RESUMEN
ABSTRACT This report describes a case of retinal racemose hemangioma that first presented as a vitreous hemorrhage. The authors present the case of a 47-year-old woman with a sudden 5-day painless visual loss in her left eye. At the first visit, the best-correct visual acuities were 20/20 in the right eye and hand motions in the left eyes. Ultrasonography showed an attached retina and a massive vitreous hemorrhage. Pars plana vitrectomy was performed and a dilatation of large vessels was detected bulging from the optic disc. The best-correct visual acuities on day 30 postoperatively was 20/25 in the left eye. Fundus angiography and spectral-domain optical coherence tomography angiography showed anomalous arteriovenous communications with no intervening capillaries. The diagnosis was racemose hemangioma, an arteriovenous malformation of group 2 retina based on the Archer classification.
RESUMO Este relato descreve um caso de hemangioma racemoso da retina que se apresentou inicialmente como hemorragia vítrea. Os autores apresentam o caso de uma mulher de 47 anos com perda visual súbita e indolor 5 dias antes no olho esquerdo. Na primeira visita, a melhor acuidade visual corrigida foi de 20/20 no olho direito e movimentos das mãos no olho esquerdo. A ultrassonografia mostrou uma retina aderida e uma hemorragia vítrea maciça. Foi realizada vitrectomia pars plana, sendo detectada proliferação de grandes vasos salientes do disco óptico. A acuidade visual no dia 30 de pós-operatório foi de 20/25 no olho esquerdo. A angiografia de retina e a angiotomografia de coerência óptica de domínio espectral mostraram comunicações arteriovenosas anômalas sem capilares intermediários. O diagnóstico foi hemangioma racemoso, uma malformação arteriovenosa da retina do grupo 2 com base na classificação de Archer.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Malformaciones Arteriovenosas/complicaciones , Vasos Retinianos/anomalías , Hemorragia Vítrea/etiología , Angiografía , Hemangioma/complicaciones , Malformaciones Arteriovenosas/cirugía , Malformaciones Arteriovenosas/diagnóstico , Enfermedades de la Retina , Vasos Retinianos/diagnóstico por imagen , Vitrectomía , Hemorragia Vítrea/cirugía , Hemorragia Vítrea/diagnóstico , Ultrasonografía , Tomografía de Coherencia Óptica , Hemangioma/cirugía , Hemangioma/diagnósticoAsunto(s)
Humanos , Femenino , Anciano , Malformaciones Arteriovenosas/complicaciones , Malformaciones Arteriovenosas/diagnóstico , Divertículo/complicaciones , Divertículo/diagnóstico , Enfermedades del Yeyuno/complicaciones , Enfermedades del Yeyuno/diagnóstico , Malformaciones Arteriovenosas/cirugía , Tomografía Computarizada por Rayos X , Divertículo/cirugía , Hemorragia Gastrointestinal/etiología , Enfermedades del Yeyuno/cirugía , LaparotomíaRESUMEN
INTRODUCTION: Lower limb high-flow arteriovenous malformations (AVM) are a rare pathology with a chronic and progressive evolution. Development in imaging and treatment has helped to improve outcome. OBJECTIVE: We report a case treated with multi-session endovascular embolization therapy with favorable results. CASE REPORT: A 44-year-old man referred with a complex high-flow lower limb AVM, previously treated with covered stents and a bypass. Six endovascular interventions were performed, combining different embolization methods. CONCLUSION: Endovascular treatment is a safe and effective option for high-flow AVMs. Embolization should be done carefully to prevent complications that could threaten the patient's limb or life.
INTRODUCCIÓN: Las malformaciones arteriovenosas (MAV) son una patología con un curso crónico y una evolución progresiva. OBJETIVO: Reportar el caso de una MAV tratada con embolización endovascular en múltiples sesiones con resultados favorables. REPORTE DE CASO: Masculino de 44 años referido con una MAV de alto flujo del miembro pélvico derecho, tratado previamente con un stent recubierto y un bypass. Se realizaron seis sesiones endovasculares combinando diferentes métodos de embolización. CONCLUSIÓN: El manejo endovascular de las MAV de alto flujo es seguro y efectivo, debe de realizarse cuidadosamente evitando poner en riesgo la extremidad del paciente e incluso la vida.
Asunto(s)
Malformaciones Arteriovenosas , Embolización Terapéutica , Procedimientos Endovasculares , Adulto , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Humanos , Extremidad Inferior , Masculino , Resultado del TratamientoRESUMEN
Vascular arteriovenous malformations originate during the early stages of embryonic development and generally grow progressively, especially during adolescence and pregnancy. Limb salvage using microsurgery is presented, in a patient with an arteriovenous malformation who was initially a candidate for limb amputation. En bloc resection of the arteriovenous malformation of all segments with extended brachial approach and the cutaneous component was performed, with an anterolateral thigh free flap for the lateral reconstruction of the hand.
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Malformaciones Arteriovenosas/cirugía , Colgajos Tisulares Libres/cirugía , Deformidades Congénitas de la Mano/cirugía , Recuperación del Miembro/métodos , Muslo/cirugía , Adolescente , Malformaciones Arteriovenosas/diagnóstico por imagen , Femenino , Colgajos Tisulares Libres/irrigación sanguínea , Mano/irrigación sanguínea , Mano/diagnóstico por imagen , Mano/cirugía , Deformidades Congénitas de la Mano/diagnóstico por imagen , Humanos , Microcirugia/métodos , Muslo/irrigación sanguíneaRESUMEN
A retrospective study was performed to describe the demographic and clinicopathological characteristics of cases of vascular anomalies in a Brazilian population. The data of cases diagnosed as vascular anomalies over a period of 46 years, were retrieved from the archives of the Pathological Anatomy Service of the Department of Dentistry of Federal University of Rio Grande do Norte. Information about sex, age, race, diagnosis, location, and clinical characteristics was extracted. A database was created for analysis in the SPSS system and description of the results. The sample consisted of 597 cases categorized as follows: pyogenic granuloma (n = 454), infantile hemangioma (n = 57), vascular malformation (n = 37), lymphangioma (n = 20), hemangiolymph angioma (n = 10), vascular thrombus (n = 7), hemangio endothelioma (n = 5), angiofibroma (n = 1), hemangioendothelio sarcoma (n = 1), and Kaposi sarcoma (n = 5). Overall, there was a predominance of females (64.2 %), white race (54.2 %), and patients in the 3rd and 4th decades of life. Most cases affected the gingiva/ ridge (44.75 %), had a red/reddish color (60.07 %), sessile implantation (52.4 %), soft consistency (52.7 %) and nodular appearance (53, 9 %), and were non-hemorrhagic (51.3 %) and asymptomatic (76.6 %). The demographic and clinicopathological findings obtained for most of the vascular lesions analyzed are similar to those reported in published studies involving other populations. Knowledge of the particularities of these disorders is important for appropriate diagnosis and treatment decision.
Se realizó un estudio retrospectivo para describir las características demográficas y clínico-patológicas de casos de anomalías vasculares en una población brasileña. Los datos de los casos diagnosticados como anomalías vasculares durante un período de 46 años, fueron obtenidos de los archivos del Servicio de Anatomía Patológica del Departamento de Odontología de la Universidade Federal de Rio Grande do Norte. Se analizó la información de sexo, edad, raza, diagnóstico, ubicación y características clínicas, y se creó una base de datos para análisis en el sistema SPSS y descripción de los resultados. La muestra consistió de 597 casos categorizados de la siguiente manera: granuloma piógeno (n = 454), hemangioma infantil (n = 57), malformación vascular (n = 37), linfangioma (n = 20), hemangiolinfangioma (n = 10), trombo vascular (n = 7), hemangioendotelioma (n = 5), angiofibroma (n = 1), hemangioendoteliosarcoma (n = 1) y sarcoma de Kaposi (n = 5). En general predominaron las mujeres de raza blanca (64,2 %), (54,2 %), y pacientes en la 3ª y 4ª década de la vida. La mayoría de los casos afectaban la encía / cresta (44,75 %), tenían un color rojo / rojizo (60,07 %), implantación sésil (52,4 %), consistencia blanda (52,7 %) y apariencia nodular (53,9 %), no hemorrágicos (51,3 %) y asintomáticos (76,6 %). Los hallazgos demográficos y clínico-patológicos de la mayoría de las lesiones vasculares analizadas son similares a los reportados en la literatura de otras poblaciones. El conocimiento de las particularidades de estos trastornos es importante para el diagnóstico y la decisión de tratamientos adecuados.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Adulto , Persona de Mediana Edad , Anciano , Malformaciones Arteriovenosas/diagnóstico , Hemangioma/epidemiología , Malformaciones Arteriovenosas/cirugía , Brasil/epidemiología , Fotomicrografía/métodos , Estudios Retrospectivos , Factores SociodemográficosRESUMEN
OBJECTIVE: Arteriovenous malformations (AVM) of the ear show unique features. Progressive growth or inadequate management of AVMs may lead to bleeding, infection, cartilage exposure, and ultimately loss of structure. Total ear amputation is an alternative; however, due to the structural complexity of the ear, reconstruction is technically challenging. This study presents a treatment algorithm based on a clinical series, with treatment options including resection and immediate and late reconstruction. METHODS: Between 2004 and 2018, 12 patients with auricular AVMs were treated with AVM resection and ear reconstruction at our hospital. Among these 12 patients, seven were women, and patients' ages ranged between 4 and 34 years. Parameters considered before resection and reconstruction were compromised ear extension (partial, total, or extra-auricular involvement), thickness (cutaneous and cartilaginous), symptoms (bleeding, infection, ulceration, and/or cartilage exposure), and preoperative embolization. Total resection of AVMs was planned as the first step in all cases, followed by primary closure. AVM resection was categorized into a partial or total procedure, resulting in partial or total ear defects. Reconstruction was categorized as immediate or delayed. RESULTS: Preoperative embolization was performed in 10 patients. AVMs were totally removed, resulting in seven total ear amputations. In six of these patients, total ear reconstruction was performed 6 months later, and all patients were recurrence-free. Only one patient did not undergo ear reconstruction. Regrowth was not observed in any reconstructed ear. CONCLUSION: Treatment of ear AVMs requires a planned approach to achieve favorable clinical outcomes and for concomitant safe and definitive reconstruction. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1322-1326, 2020.
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Algoritmos , Malformaciones Arteriovenosas/cirugía , Oído Externo/irrigación sanguínea , Oído Externo/cirugía , Adolescente , Adulto , Niño , Preescolar , Protocolos Clínicos , Femenino , Humanos , Masculino , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Procedimientos Quirúrgicos Vasculares/métodos , Adulto JovenRESUMEN
Patients with functionally single ventricle and interrupted inferior vena cava may develop progressive cyanosis soon after the Kawashima operation. Therefore, early redirection of the hepatic venous return to the pulmonary circulation is recommended. To avoid performing an early redo sternotomy, we propose to prepare these patients for the interventional Fontan-Kreutzer at the time of the Kawashima operation using a technical modification of the approach reported by Prabhu and coworkers in 2017. The technique described here uses an expanded polytetrafluoroethylene conduit interposed between the hepatic veins and the right pulmonary artery. This graft is everted and divided into two portions with a pericardial patch. The lower one is widely opened and anastomosed side-to-side to the atrium. A few months after the operation, percutaneous Fontan-Kreutzer completion can easily be performed using covered stents to open the patch and at the same time close the opening between the conduit and the atrium.
Asunto(s)
Malformaciones Arteriovenosas/diagnóstico , Vena Ácigos/anomalías , Procedimiento de Fontan , Puente Cardíaco Derecho , Ventrículos Cardíacos/anomalías , Vena Cava Inferior/anomalías , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Vena Ácigos/cirugía , Femenino , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/cirugía , Humanos , Lactante , Vena Cava Inferior/cirugíaRESUMEN
Abstract Arteriovenous malformations (AVMs) are usually found in the pelvic area and the brain. These vascular anomalies are rarely reported in the toes. AVMs in the toes may be asymptomatic, but can also cause atypical symptoms. Congenital AVMs can expand as patients age and manifest in adulthood. They may be provoked by injury. Acquired AVM might be caused by iatrogenic factors, venous or arterial catheterization, percutaneous invasive vascular procedures, surgery, or degenerative vascular disorders. An AVM can damage surrounding tissues and can cause destruction of skin, nails and bones. The course of the disease is often unpredictable and diagnosis is usually delayed as a result.
Resumo As malformações arteriovenosas (MAVs) são geralmente encontradas na região pélvica e no cérebro.. Essas anomalias vasculares raramente são relatadas nos dedos dos pés. A MAV nesse local pode ser assintomática ou apresentar sintomas atípicos. MAVs congênitas podem evoluir com a idade e se manifestar na idade adulta. O fator provocante pode ser uma lesão traumática. Uma MAV adquirida pode ser causada por fatores iatrogênicos, cateterismo venoso e arterial, procedimentos percutâneos vasculares invasivos, cirurgias e alterações degenerativas vasculares. A MAV pode danificar tecidos adjacentes e pode causar destruição de pele, unhas e ossos. O curso da doença é muitas vezes imprevisível, e como resultado, atrasar o diagnóstico.
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Humanos , Masculino , Persona de Mediana Edad , Malformaciones Arteriovenosas/cirugía , Hallux/anomalías , Uñas Malformadas , Malformaciones Arteriovenosas/complicaciones , Enfermedades de la Piel , Hallux/irrigación sanguínea , Amputación Quirúrgica , Uñas/anatomía & histologíaAsunto(s)
Malformaciones Arteriovenosas/cirugía , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Hemotórax/etiología , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalías , Adulto , Malformaciones Arteriovenosas/complicaciones , Malformaciones Arteriovenosas/diagnóstico , Femenino , Hemotórax/diagnóstico , Hemotórax/cirugía , Humanos , Arteria Pulmonar/diagnóstico por imagen , Venas Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Introdução: A síndrome de Klippel-Trénaunay-Weber (SKTW) é caracterizada pelo conjunto de sinais que consiste em malformações capilares, malformações venosas com ou sem malformações linfáticas associado ao supercrescimento de membros. Na maioria das vezes, envolve apenas uma extremidade com malformação arteriovenosa e cerca de 75% dos pacientes manifestam antes dos 10 anos de idade. Relato de Caso: Relatamos um caso de Klippel-Trénaunay- Weber em um paciente de 7 meses em acompanhamento na enfermaria da Cirurgia Plástica do Hospital de Clínicas da Universidade Federal de Uberlândia para o qual foi proposto tratamento cirúrgico da lesão. Conclusão: Como a SKTW é uma doença com morbidade progressiva e grave, o paciente deve ser acompanhado em um centro de referência com experiência e arsenal terapêutico diversificado para atuar da melhor forma possível no tratamento.
Introduction: The Klippel-Trénaunay-Weber syndrome (KTWS) is characterized by several signs, including capillary malformations and venous malformations with or without lymphatic malformations associated with limb overgrowth. In most cases, only one extremity is involved with arteriovenous malformation, and approximately 75% of the patients manifest symptoms before 10 years of age. Case Report: We report a case of a 7-month-old patient with KTWS followed-up at the Plastic Surgery Service of the Hospital de Clínicas, Federal University of Uberlândia; surgical treatment of the lesion was proposed for the patient. Conclusion: Since KTWS is a progressive disease with severe morbidity, the patient must be followed-up at a reference center by experienced staff with diverse therapeutic arsenal.
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Humanos , Masculino , Lactante , Malformaciones Arteriovenosas/cirugía , Anomalías Congénitas/cirugía , Síndrome de Klippel-Trenaunay-Weber/cirugía , Malformaciones Vasculares/cirugía , Hemangioma/cirugía , Morbilidad , Síndrome de Klippel-Trenaunay-WeberRESUMEN
RATIONALE: Visual therapy, which includes a restorative and compensatory approach, seems to be a viable treatment option for homonymous defects of the visual field in patients with postgeniculate injury of the visual pathway, due to occipital arteriovenous malformation (AVM). Until now, the Mexican population suffering from homonymous hemianopia did not have health services that provided any type of visual therapy for their condition. PATIENT CONCERNS: A 31-year-old patient, who underwent a surgical procedure for resection of the AVM, was referred with posterior low vision on the left side. DIAGNOSES: The patient was diagnosed with left homonymous hemianopia. INTERVENTIONS: Visual neurorehabilitation therapy (NRT), which integrated restorative and compensatory approaches, was administered for 3âhours each week. NRT included fixation, follow-up, search, peripheral vision, and reading. OUTCOMES: The NRT did not change visual field defects and, retinotopocally, the same campimetric defects remained. However, after training the tracking ocular movements improved to standard values on the ENG, further, the visual search became more organized. The reading reached a level without mistakes, with rhythm and goog intonation. The Beck test demostrated an improvement in depression symptoms. Regarding the daily life activities, the patient reported significant improvements. LESSONS: Visual NRT can significantly improve eye movements, as well as the quality of life and independence of the patient. This integral approach could be an effective therapeutic option for homonymous defects of the visual field.
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Malformaciones Arteriovenosas/cirugía , Hemianopsia , Rehabilitación Neurológica/métodos , Lóbulo Occipital , Complicaciones Posoperatorias , Calidad de Vida , Movimientos Sacádicos , Procedimientos Quirúrgicos Vasculares/efectos adversos , Adulto , Femenino , Hemianopsia/diagnóstico , Hemianopsia/etiología , Hemianopsia/fisiopatología , Hemianopsia/psicología , Humanos , Lóbulo Occipital/irrigación sanguínea , Lóbulo Occipital/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/psicología , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos , Pruebas del Campo Visual/métodos , Vías Visuales/lesionesRESUMEN
Introducción: Las anomalías vasculares son un grupo heterogéneo de patologías, que considera tanto tumores como malformaciones vasculares. Son, habitualmente, de diagnostico y manejo durante la infancia, algunas lesiones persisten hasta la edad adulta. El tratamiento habitual considera terapias poco invasivas, siendo la alternativa resecctiva un opcion infrecuente. Objetivos: El objetivo de este estudio es presentar el manejo quirúrgico de pacientes portadores de anomalías vasculares realizado por el equipo de Cirugía Plástica y Reconstructiva del Hospital Clínico de la Universidad de Chile. Material y Métodos: Serie de casos retrospectiva de pacientes con diagnóstico de anomalias vasculares, sometidos a manejo quirúrgico por el equipo de Cirugía Plástica y Reconstructiva del Hospital Clínico de la Universidad de Chile. Se incluyó todos los pacientes con diagnóstico de anomalías vasculares intervenidos entre los años 2010 2016. Se realizó una revisión del historial clínico de cada paciente elaborando un análisis descriptivo. Resultados: Serie de 9 pacientes, 6 (66,6%) de sexo femenino, con edad promedio de 34,88 ±15,70 años. De los cuales 6 (66,67%) presentaron malformaciones vasculares y 2 (22,22%) tumores vasculares. Se observo compromiso de cabeza en 6 (66,67%) casos y 2 (22,22,%) genital. Se utilizo colgajos locales de avance en 6 (66,67%) y colgajos de transposición en 2 (22,22%) casos. Conclusiones: El manejo quirúrgico es una alternativa terapéutica segura que ofrece resultados buenos a las lesiones complejas. Y por tanto, creemos que es necesario un trabajo multidisciplinario entre pediatras, dermatólogos, radiólogos fisiatras, psicólogos y cirujanos plásticos para poder ofrecer mejores resultados a nuestros pacientes.
Introduction: Vascular anomalies are a heterogeneous group of pathologies, which considers tumors and vascular malformations. Usually diagnosed and treated during childhood, some lesions persist into adulthood. The usual treatment considers non-invasive therapies, being the respective alternative an uncommon option. Objectives: Present the surgical management of adults patients with vascular anomalies performed by the Plastic and Reconstructive Surgery team of the Clinical Hospital of the University of Chile. Material and methods: Retrospective case series of patients with diagnosis of vascular anomalies submitted to surgical management by the Plastic and Reconstructive Surgery team of the Clinical Hospital of the University of Chile. All patients with diagnosis of vascular anomalies operated between the years 2010 - 2016 were included. A review of the clinical history of each patient was carried out and a descriptive analysis was done. Results: Series of 9 patients, 6 (66.6%) female, with a mean age of 34.88 ± 15.70 years. Of these, 6 (66.67%) had vascular malformations and 2 (22.22%) had vascular tumors. Head involvement was observed in 6 (66.67%) cases and 2 (22.22%) genital. Local flaps were used in 6 (66.67%) and transposition flaps in 2 (22.22%) cases. Conclusions: Surgical management is a safe therapeutic alternative that offers beneficial results to complex lesions. Therefore, we believe a multidisciplinary work between pediatricians, dermatologists, radiologists.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Procedimientos de Cirugía Plástica , Malformaciones Vasculares/cirugía , Malformaciones Arteriovenosas/cirugía , Colgajos Quirúrgicos , Procedimientos Quirúrgicos Vasculares , Estudios Retrospectivos , Hemangioma/cirugíaRESUMEN
Paciente varón de 21 años, sin antecedentes de importancia que ingresa a Emergencia por presentar deposiciones rojo oscuras, tendencia al sopor e hipotensión, con anemia importante procediéndose a realizar sucesivamente transfusión sanguínea, endoscopia digestiva alta, angiotomografía abdominal y arteriografía que, con diagnóstico clínico de lesión de Dieulafoy, motivó laparotomía exploratoria encontrándose una lesión vascular a nivel yeyunal con sangrado activo. Se discute el manejo de hemorragia digestiva severa con compromiso hemodinámico y la causa poco común de malformación arteriovenosa a nivel yeyunal hallada por patología.
A 23-year old male patient with no history of importance was admitted to Emergency because of dark red stools, tendency to lethargy and hypotension, with significant anemia proceeding to perform on blood transfusion, upper endoscopy, abdominal angiotomography and arteriography with clinical diagnosis of Dieulafoy lesion motivated exploratory laparotomy finding injury vascular, the jejunum with active bleeding. The management of severe gastrointestinal bleeding with hemodynamic compromise and uncommon cause of arteriovenous malformation in the jejunum is discussed.
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Humanos , Masculino , Adulto Joven , Malformaciones Arteriovenosas/complicaciones , Hemorragia Gastrointestinal/etiología , Yeyuno/irrigación sanguínea , Malformaciones Arteriovenosas/cirugía , Malformaciones Arteriovenosas/diagnóstico , Malformaciones Arteriovenosas/patología , Anastomosis Quirúrgica , Hemodinámica , Yeyuno/cirugía , Divertículo Ileal/cirugía , Divertículo Ileal/complicacionesRESUMEN
BACKGROUND: The mesial temporal region (MTR) is located deep in the temporal lobe and it is surrounded by important vascular and nervous structures that should be preserved during surgery. OBJECTIVE: To describe microsurgical anatomy and approaches to the MTR in relation to cavernomas and arteriovenous malformations (AVMs). METHODS: Five formalin-fixed and red silicone-embedded heads of adult cadavers were used for this study. Between January 2003 and June 2014, 7 patients with cavernomas and 6 patients with AVMs in the MTR underwent surgery. RESULTS: The MTR of the cadavers was divided into 3 areas: anterior, middle, and posterior. Of the 7 patients with MTR cavernomas, 4 were located anteriorly, 2 were located medially, and 1 was located posteriorly. Of the 6 patients with MTR AVMs, 3 were located in the anterior sector, 2 in the middle sector, and 1 in the posterior sector. For the anterior portion of the MTR, a transsylvian-transinsular approach was used; for the middle portion of the MTR, a transtemporal approach was used (anterior temporal lobectomy); and for the posterior portion of the MTR, a supracerebellar-transtentorial approach was used. CONCLUSION: Dividing the MTR into 3 regions allows us to adapt the approach to lesion location. Thus, the anterior sector can be approached via the sylvian fissure, the middle sector can be approached transtemporally, and the posterior sector can be approached via the supracerebellar approach.
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Malformaciones Arteriovenosas/cirugía , Neoplasias Encefálicas/cirugía , Hemangioma Cavernoso/cirugía , Microcirugia/métodos , Lóbulo Temporal/patología , Lóbulo Temporal/cirugía , Adulto , Anciano , Malformaciones Arteriovenosas/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Angiografía Cerebral , Femenino , Hemangioma Cavernoso/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
ABSTRACT CONTEXT: Dieulafoy's disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION: Dieulafoy's disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy's disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.
RESUMO CONTEXTO: A doença de Dieulafoy da árvore brônquica é uma condição muito rara, poucos casos foram descritos na literatura. Pode ser assintomática ou manifestar-se com hemoptise maciça. Esta doença deve ser considerada em fumadores pesados quando eles têm recorrentes hemoptises maciças sem outros achados anormais. O tratamento pode ser tanto embolização arterial como intervenção cirúrgica. RELATO DE CASO: Uma menina de 16 anos foi admitida no Serviço de Urgências devido a hemoptise com uma lesão nos brônquios de origem desconhecida. Havia sofrido hemoptise maciça e insuficiência respiratória uma semana antes da admissão. A broncoscopia de fibra óptica relevou lesão no brônquio do lobo inferior direito, com suspeita de ser lesão de Dieulafoy. Foi realizada uma segmentectomia do lobo inferior direito com excisão da lesão. O resultado da paciente foi excelente. CONCLUSÃO: A doença de Dieulafoy é uma anomalia vascular rara, sendo extremamente rara na árvore brônquica. Na doença de Dieulafoy bronquial, embolização seletiva tem sido sugerida como método para cessação do sangramento; no entanto, a habitual resseção anatômica do pulmão é uma alternativa segura e curativa.
Asunto(s)
Humanos , Femenino , Adolescente , Malformaciones Arteriovenosas/diagnóstico por imagen , Enfermedades Bronquiales/diagnóstico por imagen , Hemoptisis/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Enfermedades Bronquiales/cirugía , Hemoptisis/cirugíaRESUMEN
CONTEXT:: Dieulafoy's disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT:: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION:: Dieulafoy's disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy's disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.
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Malformaciones Arteriovenosas/diagnóstico por imagen , Enfermedades Bronquiales/diagnóstico por imagen , Hemoptisis/diagnóstico por imagen , Adolescente , Malformaciones Arteriovenosas/cirugía , Enfermedades Bronquiales/cirugía , Femenino , Hemoptisis/cirugía , HumanosRESUMEN
A 23-year old male patient with no history of importance was admitted to Emergency because of dark red stools, tendency to lethargy and hypotension, with significant anemia proceeding to perform on blood transfusion, upper endoscopy, abdominal angiotomography and arteriography with clinical diagnosis of Dieulafoy lesion motivated exploratory laparotomy finding injury vascular, the jejunum with active bleeding. The management of severe gastrointestinal bleeding with hemodynamic compromise and uncommon cause of arteriovenous malformation in the jejunum is discussed.
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Malformaciones Arteriovenosas/complicaciones , Hemorragia Gastrointestinal/etiología , Yeyuno/irrigación sanguínea , Anastomosis Quirúrgica , Malformaciones Arteriovenosas/diagnóstico , Malformaciones Arteriovenosas/patología , Malformaciones Arteriovenosas/cirugía , Hemodinámica , Humanos , Yeyuno/cirugía , Masculino , Divertículo Ileal/complicaciones , Divertículo Ileal/cirugía , Adulto JovenRESUMEN
Arteriovenous malformations (AVMs) of the scalp are rare lesions. The clinical picture presents with complaints of increased scalp, scalp disfigurement, pain and neurological symptoms. Its origin can be congenital or traumatic. We present a case of giant scalp AVMs and its management, followed by a brief literature review on the subject. The diagnosis of scalp AVMs is based on physical examination and confirmed by internal and external carotid angiography or computed tomographic angiography (CTA). Surgical excision is especially effective in scalp AVMs, and is the most frequently used treatment modality.
Asunto(s)
Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Cuero Cabelludo/irrigación sanguínea , Adulto , Angiografía por Tomografía Computarizada , Humanos , Masculino , Fotograbar , Cuero Cabelludo/anomalías , Cuero Cabelludo/cirugíaRESUMEN
SUMMARY Arteriovenous malformations (AVMs) of the scalp are rare lesions. The clinical picture presents with complaints of increased scalp, scalp disfigurement, pain and neurological symptoms. Its origin can be congenital or traumatic. We present a case of giant scalp AVMs and its management, followed by a brief literature review on the subject. The diagnosis of scalp AVMs is based on physical examination and confirmed by internal and external carotid angiography or computed tomographic angiography (CTA). Surgical excision is especially effective in scalp AVMs, and is the most frequently used treatment modality.
RESUMO Malformações arteriovenosas (MAV) do couro cabeludo são lesões raras. O quadro clínico apresenta-se com queixas de aumento do couro cabeludo, desfiguração do couro cabeludo, dor e sintomas neurológicos. A origem pode ser congênita ou traumática. Apresentamos um caso de MAV gigante de couro cabeludo e o tratamento adotado, seguindo-se uma breve revisão da literatura. O diagnóstico das MAV de couro cabeludo baseia-se no exame físico e é confirmado pela angiografia carótida interna e externa ou angiografia por tomografia computadorizada. A excisão cirúrgica é especialmente eficaz em MAV de couro cabeludo e é a modalidade de tratamento mais frequentemente utilizada.