ABSTRACT
PURPOSE: This study describes several cases of endovascular coil embolization of the proximal internal mammary artery injured by blind approach to the subclavian vein for central venous catheter or pacemaker lead insertion. MATERIALS AND METHODS: We conducted a retrospective analysis of five patients with iatrogenic arterial lesions of the internal mammary artery (IMA). The lesions occurred in three patients from a puncture of the subclavian vein during insertion of a central venous catheter and in two patients from a puncture of the subclavian vein for insertion of a pacemaker lead. Four patients had acute symptoms of bleeding with mediastinal hematoma and hematothorax and one patient was investigated in a chronic stage. A pseudoaneurysm was detected in all five patients. All four acute and hemodynamic unstable patients required hemodynamic support. RESULTS: In all patients, embolization was performed using a coaxial catheter technique, and a long segment of the IMA adjacent distally and proximally to the source of bleeding was occluded with pushable microcoils. In one patient, additional mechanically detachable microcoils were used at the very proximal part of the IMA. Microcoil embolization of the IMA was successful in all patients, and the source of bleeding was eliminated in all patients. CONCLUSION: Transarterial coil embolization is a feasible and efficient method in treating acute bleeding and pseudoaneurysm of the IMA and should be considered if mediastinal hematoma or hemathorax occurs after blind puncture of the subclavian vein.
Subject(s)
Aneurysm, False/etiology , Aneurysm, False/therapy , Catheterization, Central Venous/adverse effects , Electrodes, Implanted/adverse effects , Embolization, Therapeutic/methods , Mammary Arteries/injuries , Wounds, Penetrating/etiology , Wounds, Penetrating/therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Pacemaker, Artificial/adverse effects , Treatment Outcome , Young AdultABSTRACT
Propionic acidemia is an inherited disorder caused by a defect of propionyl CoA carboxylase. Untreated, propionic acidemia leads to metabolic decompensation and toxic encephalopathy. We report on the magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) findings in five children who were properly treated by protein restriction and carnitine supplementation, during a phase of clinically and metabolically stable conditions. The examinations were performed on a whole-body 1.5 T scanner. During the observation period, from 1992 to 1996 we employed long echo time single-voxel spectroscopy and chemical shift imaging in addition to a conventional MRI protocol. The two children with the longest delay before onset of therapy showed cerebral atrophy. MRS yielded elevated lactate peaks in four of the children. These results indicate that MRS can detect metabolic alterations in the brains of children with propionic acidemia during metabolically stable conditions. The presence of lactate could be caused by hampered aerobic oxidation within the citrate cycle due to intracellular elevated propionic metabolites.
Subject(s)
Amino Acid Metabolism, Inborn Errors/diagnosis , Brain/pathology , Central Nervous System Diseases/diagnosis , Magnetic Resonance Spectroscopy/methods , Propionates/metabolism , Amino Acid Metabolism, Inborn Errors/complications , Atrophy/diagnosis , Central Nervous System Diseases/etiology , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Sensitivity and SpecificityABSTRACT
We report a single-case study of a patient suffering from Marchiafava-Bignami disease (MBD), a rarely intra vitam diagnosed syndrome with focal demyelination in the corpus callosum, which is usually found in patients with chronic alcohol abuse. Our study explored a variety of motor, sensory and visual functions. Striking features were left apraxia caused by two lesions in the rostral area, and left hemidyslexia related to a large splenial lesion demonstrated by MRI. As symptoms of disconnection may remain undetected clinically, MRI is a most useful tool for the diagnosis of MBD.
