestation. Although arterio-venous fistulas in the lungs have been reported, gross peripheral vascular abnormality associated with the disease has not been published until now. We describe a case of dyskeratosis congenita with portal hypertension and associated coagulopathy in whom transjugular liver biopsy could not be performed because of a vascular anomaly at the bifurcation of the internal jugular and subclavian veins.

'Ecstasy'(MDMA)-induced pneumomediastinum and epidural pneumatosis.

Epidural pneumatosis and pneumomediastinum may occur after the inhalation of "Ecstasy" (methylenedioxymetamphetamine), but only one case has been reported in the literature. We report the case of a 21- year-old male patient who presented with epidural pneumatosis and pneumomediastinum. Chest CT demonstrated the pneumomediastinum and multiple air bubbles within the spinal canal.

Renal arteriographic data of young male patients with suspected renovascular hypertension.

The aim of the study was to determine whether the anatomical variant in which one or more renal vessels arose from the aorta was associated with hypertension in young male patients. We investigated the renal arteriographic data of 73 young male patients (age: 27.4 +/- 7.4, blood pressure: 162.7 +/- 17.5/104.6 +/- 10.1 mmHg) with grade-II hypertension. All studied patients underwent angiography to exclude renal artery stenosis. The patients were divided into two groups on the basis of their renal angiograms. We determined no abnormal findings in 33 renal arteriograms (45.2%). Twenty three (31.5%) patients had an additional renal artery without renal artery stenosis or renal anatomical variations. In conclusion, although the significance of this form of hypertension is still largely obscure, we believe that the presence of additional renal arteries may be associated with hypertension.