Aberrant right subclavian artery: a series of case reports and discussion of morphology and its clinical and surgical implications / Arteria subclavia derecha aberrante, una serie de informes de casos y discusión de la morfología y sus implicaciones clínicas y quirúrgicas

SUMMARY: Aberrant right subclavian artery (arteria lusoria) is a rare embryological abnormality but the most common among aortic arch vascular anomalies. It represents an anatomical variant of right subclavian artery originating as the last branch of aortic arch, passing then retroesophageal to the normal position. It is usually asymptomatic and is found mostly incidentally during imaging examinations. Symptoms are produced when the aberrant artery compresses the nearby structures and the most frequent symptoms are dysphagia and dyspnea. It may be associated with other vascular or heart abnormalities. We are presenting a series of case reports which presented an aberrant right subclavian artery alone or associated with other vascular abnormalities, diagnosed incidentally in adult patients while performing CT examinations for other reasons. Through a literature review we aim to discuss the clinical implications of this vascular anomaly, to point out the importance of being aware of it especially in patients with dysphagia or dyspnea or in patients who undergo operations in the thorax and neck or vascular surgery and endovascular procedures involving the aortic arch and its branches.

RESUMEN: La arteria subclavia derecha aberrante (Arteria lusoria) es una anomalía embriológica rara, pero la más común entre las anomalías vasculares del arco aórtico. Representa una variante anatómica de la arteria subclavia derecha que se origina como la última rama del arco aórtico, pasando luego retroesofágicamente a la posición normal. Por lo general, esta anomalía es asintomática y se encuentra principalmente de manera incidental durante los exámenes de imagen. Los síntomas se producen cuando la arteria aberrante comprime las estructuras cercanas y los síntomas más frecuentes son la disfagia y la disnea. Puede estar asociado con otras anomalías vasculares o cardíacas. Presentamos una serie de informes de casos en los que se presentó una arteria subclavia derecha aberrante única o asociada a otras anomalías vasculares, diagnosticada incidentalmente en pacientes adultos durante la realización de TC por otros motivos. A través de una revisión bibliográfica pretendemos discutir las implicaciones clínicas de esta anomalía vascular, señalar la importancia de conocerla especialmente en pacientes con disfagia o disnea o en pacientes sometidos a operaciones de tórax y cuello o cirugía vascular y procedimientos endovasculares. involucrando el arco aórtico y sus ramas.

A rare case report of simultaneous occurrence of a pediatric pleuropulmonary blastoma and an intralobar pulmonary sequestration.

We are presenting a rare case with the simultaneous occurrence of pleuropulmonary blastoma and an intra lobar pulmonary sequestration. Although there have been cases reported previously with pleuropulmonary blastoma associated with congenital pulmonary malformations, the association with an intra lobar pulmonary sequestration is very rare. The patient, a female, 6-month-old child arrived at our pediatric service with the clinic of cough, respiratory distress, and fever after being treated for 2 weeks for left lung bronchopneumonia according clinical signs and radiographic description but without clinical improvements. Contrast enhanced CT images showed the simultaneous presence of 2 different lesions in the left lung, a heterogeneous mass in the superior lobe without delineation with mediastinal structure compatible with a pleuropulmonary blastoma and a consolidation in the inferior lobe with bronchogram present and a systemic vessel feeding compatible with an intra lobar pulmonary sequestration, both confirmed by histologic examinations after the surgical intervention. Although it is very rare, the simultaneous presence of these distinct embryogenic lesions may occur and radiologist should be aware as the imaging diagnosis may be very helpful for the further management of the patient.

Ectopic liver tissue in the left hypocondrium: a case report and a literature review / Tejido hepático ectópico en el hipocondrio izquierdo: reporte de un caso y revisión de la literatura

Ectopic liver tissue is a rare developmental abnormality. It is often asymptomatic and is commonly found incidentally, during surgery or autopsy. It has been reported in various abdominal and extra-abdominal sites, most often in the gall bladder. We are reporting an incidentally found mass in the left subdiafragmatic region, diagnosed as ectopic liver in abdominal CT and intraoperatively. We aim to assess the importance of imaging examinations in the differential diagnosis of intraabdominal masses ranging from benign to malignant entities and to point out that despite the low incidence of ectopic liver, it is necessary to be aware of this diagnostic possibility.

El tejido hepático ectópico es una rara anormalidad del desarrollo. A menudo es asintomático y generalmente se encuentra de manera incidental, durante la cirugía o la autopsia. Se ha informado en varios sitios abdominales y extraabdominales, con mayor frecuencia en la vesícula biliar. Reportamos el caso de una masa encontrada en la región subdiafragmática izquierda, diagnosticada como hígado ectópico en la TC abdominal e intraoperatoriamente. Nuestro objetivo fue evaluar la importancia de los exámenes por imágenes en el diagnóstico diferencial de masas intraabdominales que incluyen masas benignas como también malignas, y señalar que a pesar de la baja incidencia de hígado ectópico, es necesario tener en cuenta esta posibilidad en el diagnóstico.

Spondylodiscitis due to Sallmonela in an immunocompetent patient.

Salmonella is a gram-negative bacillus that penetrates in human from contaminated food or water. Sallmonela spondylodiscitis is a rare condition occur secondary to hematogenous spread after bacteremia episode. We presented a successful treatment with Levofloxacin in a 26 years old immunocompetent male with a septic form of sallmonelosis complicated with lumbar spondylodiscitis without surgery. He was treated with intravenous Levofloxacin for three weeks and was discharged from the hospital with oral Levofloxacin for more than two months. Clinical and laboratory evaluation two months after oral treatment resulted normal.