A. Khayati

Intracavitary cardiac hydatid cyst

The purpose of this study is to determine the diagnosis means, the surgical management and the prognosis of patients with intracavitary cardiac hydatid cyst. We report a series of seven patients. The diagnosis was orientated by coexisting pulmonary locations in all patients. The cyst was located in the right cardiac chambers. Cardiopulmonary bypass with aortic cross clamping and cardioplegia was necessary in all cases. The postoperative course was satisfactory for all patients. There was a recurrence of pulmonary cysts in all patients after a mean duration of 42 months. Medical treatment (Albendazole) was instituted. One late death occurred at 3 years of follow-up due to chronic right heart failure. In conclusion, cardiac hydatid cysts with intracavitary location must be suspected in patients with pulmonary or systemic embolization. Early surgical treatment is necessary and medical treatment must be instituted after surgery.

Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture

Most popliteal arteriovenous fistula and pseudoaneurysm formation are related to trauma. Few cases have previously been reported after acupuncture therapy. Such events are typically observed when the procedure is performed by non-medical acupuncturist. They may present with acute ischemia, recent claudication, distal emboli, or less commonly rupture. Duplex ultrasound should be considered as the 1st method of investigation. Computed tomography scanning is particularly accurate in making the diagnosis. Treatment strategies consist of surgery or endovascular management. The most commonly performed surgical technique for popliteal pseudoaneurysm repair is resection with bypass grafting, whereas popliteal arteriovenous fistula are usually treated surgically with ligation and primary repair. Endovascular procedure using a stent-graft is thought to be a reasonable option for treating popliteal false aneurysm or even arteriovenous fistula. We will describe two cases of an arteriovenous fistula and pseudoaneurysm of the popliteal artery that developed after acupuncture needling in the region of the popliteal artery.

Prise en charge des ruptures de l’isthme aortique post-traumatiques. À propos de 37 cas

OBJECTIVES The aim of this study was to review our experience in the management of traumatic rupture of the aortic isthmus, to evaluate the results of surgery and endovascular exclusion and to develop an adequate therapeutic strategy based on the existence and severity of associated injuries. MATERIAL A series of 37 patients presenting posttraumatic aortic rupture associated with other severe lesions was collected from 2000 to 2012. There were 33 males and four females, mean age 38 years. In this series, 25 patients underwent surgical treatment and 12 endovascular exclusion. RESULTS Six patients died during or after surgery. Overall mortality was 16% (24% in the surgery group). The postoperative period was uneventful in all patients treated with the endovascular procedure. Postoperative computed tomography controls at one week, 1 month and 12 months showed good positioning of the stent without endoleakage. CONCLUSION Traumatic aortic rupture is often the result of a severe high-energy chest trauma. Other serious injuries are often associated. Results of immediate surgical repair are associated with high morbidity and mortality. The advent of endovascular treatment has revolutionized the treatment of traumatic aortic rupture, especially in patients with a high surgical risk.

Cas cliniqueAnévrysme de l’aorte abdominale sous-rénale rompu inaugural d’une maladie de Takayasu chez un homme de 39 ansAcute rupture of an abdominal aortic aneurysm revealing Takayasu arteritis☆

Arterial aneurysms are most commonly (60% of cases) located in the infrarenal abdominal aorta. An inflammatory mechanism is involved in only 10% of cases. Infrarenal abdominal aortic aneurysms revealing Takayasus disease is unusual. Takayasus disease is a rare vasculitis affecting large arteries in young people. It is 10 times more common in women. We report the case of an acute rupture of an abdominal aortic aneurysm revealing Takayasu arteritis in a 39-year-old man with an uneventful medical history.

Anévrysme de l’aorte abdominale sous-rénale rompu inaugural d’une maladie de Takayasu chez un homme de 39 ans ☆

Arterial aneurysms are most commonly (60% of cases) located in the infrarenal abdominal aorta. An inflammatory mechanism is involved in only 10% of cases. Infrarenal abdominal aortic aneurysms revealing Takayasus disease is unusual. Takayasus disease is a rare vasculitis affecting large arteries in young people. It is 10 times more common in women. We report the case of an acute rupture of an abdominal aortic aneurysm revealing Takayasu arteritis in a 39-year-old man with an uneventful medical history.

Présentation atypique d'images kystiques bilatérales

Le patient R.H. âgé de 15 ans s’est présenté aux urgences pour douleurs thoraciques d’intensité modérée évoluant depuis quelques jours avec exacerbation récente. L’interrogatoire n’a pas noté d’antécédents pathologiques particuliers mais avait retrouvé la notion d’une vomique hydatique. L’examen à l’admission avait trouvé un patient en bon état général, apyrétique et l’examen physique était normal. La biologie avait noté une hyperleucocytose à 13 900/mm 3 . La radiographie du thorax avait objectivé une première opacité excavée du lobe supérieur du poumon gauche correspondant au kyste hydatique vomiqué et une deuxième grosse opacité bien limitée occupant le médiastin antérieur dans sa partie moyenne et inférieure, accolée au bord droit du cœur (fig. 1) . L’échographie transthoracique avait alors mis en évidence une énorme masse échogène et homogène longeant le bord latéral de l’oreillette droite et du ventricule droit avec un plan de clivage par rapport à l’oreillette droite. Le scanner thoracique avait conclu à un volumineux kyste médiastinal antérieur étendu le long des étages supérieur, moyen et inférieur sur environ 20 centimètres refoulant et comprimant les cavités cardiaques droites et un deuxième kyste excavé intraparenchymateux lobaire supérieur au niveau du poumon gauche (fig. 2) . L’échographie abdominale pratiquée dans le cadre du bilan d’extension hydatique n’a pas retrouvé de localisation intra abdominale.