Vincent J. D'Souza

A persistent fifth aortic arch in man: A double-lumen aortic arch (presentation of a new case and review of the literature)

SummaryPersistent fifth aortic arch manifested as a double-lumen aortic arch (DLAA) is a rare anomaly. We present such a case with transposition of the great arteries, ventricular septal defect (VSD), and pulmonary atresia. Review of the eight previously published cases indicates relatively frequent association of DLAA with preductal coarctation of the aorta. We attempt to explain the coexistence of this lesion with DLAA. We also discuss evidence supporting derivation of the inferior channel of the DLAA from the embryologic fifth aortic arch.

Phaeochromocytoma and cardiomyopathy

Phaeochromocytoma is a rare endocrine tumour. There are several reports dealing with isolated complications due to the systemic effects of its metabolites. We would like to report a patient seen at our institution with a right adrenal phaeochromocytoma who had many associated complications: cardiomyopathy with congestive heart failure, intracavitary left ventricular thrombus, invasion of the inferior vena cava and peripheral vascular embolus. A discussion of the findings and review of the literature is presented stressing the fact that cardiomyopathy may be the initial presentation in these patients, a situation not reported in the radiological literature. A 23-year-old man was admitted to the hospital with a history of fever, chills, night sweats, anorexia, arthralgias and a 10 lb weight loss over a period of two weeks. He also had right pleuritic pain, a productive cough and occasional haemoptysis. He had a history of gastrectomy at the age of 13 for peptic ulcer disease, and crossed fused ectopia with ...

Mirror-image right aortic arch: A proposed mechanism in symptomatic vascular ring

We describe a rare case of right aortic arch with mirror-image branching and a left ductus arteriosus that form an anomalous vascular ring. The unusual feature of this symptomatic vascular ring is presence of a left (posterior) circumflex descending aorta in lieu of an aortic diverticulum which usually represents the posterior element of the vascular ring associated with right aortic arch and mirror-image branching. This we believe is the seventh reported case of Type 1 right aortic arch and only the third such case with a left circumflex descending aorta. Accurate diagnosis was made by barium esophagogram and angiocardiogram and was confirmed surgically. We propose a new theory as to why some vascular rings formed by the right aortic arch are symptomatic while others are not.

Combined Radiological and Surgical Management of Arteriovenous Malformation of the Lung

Multiple, bilateral arteriovenous malformations (AVMs) of the lung are diagnostically and therapeutically challenging. In staged procedures over seven days, a 19-year-old woman underwent blocking of the feeding artery to six moderate-sized AVMs in the left lower lobe, embolization of three more AVMs in the left lower lobe, and resection of a large AVM in the right lower lobe through a right-sided thoracotomy. These procedures preserved maximal lung tissue, and one year later the patient is essentially symptom free.

Nonsurgical treatment of childhood hypertension: Embolization of an intrarenal aneurysm

Renal artery aneurysms are an unusual cause of renovascular hypertension in children. When present in an intrarenal location, they pose a difficult surgical problem and transcatheter embolization may represent an effective alternative treatment.

Focal nodular hyperplasia of the liver imaging by differing modalities.

The logistic approach in diagnosis of focal nodular hyperplasia (FNH) of the liver is discussed, based on the experience with three children. In only one child could the diagnosis be made without angiography. In that child the combination of hypervascularity on the radionuclide angiogram and uptake of the radiocolloid by Kupffer cells was sufficient for the diagnosis of FNH. If the radionuclide scintigraphy is inconclusive, angiography has to be done to show the typical features of FNH, seen in all three patients. Only if scintigraphy and angiography are not able to differentiate FNH from hepatic adenoma, biopsy or exploratory laparotomy is indicated as a final diagnostic procedure. Ultrasonography or computerized tomography is of value only in screening for hepatic mass lesions.

The use of the bristle brush for transcatheter embolization.

Small nylon brushes with a stainless steel core have been found safe and effective for transcatheter arterial occlusion. Studies performed in 14 dogs demonstrate the brushes result in rapid occlusion of the renal artery. Follow-up studies for periods up to ten months document the safety and permanence of the occlusion. The animal studies reported herein suggest that these devices can be safely used in humans in cases where large artery occlusion is desired.

Anomalous Origin of Coronary Artery in Association with Aorticopulmonary Window

Aorticopulmonary window associated with anomalous origin of coronary arteries is rare; only 12 cases have been reported previously. Origin of coronary arteries from the communicating bridge is rare, having occurred in only five of these cases. We describe two additional cases of this entity, in one of which the right coronary artery arose from the window proper. We also review the previously reported cases.

Correlation Between Intracoronary 201TI Myocardial Scanning, Coronary Angiography and Left Ventriculography

One hundred and six patients with angina pectoris who underwent routine coronary angiography and left ventriculography were given intracoronary injection of thallium 201. The myocardial images had excellent resolution because of lack of interference from the background activity. The myocardial images and the left ventriculograms showed 94% correlation. Correlation between scans and EKG was lower. There was no correlation between the degree of coronary artery stenosis and 201Tl scan. Currently, the intracoronary injection of 201Tl at rest does not yield additional information to coronary angiography and left ventriculography.

Calcified thrombus of the inferior vena cava in transposition of the great vessels

Calcified thrombus of the inferior vena cava (IVC) in children is an entity usually not associated with significant complications. The possibility of pulmonary embolism from the soft thrombus, however, has been suggested but never reported. We give an account of a child with transposition of the great vessels who suffered embolization from a calcified thrombus in the IVC that entered the systemic circulation.