1/10. Isotope angiograpy for detection of embolic arterial occlusion.radionuclide angiography is a safe, noninvasive, easily performed and rapidly executed technique which will accurately demonstrate the presence of an acute occlusion of the arterial tree of the lower extremities. The diagnosis of embolic or thrombotic occlusion of the arterial circulation of the lower extremity in the critically ill patient often is not clear. Visualization of the arterial tree prior to any operation is advantageous, but these patients are invariably in such poor general physical condition that one wound prefer not to submit them to the invasive and time-consuming procedure of conventional contrast arteriography. radionuclide angiography was performed in three patients who had an equivocal diagnosis of acute occlusion of the femoral artery. Acute occlusion was correctly diagnosed by this technique in all three patients.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/10. An embolizing lesion in a minimally diseased aorta.A case report of a patient with an unusual source of emboli resulting in acute limb-threatening ischemia is presented. Diagnostic angiography of the lower extremity was performed, followed by thromboembolectomy, which successfully restored normal arterial flow to the threatened leg. After surgery the patient underwent transesophageal echocardiography, which failed to identify an embolic source. Because of the high degree of clinical suspicion that the primary disease process was embolic rather than thrombotic, a thorough evaluation of the arterial tree was performed, including computed tomography and aortography. A large, mobile intravascular lesion arising from a normal descending thoracic aorta was identified and successfully treated with resection and graft placement.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
3/10. Young stroke, cardiac myxoma, and multiple emboli: a case report and literature review.Cardiac myxoma is a source of emboli to the vascular tree, especially to the central nervous system. Although it is rare, its early recognition is particularly important because of its unique clinical features of subsequently leading to intracerebral or subarachnoid hemorrhage, even brain metastases, and its potential for surgical cure. Missing the diagnosis may lead to devastating results, including stroke, even sudden death. A 40-year-old male with no other conventional vascular risk factors such as hypertension, diabetes or hyperlipidemia presented with right hemiplegia, global aphasia, vomiting, and fever. infarction over the left middle cerebral artery was disclosed on magnetic resonance imaging study, and echocardiogram showed a huge mass, about 5cm in size, on the mitral valve which was histopathologically proved to be a cardiac myxoma. He also presented with multiple emboli to the kidneys and the left eye. There is uncertainty about the role of anticoagulation. The treatment of choice remains surgical excision of the cardiac myxoma which may lead to normalization of serum interleukin-6 levels and resolution of constitutional symptoms, and the intracranial aneurysms may regress and resolve.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
4/10. Unusual presentation of bronchogenic carcinoma: case report and review of the literature.Although blood spread of pulmonary malignancy presumably occurs through microembolization, frank embolization of tumor fragments is uncommon. The first reported case of bronchogenic carcinoma appearing as a peripheral arterial embolus is described. The patient, a 64-year-old female, had acute ischemia of the left leg secondary to tumor embolism to the left profunda femoris and popliteal arteries. Shortly after embolectomy, she suffered atelectasis of the whole left lung from an epitheloid carcinoma in the left main bronchus. Twenty-eight cases of frank tumor embolism to the arterial tree occurring during the course of a noncardiac malignancy have been reported. None, however, occurred as an initial event. Pulmonary metastasis in patients with advanced malignancy was the source of the arterial emboli in 45% (13/29) of reported cases, but bronchogenic carcinoma was the original cell type in 38% (11/29) of cases. In general, arterial tumor embolism is a complication of advanced malignancy usually originating from one of multiple pulmonary metastases. This first case report of tumor embolism to a lower extremity occurring as the initial event in the clinical course of a bronchogenic carcinoma serves to emphasize the protein manifestations of malignant disease.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
5/10. renal artery aneurysm with peripheral embolization of kidney.This case demonstrates that a renal artery aneurysm may give rise to microemboli which pass peripherally to occlude branches of the renal arterial tree. These microemboli will result in segmental infarction of the renal parenchyma.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
6/10. Embolization of caval umbrella. Discussion and report of successful removal from the right ventricle.The first case of successful diagnosis and operative removal of a vena caval umbrella which had become detached and migrated to the right ventricle is reported. Complications from the employment of this device are discussed. In all cases of umbrella embolization to the right heart and pulmonary arterial tree, immediate operative removal is indicated. Precautions regarding umbrella insertion which minimize the likelihood of dislodgment and embolization are also mentioned.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
7/10. air rifle pellet injury to the heart with retrograde caval migration.Great emphasis is placed on the lethality of modern high-powered street weapons, and their impact on mortality from firearm injuries. Presented is a case of an air rifle BB injury to the chest, resulting in a penetrating injury of the right heart, with apparent retrograde embolization to the inferior vena cava. Although no clinical evidence of pericardial tamponade was present 4 hours following injury, 150 mL of pericardial blood was encountered at median sternotomy, secondary to a right atrial appendage entry wound. This case exemplifies three important principles regarding penetrating chest trauma and air guns: (1) Modern air rifles, capable of muzzle velocities as high as 900 fps, are intrinsically lethal weapons; (2) missiles within the cardiovascular system have a propensity for embolization, and often follow an intuitively unexpected course; and (3) young healthy patients with potentially lethal penetrating cardiac injuries, particularly those caused by low velocity firearms, may appear stable and minimally injured in the emergency room. A strong suspicion of cardiac injury and prompt intervention should be extended to airgun injuries of the thorax.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
8/10. The "blue-toe" syndrome as a harbinger of impending infrainguinal vein graft failure: a report of three cases.Spontaneous "blue-toe" syndrome classically results from distal lower extremity microembolization of intraluminal atheromatous debris from a proximal source to the digital end arteries. During a 6-year period, 274 consecutive infrainguinal reversed vein arterial reconstructions were performed; in three patients (1.1% incidence), atypical distal microembolization originating from focal preocclusive intraluminal vein graft stenoses was identified. Sudden, spontaneous onset of ipsilateral blue-toe syndrome occurred at intervals of 4 to 11 months. Subsequent duplex scans and arteriography demonstrated patent grafts with high-grade, hemodynamically significant focal proximal short-segment sclerotic vein graft stenosis (n = 1) and midgraft valvular weblike stenoses (n = 2) with luminal irregularity. No other associated tandem lesions in the proximal or distal arterial tree were noted that would account for the microembolic phenomenon. The stenotic vein segments were excised with interposition vein graft replacement (n = 1) or with primary end-to-end reanastomoses (n = 2), resulting in complete resolution of the distal microembolic events without need for amputation. Histologic examination of these graft lesions demonstrated significant focal myointimal hyperplasia with adherent platelet aggregates and organized thrombus. The clinical presentation of distal lower extremity cutaneous digital ischemia consistent with microembolization developing ipsilateral to a previously placed vein conduit arterial bypass may signify a "failing" graft with a source from a preocclusive lesion. This finding should prompt aggressive evaluation and immediate revision to maintain assisted primary graft patency and prevention of tissue loss.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
9/10. lower extremity atheromatous embolization.Eleven patients with lower extremity atheromatous microembolization are described. The diagnostic feature of sudden, often repetitive, episodes of focal ischemia, patent major arteries of the legs, and arteriographic demonstration of nonocclusive atheromas of the proximal arterial tree are characteristic. Successful removal of the causative lesion in these patients has prevented further ischemic episodes.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
10/10. "Blue toe" syndrome. An indication for limb salvage surgery.We describe 31 patients in whom proximal lesions in the arterial tree were identified as probable sources of emboli causing the "blue toe" syndrome. This syndrome consists of acute digital ischemia caused by microembolization to the digital arteries from a proximal source via a patent arterial tree, as evidenced by an otherwise well-perfused foot. It is closely analogous to the transient ischemic attacks of the brain, and carries the same potential for serious tissue loss because of repeated embolic showers. The prompt delineation and eradication of the embolic source is of prime importance, in addition to restoration of arterial continuity. Along with the other well-known features of chronic severe ischemia, that is, rest pain, gangrene, etc, the "blue toe" syndrome is therefore an indication for limb salvage surgery.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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