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Fulltext Spontaneous thrombosis in a post-traumatic splenic pseudo-aneurysm

Suraini, M. S., Bux, S. I.

Malaysian Journal of Medicine and Health Sciences, 2010;6(1):119-123.
MyJurnal

Introduction: Splenic pseudo-aneurysm is an uncommon complication following splenic injury caused by blunt abdominal trauma. Pseudo-aneurysm is usually treated with splenic arterial embolisation. Spontaneous thrombosis of a splenic pseudo-aneurysm can occur but it is rare. Method: We report a case of spontaneous thrombosis in a post-traumatic splenic pseudo-aneurysm. The patient was managed conservatively as he was haemodynamically stable with a repeat CT scan on the 7th day showing a tubular enhancing structure in the upper pole of the spleen demonstrating the same attenuation value .
Conclusion: This case illustrates a spontaneous resolution of splenic pseudo-aneurysm, which is a rare outcome of the condition.

Matched MeSH terms: Aneurysm, False
Fulltext Pseudoaneurysm Of External Iliac Artery Following Septic Loosening Of Total Hip Arthroplasty

Rengsen, P., Abbas, A.A., Choon, S.K., Tai, C.C.

Malays Orthop J, 2007;1(1):42-43.
MyJurnal

The incidence of pseudoaneurysm after total hip arthroplasty is extremely rare. The most common mechanism of vascular injury is due to direct trauma during the operative procedure and most reported cases are acute in a presentation. We report an unusual case of pseudoaneurysm of the external iliac artery, presenting 6 years after initial surgery, and occurring following septic loosening of total hip arthroplasty. This case highlights the importance of prompt recognition of infection of total hip arthroplasty, and also indicates the need for prompt and appropriate treatment for these infections.

Matched MeSH terms: Aneurysm, False
Fulltext Role of Uterine Artery Embolization in Pseudoaneurysm of Uterine Artery: A Rare Cause of Secondary Postpartum Hemorrhage

Subramaniam S, Nadarajan C, Aziz ME

Cureus, 2018 Feb 23;10(2):e2220.
PMID: 29692958 DOI: 10.7759/cureus.2220

Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage, although it carries a high mortality rate. The etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. We present a post-cesarean female who developed delayed hemorrhage and was diagnosed with left uterine artery pseudoaneurysm. Selective transcatheter arterial embolization was performed and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and efficient method of treatment of postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Thus, it should be considered as a treatment option before opting for surgery in favorable cases.

Matched MeSH terms: Aneurysm, False
Fulltext Spontaneous resolution of asymptomatic hepatic pseudoaneurysm post radiofrequency ablation

Ch'ng LS, Tazuddin EEM, Young B, Ali AFM

BJR Case Rep, 2016;2(2):20150306.
PMID: 30363592 DOI: 10.1259/bjrcr.20150306

Radiofrequency ablation (RFA) of a hepatic tumour is an established treatment option with an acceptable complication rate. Formation of a pseudoaneurysm after RFA of liver metastasis is an uncommon complication. We report the case of a 69-year-old female patient developing a hepatic pseudoaneurysm after RFA of liver metastasis. On a follow-up CT scan 6 weeks later, there was spontaneous resolution of the pseudoaneurysm. Hepatic pseudoaneurysms are usually treated owing to the risk of rupture. Invasive procedures or conservative management of an asymptomatic hepatic pseudoaneurysm is still the subject of debate. The spontaneous resolution of a hepatic pseudoaneurysm in our patient suggests that an asymptomatic pseudoaneurysm maybe observed for resolution instead of being treated at presentation.

Matched MeSH terms: Aneurysm, False
Fulltext Tuberculous aortic pseudoaneurysm treated with in situ silver-impregnated vascular inlay graft

Hussein H, Azizi ZA

Asian J Surg, 2008 Apr;31(2):87-9.
PMID: 18490221 DOI: 10.1016/S1015-9584(08)60064-0

A 62-year-old man presented with continuous, persistent backache shortly after completion of antituberculosis medication for tuberculosis (TB) of the spine. Computed tomography scan revealed a pseudoaneurysm involving the infrarenal aorta. He was restarted on anti-TB medication and underwent repair of the pseudoaneurysm with an in situ silver-coated bifurcated Dacron graft. His postoperative recovery was uneventful and he remained well up to 12 months of follow up. To our knowledge, this is the first case in the literature where an in situ silver-impregnated vascular graft has been successfully used in treating a tuberculous pseudoaneurysm.

Matched MeSH terms: Aneurysm, False/surgery*
Fulltext Behcet's disease with vascular complications

Normayah K, Mazri YM, Suib I, Zainal AA

Med J Malaysia, 2004 Oct;59(4):547-9.
PMID: 15779593

A young gentleman presented with a history of multiple pseudoaneurysms of the right carotid artery, left radial artery, right femoral artery as well as deep vein thrombosis involving the right femoral vein. A diagnosis of Behcet's disease was made on the basis of his history of recurrent oral and genital ulceration with characteristic eye lesion.

Matched MeSH terms: Aneurysm, False/etiology
Fulltext Endovascular stent graft repair of aorto-iliac pseudoaneurysms - Hospital Kuala Lumpur experience

Khang NC, Zainal AA

Med J Malaysia, 2016 02;71(1):17-22.
PMID: 27130738

BACKGROUND: This is a single institutional review of aortoiliac pseudoaneurysm of various aetiologies managed with endovascular stent graft repair.

METHODS: From 2009 to 2014, 16 patients had endovascular stent graft inserted for pseudoaneurysm of the thoracic aorta, abdominal aorta and iliac arteries in Hospital Kuala Lumpur. Co-morbidity, causative agents, in-hospital mortality, complications and outcomes were examined.

RESULTS: The average age was 59.1 years (range 36-77). Comorbidities include hypertension, diabetes mellitus, tuberculosis, prior infection and previous open aneurysmal repair. All patients had raised WBC (>10.0x10(9) /L), ESR or Creactive protein on admission while 50% of patients had fever. Blood cultures were positive in 4 patients. All patients were given antibiotics. Only one in-hospital mortality was noted at day-47 post-procedure. Two patients died of aortoenteric fistula at district hospital eight and 16 months later. One patient died of chronic graft infection two years later. One died of unrelated cause. One patient developed type IB endoleak from internal iliac artery two years later and surgical ligation was performed. The average follow up was 15.8 months.

CONCLUSION: Endovascular stent graft repair for pseudoaneurysm is a viable option compared to open surgery. It is less invasive, has lower operative morbidity and fair outcomes. However, some cases may be due to inflammatory aortitis instead of infective pseudoaneurysm, given the frequent culture-negative results. In order to obtain high yield of bacteria culture for infected pseudoaneurysm, open repair with tissue culture is still the main mode of treatment especially for patients with low comorbidity.

Matched MeSH terms: Aneurysm, False/surgery*
A rare case of mycotic pseudoaneurysm in a patient post Rastelli procedure with infective endocarditis

Chua C, Then K, Mohd Khalid KF

Cardiol Young, 2023 May;33(5):827-828.
PMID: 36511131 DOI: 10.1017/S1047951122002931

Mycotic pseudoaneurysm secondary to infective endocarditis is an uncommon complication in CHD with conduit placement. We report a case of late presentation of bacterial infective endocarditis with pseudoaneurysm in an 8-year-old girl with underlying pulmonary atresia with ventricular septal defect, post Rastelli procedure done at the age of 3 years old.

Matched MeSH terms: Aneurysm, False*
Endovascular management of axillosubclavian artery injuries: report of three cases

Leong BD, Naresh G, Hanif H, Lee SK, Zainal AA, Sara CM

Surg Today, 2013 Aug;43(8):918-22.
PMID: 22987278 DOI: 10.1007/s00595-012-0330-6

Open surgical repair of axillosubclavian artery injuries is technically demanding and associated with significant morbidity and mortality. Endovascular intervention has emerged as a valuable alternative to open surgical repair. This report presents three cases with axillosubclavian artery injuries managed with endovascular intervention. All three cases had a pseudoaneurysm of the axillosubclavian artery with one case associated with an arteriovenous fistula. They were successfully treated with endovascular stenting and balloon angioplasty. There were no observed acute complications. No complications or recurrence have occurred, with a mean follow-up of 26 months. Endovascular intervention for axillosubclavian artery injuries is less invasive, safe and effective; however, data concerning the long-term effects and complications associated with this technique are lacking.

Matched MeSH terms: Aneurysm, False/surgery*
Fulltext Successful endovascular treatment of post-traumatic inferior pancreaticoduodenal artery pseudoaneurysm

Leong BD, Chuah JA, Kumar VM, Mazri MY, Zainal AA

Singapore Med J, 2008 Nov;49(11):e300-2.
PMID: 19037533

True and pseudoaneurysms of the visceral arteries are uncommon. They represent 0.1-0.2 percent of all vascular aneurysms. Visceral artery aneurysms (VAAs) should be treated due to their propensity to rupture and associated high mortality. We describe a 58-year-old man with pseudoaneurysm of the inferior pancreaticoduodenal artery and who presented with post-motor vehicle accident abdominal pain and a pulsatile epigastic mass. Computed tomography (CT) showed a pseudoaneurysm of the visceral artery, and selective mesenteric angiography showed the aneurysm to be arising from the inferior pancreaticoduodenal artery. The aneurysm was successfully treated with endovascular coil embolisation. CT angiogram at one month post-procedure revealed persistent occlusion of the aneurysm. To the best of our knowledge, this is the first reported pseudoaneurysm of inferior pancreaticoduodenal artery secondary to blunt abdominal trauma from a motor vehicle accident and also the first reported VAA from Malaysia.

Matched MeSH terms: Aneurysm, False/etiology*; Aneurysm, False/therapy*
Fulltext Aorto-oesophageal fistula and aortic pseudoaneurysm caused by a swallowed fish bone

Sia KJ, Ashok GD, Ahmad FM, Kong CK

Hong Kong Med J, 2013 Dec;19(6):542-4.
PMID: 24310662 DOI: 10.12809/hkmj133668

We describe a rare case of aorto-oesophageal fistula and aortic pseudoaneurysm in a middle-aged man, who presented with chest pain and haematemesis 1 week after swallowing a fish bone. Oesophagogastroduodenoscopy and computed tomographic angiography findings were consistent with oesophageal perforation, proximal descending aortic pseudoaneurysm, and aorto-oesophageal fistula. Thoracic endovascular aortic repair was performed. The patient died from severe mediastinal sepsis. Early surgical intervention and broad-spectrum antibiotic therapy are crucial in preventing life-threatening mediastinal infection.

Matched MeSH terms: Aneurysm, False/etiology*; Aneurysm, False/pathology; Aneurysm, False/surgery
Fulltext A case report of airway stenting in tracheal compression secondary to right subclavian artery pseudo-aneurysm

Muhammad Naimmuddin Abdul Azih, Aishah Ibrahim, How, Soon Hin, Kuan, Yeh Chunn

International Medical Journal Malaysia, 2018;17(1):141-144.
MyJurnal

We report a 55-year old lady with the presentation of stridor and type II respiratory failure requiring tracheal intubation. She had right Horner’s syndrome associated with pleural effusion. Her chest radiograph revealed right upper zone lobulated opacities and therefore right Pancoast tumor was the initial diagnosis. However, her CECT thorax revealed a huge right subclavian artery pseudoaneurysm with severe tracheal compression. This rare condition imposed a significant diagnostic as well as therapeutic challenge. Vascular surgery is the definitive treatment but it is associated with high risks. The exact role of rigid bronchoscopy for airway stenting is unknown due to limited evidence available. Indeed, this form of central airway obstruction may benefit from temporary tracheal stenting whilst the surgical repair of the lesion is planned. It may facilitate early weaning and allows less complicated airway control.

Matched MeSH terms: Aneurysm, False
Fulltext Superficial femoral artery thrombosis after midshaft femoral fracture fixation with an intramedullary nail: a case report

Ramachandran Rubenandran, Rampal Sanjiv, Sivalingarajah Prema, Tan Eng Kee, Devaraj Navin Kumar

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):316-318.
MyJurnal

Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dread- ed complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.

Matched MeSH terms: Aneurysm, False
Fulltext Transposed Basilic Vein Fistula: A Credible Option

Leong BD, Zainal AA, Hanif H, Tajri HM, Govindarajantran N, Pillay K, et al.

Ann Vasc Dis, 2018 Jun 25;11(2):223-227.
PMID: 30116415 DOI: 10.3400/avd.oa.18-00018

Objective: Native fistula creation for hemodialysis in patients who have exhausted all their superficial veins presents a challenge to vascular practice. We review our experience in transposed basilic vein fistula (BVT) creation and its usage for hemodialysis. Materials and Methods: We analyzed the hospital operative registry from January 2009 till June 2012 to identify the total number of BVT created in our center. Medical records of all patients were traced, and patients were interviewed using a standard proforma. In our center, BVT is performed as a two-stage procedure. All patients were routinely assessed with duplex scan preoperatively and postoperatively. Results: Two hundred thirty-nine patients were recruited in the study. Of these patients, 50.6% were male and 49.4% were female. Mean age was 53.4 years. Of these patients, 81.2% had history of other previous fistula creation. Risk factors profile includes diabetes mellitus in 59.8%, hypertension in 86.2%, and smoking in 13.0%. Of these patients, 84.5% had no operative complication. Commonest complication was wound infection, 6.3%, followed by hemorrhage or hemotoma required surgical intervention, 5.9%, and pseudoaneurysm, 1.3%. Primary and secondary patencies were at 84.2% and 86.1% at 1 year and 67.7% and 70.5% at 3 years, respectively. Conclusion: BVT is a credible option for challenging patients with absence of superficial veins for native fistula creation with good patency and low operative complication rate. Preoperative ultrasound assessment improves patient selection and outcome of BVT.

Matched MeSH terms: Aneurysm, False
Traumatic Pseudoaneurysm of Right Extracranial Internal Carotid Artery: A Rare Entity and Recent Advancement of Treatment with Minimally Invasive Technique

Ong JL, Jalaludin S

Malays J Med Sci, 2016 Mar;23(2):78-81.
PMID: 27547119 MyJurnal

The purpose is to describe a case of traumatic right extracranial internal carotid artery (EICA) pseudoaneurysm, which is a rare entity and the evolution of treatment from surgery to minimally invasive intervention by endovascular stenting and coiling. We reported a case of traumatic right EICA pseudoaneurysm who presented with multiple cranial nerve palsies. Multiple radiological examinations [including magnetic resonance imaging (MRI) with angiogram, computed tomography angiogram (CTA), and digital subtraction angiogram (DSA)] demonstrated right EICA pseudoaneurysm. The pseudoaneurysm was successfully treated with endovascular stenting and coiling. EICA pseudoaneurysm is a rare entity, and open surgery was the gold standard of treatment. Current technology allows endovascular stenting and coiling of pseudoaneurysm as an alternative treatment. It is minimally invasive, associated with lesser complications, better recovery and a shorter hospital stay.

Matched MeSH terms: Aneurysm, False
Fulltext Acute Shortening and Re-Lengthening (ASRL) in Infected Non-union of Tibia - Advantages Revisited

Baruah RK, Baruah JP, Shyam-Sunder S

Malays Orthop J, 2020 Jul;14(2):47-56.
PMID: 32983377 DOI: 10.5704/MOJ.2007.012

Introduction: A gap non-union in various conditions has been treated successfully by the Ilizarov method. The gap can be filled up either by an acute shortening and re-lengthening (ASRL) procedure or by an internal bone transport (IBT). We compared the functional and clinical outcome of ASRL and IBT in gap non-unions of the infected tibia.
Material and Methods: A retrospective study was conducted in our department from the data collected in the period between 1997 and 2010. There were 86 cases of infected non-union of the tibia, in patients of the age group 18 to 65 years, with a minimum two-year follow-up. Group A consisted of cases treated by ASRL (n=46), and Group B, of cases by IBT (n=40). The non-union following both open and closed fractures had been treated by plate osteosynthesis, intra-medullary nails and primary Ilizarov fixators. Radical debridement was done and fragments stabilised with ring fixators. The actual bone gap and limb length discrepancy were measured on the operating table after debridement. In ASRL acute docking was done for defects up to 3cm, and subacute docking for bigger gaps. Corticotomy was done once there was no infection and distraction started after a latency of seven days. Dynamisation was followed by the application of a patellar tendon bearing cast for one month after removal of the ring with the clinico-radiological union.
Results: The bone loss was 3 to 8cm (4.77±1.43) in Group A and 3 to 9cm (5.31± 1.28) in Group B after thorough debridement. Bony union, eradication of infection and primary soft- tissue healing was 100%, 85% and 78% in Group A and 95%, 60%, 36% in Group B respectively. Nonunion at docking site, equinus deformity, false aneurysm, interposition of soft-tissue, transient nerve palsies were seen only in cases treated by IBT.
Conclusion: IBT is an established method to manage gap non-union of the tibia. In our study, complications were significantly higher in cases where IBT was employed. We, therefore, recommend ASRL with an established protocol for better results in terms of significantly less lengthening index, eradication of infection, and primary soft tissue healing. ASRL is a useful method to bridge the bone gap by making soft tissue and bone reconstruction easier, eliminating the disadvantages of IBT.

Matched MeSH terms: Aneurysm, False
Fulltext Avoiding diagnostic pitfalls in mimics of neoplasia: the importance of a comprehensive diagnostic approach

Samsudin EZ, Kamarul T, Mansor A

Singapore Med J, 2015 May;56(5):e92-5.
PMID: 26034328 DOI: 10.11622/smedj.2015082

Any medical diagnosis should take a multimodal approach, especially those involving tumour-like conditions, as entities that mimic neoplasms have overlapping features and may present detrimental outcomes if they are underdiagnosed. These case reports present diagnostic pitfalls resulting from overdependence on a single diagnostic parameter for three musculoskeletal neoplasm mimics: brown tumour (BT) that was mistaken for giant cell tumour (GCT), methicillin-resistant Staphylococcus aureus osteomyelitis mistaken for osteosarcoma and a pseudoaneurysm mistaken for a soft tissue sarcoma. Literature reviews revealed five reports of BT simulating GCT, four reports of osteomyelitis mimicking osteosarcoma and five reports of a pseudoaneurysm imitating a soft tissue sarcoma. Our findings highlight the therapeutic dilemmas that arise with musculoskeletal mimics, as well as the importance of thorough investigation to distinguish mimickers from true neoplasms.

Matched MeSH terms: Aneurysm, False/diagnosis

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