1/14. Transesophageal echocardiography diagnosis of intramural hematoma of the ascending aorta: A word of caution.The diagnosis of intramural hematoma by echocardiography classically requires the presence of an echolucent, crescentic region in the wall of the aorta. Recently we have encountered 2 patients in whom intramural hematoma was characterized only by thickening of the aortic wall, which was circumferential in one patient, thus making the diagnosis difficult to distinguish from common atherosclerotic thickening of the aorta. In one case, computed tomography showed more clearly the abnormal tissue signature of the intramural blood. In summary, absence of an echolucent zone does not exclude the diagnosis of intramural hematoma. Alternative imaging procedures such as computed tomography and magnetic resonance imaging may enhance the diagnostic accuracy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/14. The value of repeat transesophageal echocardiography in the evaluation of embolism from the aorta.Transesophageal echocardiography (TEE) is now widely used in the evaluation of patients with unexplained stroke or transient ischemic attack, in part to exclude the presence of protruding aortic arch atheromas. We report two cases in which repeated TEE revealed an aortic clot not seen on the earlier transesophageal echocardiogram performed immediately after embolization. These cases illustrate the dynamic nature of aortic thrombus and the role of TEE in its diagnosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/14. Penetrating aortic ulcers after absorption of intramural hematoma.We report a case of a type B aortic intramural hematoma, which rapidly expanded, with ulcer-like projections, after complete absorption of the hematoma. One month after the initial presentation, a new computed tomographic scan showed the appearance of a thin ulcer-like projection in the aortic wall. Three months later, after the patient reported a new episode of chest pain, a computed tomographic scan revealed 2 penetrating ulcers and rapid aortic dilation; the aortic hematoma had been completely absorbed. Urgent thoracic aortic replacement was undertaken. Three years postoperatively, the patient was asymptomatic, with no lesion or dilation of the aorta upon computed tomography. After an acute hematoma, the strength and structure of the aortic wall can alter rapidly. Damage and weakening of the aortic wall are caused mainly by infiltration of inflammatory cells, which have pronounced proteolytic and elastolytic activity. Due to the unstable nature of the lesion, optimal management remains controversial. In our patient, the inflammatory process led to the development of 2 aortic ulcers and aortic dilation within 3 months of the acute lesion, requiring urgent surgical intervention.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/14. Recurrent aortoenteric fistula: case report and review.Aortoenteric fistulas (AEFs) are abnormal communications between the aorta and the bowel most frequently resulting from prosthetic graft erosion. Despite advances in surgery and medical technology, these entities are still associated with significant morbidity and mortality for the patient. Multiple case reports and reviews have attempted to elucidate the nature of AEFs in an effort to better characterize and manage these entities. However, reports of recurrence of this process are extremely rare. In this article, we describe a unique case of recurrence of an AEF that was successfully managed with primary aortic oversew and bowel resection. We will also review the literature on AEFs with a comprehensive overview on background, presentation, diagnosis, and current management options.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/14. crack cocaine causing fatal vasoconstriction of the aorta.Cocaine is the most powerful central nervous stimulant found in nature. All forms of cocaine cause tachycardia and vasoconstriction. A smokable, rapidly reacting form of cocaine base, "crack," is highly addictive. smoking crack introduces a high concentration of cocaine into the bloodstream, rendering it especially dangerous. We report a case that visually demonstrates severe aortic vasoconstriction from the suprarenal aorta and extending to both femoral arteries and beyond, resulting in renal failure and fatal bowel ischemia after a 5-day binge of crack cocaine.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/14. Immunohistochemical demonstration of the endothelial nature of aortic intimal sarcoma.Primary sarcomas of the aorta are rare; fewer than 30 cases have been reported. Among these, the majority are intraluminal and apparently intimal in origin. Extensive histochemical and electron-microscopic evaluation of these tumors has not previously been performed. We present a case of aortic intimal sarcoma in a 70-year-old man whose resected aorta showed multifocal, intimal tumor that appeared on light microscopy to be undifferentiated sarcoma. Electron microscopy was not helpful; however, immunohistochemical studies confirmed the endothelial nature of this neoplasm. The multifocal pattern of the tumor and the presence of intervening, atypical, proliferative endothelial cells suggests that endothelial dysplasia may have been a precursor lesion.- - - - - - - - - - ranking = 5keywords = nature (Clic here for more details about this article) |
7/14. Primary aortoduodenal fistula: manifestation, diagnosis, and treatment.Primary aortoduodenal fistulas are an especially lethal part of the spectrum of arterioenteric fistulas. The lethal nature is due to the subtleties in manifestation, leading to delays in diagnosis and institution of prompt operative repair. A review of the 118 primary aortoduodenal fistulas in the world's literature reveals that pain (32%), palpable abdominal mass (25%), and bleeding (64%) are inconsistently present as initial symptoms and that routine abdominal films, barium studies, and endoscopy have been ineffective as diagnostic aids. attention is called to the importance of recognizing the "herald bleed." Operation is usually undertaken emergently and has been successful in only 21 cases in addition to the case reported here. Repair of the duodenal rent and replacement of the aorta with a Dacron prosthesis, rather than an extra-anatomic bypass, is advised.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/14. Hypotensive central spinal cord infarction: a clinicopathological study of 3 cases of aortic disease.Neuropathological studies of 3 cases of aortic disease, complicated by severe prolonged hypotension, revealed a spectrum of central spinal cord infarction not corresponding to a specific arterial territory. The findings support the concept that the central grey matter of the caudal spinal cord is most vulnerable to oligaemic hypoxia. Variation in the longitudinal distribution of ischaemic damage in the individual case depends primarily on the anatomical pattern of the spinal arterial net and on the nature and distribution of the vascular pathology.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/14. Primary aortoduodenal fistula: a case report and review of the literature.The case of a 22-year-old female with spontanteous aortoduodenal fistula is presented, and a group of 185 other cases from the world literature are analyzed. Three additional cases were identified which did not appear to have an underlying pathologic process involving the aorta. Successful surgical correction depends upon a high index of suspicion. In the majority of patients the "herald bleed" allows a period for aggressive investigation. The "herald bleed" is usually rapid, painless, of large volume, and may present as hematochezia. Normal barium studies and endoscopy should heighten suspicion in patients with gastrointestinal hemorrhage. Arteriography may define the case of bleeding and may also delineate the nature and extent of the vascular disease. If the aortic wall is of sufficient quality, direct oversewing has the advantage of avoiding the use of a foreign body in a potentially infected field. In the vast majority of patients a vascular prosthesis is required. Consideration should be given to subcutaneous extraanatomic reconstruction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/14. Aortic regurgitation and sinus of valsalva-right atrial fistula after blunt thoracic trauma.Non-penetrating chest trauma commonly causes a wide variety of cardiac injuries. Disruption of the aortic valve with resultant aortic regurgitation is not uncommon; conversely, a sinus of valsalva-right atrial fistula, in the absence of a congenital sinus of valsalva aneurysm, has been reported only once previously. This report describes the detection by preoperative cardiac catheterisation of both aortic regurgitation, and a sinus of valsalva-right atrial fistula after blunt chest trauma, and its surgical management. The need for preoperative cardiac catheterisation in patients suffering from non-penetrating cardiac trauma is emphasised, even when the diagnosis appears cleas, because of the diverse nature and possible multiplicity of cardiac lesions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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