1/14. Aneurysms and hypermobility in a 45-year-old woman.EDS type IV presents a diagnostic and therapeutic challenge to the primary care physician, surgeon, and rheumatologist. In patients for whom the diagnosis is known, avoidance of trauma, contact sports, or strenuous activities, joint bracing and protection, and counseling on contraception are helpful preventive strategies. In patients presenting with vascular, gastrointestinal, or obstetric complications, a history of hypermobility and skin fragility (easy bruising, abnormal scarring, poor wound healing) should lead to a suspicion of this diagnosis, and to caution in the use of certain invasive diagnostic and operative techniques. Efforts should be made to examine family members. Most importantly, when caring for such patients, the acute onset of headaches, chest pain, shortness of breath, and abdominal pain should arouse suspicion of a potentially catastrophic vascular or visceral event.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. aneurysm of the internal carotid artery following soft tissue penetration injury.Aneurysms of the extracranial arteries are in most cases secondary to atherosclerosis but may also be due to degeneration, congenital abnormalities, trauma or unclear etiology. They present either with bulging in the lateral pharyngeal wall or the neck. Therefore, otolaryngologists are often among the first physicians to see the patient. In this report, we present a case of spontaneous oral bleeding that was caused by a pseudoaneurysm following 2 weeks after a soft tissue penetration injury in a child. The facial swelling of the child was initially diagnosed to be mumps by its pediatrician and the fever treated with aspirin. A pseudonaneurysm of the internal carotid artery was identified by arteriography as the source of the abrupt oral bleeding and required immediate surgical treatment including radiological means. Our report should illustrate the importance of careful preoperative evaluation as well as a high index of suspicion especially in children, where evaluation of history is difficult.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Large vessel aneurysms in Wegener's granulomatosis.Large vessel aneurysm is not a classical finding in Wegener's granulomatosis. We describe a case report of WG complicated by subclavian artery aneurysm and review the literature on large-vessel and medium-vessel aneurysms in WG. The involved arteries included the aorta and the hepatic, renal, and left gastric arteries. In all but one case, abdominal pain was the presenting symptom. Treatment included medical and vascular interventions. In two patients, the involved vessel ruptured, leading to massive hemorrhage and death. We concluded that unexplained abdominal pain or extremity ischemia in patients with WG should alert the physician to the possibility of a large-vessel or medium-vessel aneurysm.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Three-dimensional reconstruction of a rotational abdominal aortogram showing a renal artery aneurysm.This is a case of a 65-year-old woman with a history of coronary artery disease, who presented with hypertension that was poorly controlled by medical treatment. A rotational abdominal aortogram was done, followed by selective right and left renal artery angiograms. Imaging of renal artery aneurysms can be tricky, and some aneurysms might be misdiagnosed for a tortuous renal artery. In such cases, the physician needs to maintain a high index of suspicion towards this condition. Three-dimensional reconstruction allows for a better visualization of the aneurysm and its surrounding structures. It also guides the operator to the projection that best reveals the anatomical criteria of the aneurysm.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Vascular complication of neck space infection: case report and literature review.Antibiotic therapy has changed the face of medicine radically, and physicians no longer have the empirical knowledge of bacterial infections that they once had. Consequently, the diagnosis and management of complicated infections presents a significant challenge to today's otolaryngologists. We present a rare complication, even before the advent of antibiotics, of a head and neck infection: a carotid artery pseudoaneurysm resulting from peritonsillar abscess. The diagnosis and management of this problem is discussed and the pertinent literature reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Aneurysms and pseudoaneurysms of the superficial temporal artery caused by trauma.Superficial temporal artery (STA) aneurysms as a result of trauma represent less than 1% of reported aneurysms. During the past 200 years only the type of trauma and the preferred treatment have significantly changed. patients are generally young men with a recent history of blunt head trauma. They may complain of a mass, headache, or other vague symptoms. Neurologic defects are rare; however, if a neurologic deficit exists, the physician should consider either arteriography or a head CT scan to search for intracranial pathologic conditions. In most cases the diagnosis may be made by obtaining a complete history and physical examination. The treatment of choice is ligation and resection, which may be accomplished with the patient under local or general anesthesia. In rare instances, arteriography with selective embolization may be useful when the traumatic aneurysm is complicated by severe facial trauma. Three cases of STA aneurysms are presented. The history, pathophysiology, origin, presentation, diagnosis, differential diagnosis, and treatment of STA aneurysms are reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. The warning leak in subarachnoid hemorrhage and the importance of its early diagnosis.A 40-year-old man had a severe headache of sudden onset and progressive palsy of the third cranial nerve from a minor subarachnoid hemorrhage. Despite assessment by two primary care physicians the possibility of serious neurologic disease was not raised and the urgency of the situation not appreciated. Two weeks after the onset of the headache the patient was urgently admitted to hospital at the request of a neuro-ophthalmologist. cerebral angiography revealed an aneurysm of the posterior communicating artery, which was surgically occluded with a clip. The patient had a satisfactory recovery, with almost complete return of nerve function by the time of discharge from hospital. Such "warning leaks" in subarachnoid hemorrhage are discussed, and a protocol for their assessment is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. Kawasaki disease.Kawasaki disease is an acute, multisystem illness that predominantly affects young children and has been described throughout the world. The triphasic course includes an initial phase of acute illness marked by high fever, conjunctival injection, oral changes, and erythematous rash. The second, subacute, phase begins with a decline of the acute findings and proceeds with desquamation of rash, joint manifestations, thrombocytosis, and cardiac disease. Most deaths (1 to 2 percent of cases) occur in this phase, usually resulting from myocardial infarction. During the third phase all signs of clinical illness subside. The prognosis is related to the degree of cardiac involvement, and 14 to 20 percent of patients develop coronary artery aneurysms. Inhibition of platelet aggregation, combined with symptomatic relief and supportive measures, forms the cornerstone of therapy. family physicians need to be aware of this illness, particularly since it can no longer be considered rare.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. Ultrasound as a diagnostic aid in the evaluation of popliteal swelling.Ultrasound (US), because of its ability to distinguish cystic from solid tissue, is an ideal tool for diagnosing masses in the popliteal fossa. Five cases are presented. Two cases show the typical ultrasound images in the most common popliteal mass, a cyst. A third case significantly points out the necessity of further investigations if the US findings are atypical of a simple cyst and the patient is symptomatic. A fourth case demonstrates that the US image can distinguish an aneurysm of the popliteal artery from a cyst. A fifth case demonstrates that a solid tumor in the popliteal fossa, in contrast to that of a cyst, has a characteristic US image. Ultrasound is a simple, quick, noninvasive outpatient procedure available to almost every physician. In most instances, US appears to be the diagnostic procedure of choice following conventional radiography in the evaluation of swelling in the popliteal fossa.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. False aneurysm of the posterior tibial artery complicating fracture of the tibia and fibula.A false aneurysm of the posterior tibial artery associated with a fracture of the tibia and fibula is described. A review of the English language literature of the last 15 years revealed only six other similar cases. The physician should bear in mind that a persisting painful swelling at the fracture site of the leg might be the only clinical sign of a false aneurysm developing in one of the tibial vessels.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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