Case Reports in Vascular Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Transcatheter Coil Embolization of a Coronary Artery-Left Ventricular Fistula Associated with Single Coronary Artery Anomaly Mon, 10 Mar 2014 13:21:34 +0000 Single coronary artery anomaly associated with coronary fistula is a rare entity. Transcatheter coil embolization is the treatment of choice for coronary artery fistulas. In this case report, we describe a patient with both single coronary artery anomaly and coronary fistula who was successfully treated with coil embolization. Ozlem Ozcan Celebi, Alper Canbay, Erdem Diker, Barbaros Çil, Kudret Aytemir, and Ali Oto Copyright © 2014 Ozlem Ozcan Celebi et al. All rights reserved. Giant Idiopathic Pulmonary Artery Aneurysm: An Interesting Incidental Finding Sun, 09 Mar 2014 09:57:52 +0000 Idiopathic pulmonary artery aneurysm is a rare condition. This type of aneurysm can be presented with noncardiac symptoms or even asymptomatic. We report a 73-year-old man with a gigantic idiopathic pulmonary artery aneurysm which was referred to our unit for his kidney problems. During his workup we incidentally found the aneurysm by an abnormal chest-X ray and auscultation. Our further evaluations revealed a 9.8 cm aneurysm in transthoracic echocardiography. Afsoon Fazlinejad, Mohammad Vojdanparast, Reza Jafarzadeh Esfehani, Sahar Sadat Moosavi, and Parisa Jalali Copyright © 2014 Afsoon Fazlinejad et al. All rights reserved. Obstetric Considerations in a Rare Cardiovascular Catastrophe Needing Multidisciplinary Care Tue, 04 Mar 2014 14:00:27 +0000 Cardiovascular emergencies especially aortic dissections are rare in pregnancy. We report a case of Stanford Type A aortic dissection at 33 weeks of pregnancy presenting in shock. Rapid multidisciplinary approach and special obstetric considerations led to a successful outcome in this case. Neeta Singh, Debjyoti Karmakar, V. Devagorou, Rajnish Tiwari, and Sunesh Kumar Copyright © 2014 Neeta Singh et al. All rights reserved. Presence of Arteriovenous Communication between Left Testicular Vessels and Its Clinical Significance Tue, 04 Mar 2014 09:09:27 +0000 Maintenance of testicular temperature below body temperature is essential for the process of spermatogenesis. This process of thermoregulation is mainly achieved by testicular veins through pampiniform venous plexus of the testis by absorbing the heat conveyed by the testicular arteries. However, this mechanism of thermoregulation may be hampered if an abnormal communication exists between the testicular vessels. We report herewith a rare case of arteriovenous communication between testicular artery and testicular vein on left side. The calibre of the communicating vessel was almost similar to left testicular artery. Such abnormal communication may obstruct the flow of blood in the vein by causing impairment in the perfusion pressure with the eventual high risk of varicocele. Naveen Kumar, Ravindra Swamy, Jyothsna Patil, Anitha Guru, Ashwini Aithal, and Prakashchandra Shetty Copyright © 2014 Naveen Kumar et al. All rights reserved. Three Different Morphologies of Inferior Vena Cava Thrombosis: Case Reports Tue, 04 Mar 2014 07:44:37 +0000 Inferior vena cava (IVC) thrombosis is a rare but significant complication in hospitalized patients. However, relevant information regarding IVC thrombosis, especially on its morphology, remains scarce. We present three cases of IVC thrombosis, with each showing a different morphology: mural, floating, and small polyp-like thrombus. Satoshi Okayama, Yasuki Nakada, Shiro Uemura, and Yoshihiko Saito Copyright © 2014 Satoshi Okayama et al. All rights reserved. Hybrid Strategy for Residual Arch and Thoracic Aortic Dissection following Acute Type A Aortic Dissection Repair Wed, 19 Feb 2014 11:25:52 +0000 Progressive dilatation of the false lumen in the arch and descending aorta has been encountered in one-third of survivors as a late sequelae following repair of ascending aortic dissection. Conventional treatment for the same requiring cardiopulmonary bypass and deep hypothermic circulatory arrest is associated with high morbidity and mortality especially in the elderly cohort of patients. Herein we report a case of symptomatic progressive aneurysmal dilatation of residual arch and descending thoracic aortic dissection following repair of type A aortic dissection, successfully treated by total arch debranching and ascending aortic prosthesis to bicarotid and left subclavian bypass followed by staged retrograde aortic stent-graft deployment. This case report with relevant review of the literature highlights this clinical entity and the present evidence on its appropriate management strategies. Close surveillance is mandatory following surgical repair of type A aortic dissection and hybrid endovascular procedures seem to be the most dependable modality for salvage of patients detected to have progression of residual arch dissection. Sidharth Viswanathan, Vivek Agrawal, Shashidhar Kallappa Parameshwarappa, Ajay Savlania, Santhosh Kumar, and Unnikrishnan Madathipat Copyright © 2014 Sidharth Viswanathan et al. All rights reserved. Three Vessel Coronary Cameral Fistulae Associated with New Onset Atrial Fibrillation and Angina Pectoris Wed, 19 Feb 2014 08:10:31 +0000 Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient’s symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement. Murat Yuksel, Abdulkadir Yildiz, Mustafa Oylumlu, Nihat Polat, Halit Acet, and Necdet Ozaydogdu Copyright © 2014 Murat Yuksel et al. All rights reserved. Right Upper Lobe Partial Anomalous Pulmonary Venous Connection Sun, 16 Feb 2014 11:25:52 +0000 Partial anomalous pulmonary venous return (PAPVR) is a left-to-right shunt where one or more, but not all, pulmonary veins drain into a systemic vein or the right atrium. We report a case of a 45-year-old male with PAPVR to superior vena cava which was incidentally discovered during a right lower bilobectomy for lung cancer. Christos Tourmousoglou, Christina Kalogeropoulou, Efstratios Koletsis, Nikolaos Charoulis, Christos Prokakis, Panagiotis Alexopoulos, Emmanoil Margaritis, and Dimitrios Dougenis Copyright © 2014 Christos Tourmousoglou et al. All rights reserved. A Rare Variation in the Origin and Course of the Artery of Penis Wed, 12 Feb 2014 10:04:44 +0000 Vascular variations of the penis are very rare. Awareness of its variations is of utmost importance to the urologists and radiologist dealing with the reconstruction or transplants of penis, erectile dysfunctions, and priapism. We report an extremely rare variation of the artery of the penis and discuss its clinical importance. The artery of the penis arose from a common arterial trunk from the left internal iliac artery. The common trunk also gave origin to the obturator and inferior vesical arteries. The artery of the penis coursed forward in the pelvis above the pelvic diaphragm and divided into deep and dorsal arteries of the penis just below the pubic symphysis. The internal pudendal artery was small and supplied the anal canal and musculature of the perineum. It also gave an artery to the bulb of the penis. Satheesha B. Nayak, Naveen Kumar, Jyothsna Patil, Surekha D. Shetty, Srinivasa Rao Sirasanagandla, and Swamy Ravindra Copyright © 2014 Satheesha B. Nayak et al. All rights reserved. Persistent Sciatic Artery Aneurysm with Lower Limb Ischemia Mon, 10 Feb 2014 00:00:00 +0000 Persistent sciatic artery is a very rare clinical entity. Those of us who have not seen the lesion regard this as a condition which is described in the literature through less than 200 cases. We report, here, a case of a 60-year-old female who presented to the surgical outdoor with complaints of a pulsatile gluteal swelling associated with ischemic changes in the ipsilateral lower limb. On Doppler and CT angiographic analysis, the patient was determined as having persistent sciatic artery aneurysm which was then managed by a combined surgical and endovascular approach. Ours is probably the first such case to be reported from India. The objective of this case report is to highlight the relevant embryology, the pathognomonic presenting features, the diagnostic dilemma, management, and complications associated with a case of persistent sciatic artery (PSA). Gaurav Kesri, Jitendra Mangtani, Gaurav Kumar, and Krishan Kumar Dangayach Copyright © 2014 Gaurav Kesri et al. All rights reserved. Thoracic Endovascular Aortic Repair in a Patient with Mobile Aortic Thrombosis Thu, 06 Feb 2014 16:15:23 +0000 A 58-year-old female presented with acute arterial insufficiency to her left leg. Following cardiovascular evaluation using multimodality imaging, it was discovered that she had mobile thoracic thrombi overlying a normal descending thoracic aorta which had also caused a splenic infarction. This patient was treated with unfractionated heparin for three days and underwent subsequent thoracic endovascular aortic repair (TEVAR) uneventfully with no subsequent complications at one-year followup. This case highlights the diagnostic and therapeutic challenges in treating patients with this uncommon challenging clinical scenario. Graham M. Lohrmann and Ferande Peters Copyright © 2014 Graham M. Lohrmann and Ferande Peters. All rights reserved. Exercise Induced Left Bundle Branch Block Treated with Cardiac Rehabilitation: A Case Report and a Review of the Literature Thu, 06 Feb 2014 08:43:56 +0000 Exercise induced bundle branch block is a rare observation in exercise testing, accounting for 0.5 percent of exercise tests. The best treatment of this condition and its association with coronary disease remain unclear. We describe a case associated with normal coronary arteries which was successfully treated with exercise training. While this treatment has been used previously, our case has a longer followup than previously reported and demonstrates that the treatment is not durable in the absence of continued exercise. Nathan S. Anderson, Alexies Ramirez, Ahmad Slim, and Jamil Malik Copyright © 2014 Nathan S. Anderson et al. All rights reserved. Endovascular Repair of a Large Profunda Femoris Artery Pseudoaneurysm Wed, 05 Feb 2014 09:37:12 +0000 Profunda femoris artery aneurysms and pseudoaneurysms are a rare cause of peripheral arterial aneurysms but their risk of rupture is quite high. We have presented a case of a left lower leg pseudoaneurysm. We have shown that endovascular repair with angioplasty and stenting is a suitable treatment method for such a pseudoaneurysm. Due to the limited data on this disease, we suggest multi-institute collaboration to identify and standardize management for the treatment. Ahsan Syed Khalid, Omar M. Ghanem, and Seyed Mojtaba Gashti Copyright © 2014 Ahsan Syed Khalid et al. All rights reserved. Iatrogenic Injury of Profunda Femoris Artery Branches after Intertrochanteric Hip Screw Fixation for Intertrochanteric Femoral Fracture: A Case Report and Literature Review Wed, 05 Feb 2014 09:33:43 +0000 A case of arterial rupture of the profunda femoris arterial branches, following dynamic hip screw (DHS) fixation for an intertrochanteric femoral fracture, is presented. Bleeding is controlled by coil embolization, but, later on, the patient underwent orthopedic material removal due to an infection of a large femoral hematoma. Nikolaos Patelis, Andreas Koutsoumpelis, Konstantinos Papoutsis, George Kouvelos, Chrysovalantis Vergadis, Anastasios Mourikis, and Sotiris E. Georgopoulos Copyright © 2014 Nikolaos Patelis et al. All rights reserved. Intra-Aortic Balloon Pump Rupture and Entrapment Thu, 23 Jan 2014 12:24:20 +0000 Intra-aortic balloon pump is used frequently to support a failing myocardium in cardiac patients. Due to the invasive nature of this device, usage is accompanied by consistent risk of complications. Balloon rupture, although it occurs rarely, may lead to entrapment if diagnosis delays. A 78-year male who underwent cardiac surgery experienced balloon rupture and entrapment in the right femoral artery during the postoperative follow-up. Surgical extraction under local anesthesia was performed and the patient had an uneventful course. Fast and gentle solution of the problem is necessary to prevent further morbidity or mortality related to a retained balloon catheter in these delicate patients. Artan Jahollari, Atilla Sarac, and Ertugrul Ozal Copyright © 2014 Artan Jahollari et al. All rights reserved. Fatal Paraneoplastic Embolisms in Both Circulations in a Patient with Poorly Differentiated Neuroendocrine Tumour Mon, 30 Dec 2013 08:30:29 +0000 Arterial embolism with lower limb ischemia is a rare manifestation of paraneoplastic hypercoagulability in cancer patients. We report a unique case of fatal thromboembolism involving both circulations associated with a poorly differentiated neuroendocrine tumor of the lung with rapid progress despite high doses of unfractioned heparin and review the current literature on anticoagulative regimen in tumour patients. A. Busch, S. Tschernitz, A. Thurner, R. Kellersmann, and U. Lorenz Copyright © 2013 A. Busch et al. All rights reserved. Occult Bacteraemia and Aortic Graft Infection: A Wolf in Sheep’s Clothing Sun, 29 Dec 2013 13:47:39 +0000 We report a case of late-onset aortic prosthetic vascular graft infection. We stress the importance of maintaining a high index of suspicion for any patient presenting with fever on the background of in situ prosthetic material. We present the difficulties in managing these extremely complicated, often life and limb threatening infections and suggest that a multidisciplinary team approach, involving specialist centre referral, may be key to success. We highlight the difficulties in diagnosing late-onset PVGI, where presentation can be subacute with subtle signs and confusing microbiology. In this case the presentation was pyrexia of unknown origin with multiple positive blood cultures isolating a variety of gut-associated organisms; a wolf in sheep’s clothing. E. Trautt, S. Thomas, J. Ghosh, P. Newton, and A. Cockcroft Copyright © 2013 E. Trautt et al. All rights reserved. Anomalous Left Main Coronary Artery: Case Series of Different Courses and Literature Review Tue, 17 Dec 2013 16:46:37 +0000 Background. Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains the main focus of debate. Case Series. We present three cases, all presenting to our facility within one week’s time, of patients with newly discovered anomalous origination of the left coronary artery from the right sinus of Valsalva (L-ACAOS). All patients underwent cardiac computed tomography for evaluation of coronary anatomy along with other forms of functional testing. Despite the high risk nature of two of the anomalies, the patients are being treated medically without recurrence of symptoms. Summary. After review of the literature, we have found that the risk of sudden cardiac death in patients with congenital coronary anomalies, even among variants considered the highest risk, may be overestimated. In addition, the exact prevalence of coronary anomalies in the general population is currently underestimated. A national coronary artery anomaly registry based on cardiac computed tomography and invasive coronary angiography data would be helpful in advancing our understanding of these cardiac peculiarities. The true prevalence of congenital coronary anomalies and overall risk of sudden cardiac death in this population are not well known. Surgical intervention remains the mainstay of therapy in certain patients though recent investigations into the pathophysiology of these abnormalities have shown that the risk of surgery may outweigh the minimal reduction in risk of sudden cardiac death. Adam T. Marler, Jamil A. Malik, and Ahmad M. Slim Copyright © 2013 Adam T. Marler et al. All rights reserved. Rebleeding after Stent Grafting for the Celiac Artery Bleeding following Extended Pancreaticoduodenectomy Sun, 08 Dec 2013 15:29:06 +0000 We report a 74-year-old man with rebleeding following stent grafting for the celiac artery bleeding which developed after extended pancreaticoduodenectomy for cancers of the bile duct and stomach. The site of rebleeding seemed to be different from the site of the first bleeding, so it was considered not an endoleak but a new bleeding. It was successfully treated by placement of another stent graft. Kengo Ohta, Masashi Shimohira, Takuya Hashizume, Tatsuya Kawai, Masahiro Muto, Junichi Honda, and Yuta Shibamoto Copyright © 2013 Kengo Ohta et al. All rights reserved. Critical Limb Ischemia in a Young Man: Saddle Embolism or Unusual Presentation of Thromboangiitis Obliterans? Tue, 03 Dec 2013 19:10:43 +0000 Thromboangiitis obliterans (TAO), also known as Buerger’s disease, is a rare cause of peripheral arterial disease in western countries. Tobacco smoking is strongly correlated to the pathogenesis of this inflammatory vascular disease. We report the case of a 32-year-old tobacco and cannabis consumer presenting with right critical limb ischemia. Computerized tomography angiography revealed a bilateral tibioperoneal arterial occlusion and an aortoiliac saddle embolus. The patient was treated with intravenous heparin, transcatheter thrombolysis, and selective Fogarty embolectomy. Instrumental and laboratory examinations revealed that patient’s most likely diagnosis was TAO. Arterial embolism is uncommon in Buerger’s disease but should be always excluded in these patients. Federico Bucci, Adriano Redler, and Leslie Fiengo Copyright © 2013 Federico Bucci et al. All rights reserved. Pulmonary-Esophageal Variceal Bleeding: A Unique Presentation of Partial Cor Triatriatum Sinistrum Tue, 03 Dec 2013 13:17:18 +0000 Cor triatriatum sinistrum is a rare congenital disorder defined as a division of the left atrium by a diaphragmatic membrane resulting in two left atrial chambers. The membranous division of the atrium can be partial or complete and can affect either atrium, with involvement of the right atrium referred to as cor triatriatum dexter. The presence of fenestrations within the membrane allows for communication and forward passage of blood into the true atrium. Absence of fenestrations leads to early symptomatic engorgement of the lungs. We report the case of a young adult male presenting with recurrent hematemesis due to variceal bleeding. On CT imaging the patient was found to have cor triatriatum sinistrum, with a vertical membrane resulting in total obstruction of the pulmonary venous drainage on the right, with normal pulmonary venous drainage on the left. There was extensive pulmonary-systemic arterial collateralization to the right lung suggesting retrograde filling of the right pulmonary artery with effective flow reversal in the right lung. Fortune O. Alabi, Manuel Hernandez, Francis G. Christian, Fred Umeh, and Maximo Lama Copyright © 2013 Fortune O. Alabi et al. All rights reserved. Carotidynia Possibly due to Localized Vasculitis in a Patient with Latent Mycobacterium tuberculosis Infection Mon, 02 Dec 2013 09:37:39 +0000 Carotidynia is a syndrome characterized by tenderness of the carotid artery near the bifurcation due to numerous, heterogeneous causes. Here we reported the case of a 31-year-old Moroccan woman with right-sided neck pain and tenderness with irradiation to ipsilateral ear, eye, and occipital region. Clinical symptoms and imaging findings were suggestive of primary variant of carotidynia syndrome. In particular, color-Doppler ultrasonography revealed a concentric wall thickening of the distal common carotid artery, while thoracic magnetic resonance showed localized perivascular enhancement of the soft tissue in the right medial-distal common carotid artery in T1-weighted images, without intraluminal diameter variation. Moreover, careful clinicoserological and imaging investigations (cranial, cervical, and thoracic angiocomputed tomography and magnetic resonance) excluded well-known disorders potentially responsible for carotidynia syndrome. The patient was scarcely responsive to nonsteroidal anti-inflammatory drugs, but clinical symptoms resolved after three months. Of interest, the patient showed latent Mycobacterium tuberculosis infection (positive tuberculosis interferon-gamma release assay; QuantiFERON-TB Gold); this finding suggested a possible triggering role of mycobacterial antigens in the immune-mediated mechanism responsible for localized carotid injury. Giulia Cassone, Michele Colaci, Dilia Giuggioli, Andreina Manfredi, Marco Sebastiani, and Clodoveo Ferri Copyright © 2013 Giulia Cassone et al. All rights reserved. Internal Jugular Vein Phlebectasia Presenting with Hoarseness of Voice Thu, 28 Nov 2013 18:21:40 +0000 Internal jugular phlebectasia presents as a soft cystic mass in the neck that appears on straining. We present a case of a 7-year-old girl who presented with a painless soft cystic mass in the neck associated with hoarseness of voice. Based on clinical examination and CT image, diagnosis of right internal jugular phlebectasia was made. Sohini Chakraborty, Pranab Kumar Dey, Amrita Roy, Nilay Ranjan Bagchi, Debalina Sarkar, and Sumita Pal Copyright © 2013 Sohini Chakraborty et al. All rights reserved. A Giant Coronary Artery Aneurysm with Coronary Arteriovenous Fistula in Asymptomatic Elderly Patient Tue, 12 Nov 2013 16:04:16 +0000 Coronary Arteriovenous Fistula (CAF) is a rare defect that occurs in 0.1-0.2% of patients undergoing coronary angiography; Coronary Artery Aneurism (CAA) also occurs in approximately 15–19% of patients with CAF. It is usually congenital, but in rare occasions it occurs after chest trauma, cardiac surgery, or coronary interventions. The case described is that of a 72-year-old woman, without previous history of cardiovascular disease, who presented a huge cardiac mass. A multimodal approach was necessary to diagnose a giant CAA with CAF responsible for compression and displacement of cardiac structures. Due to likely congenitally origin of the lesion and the absence of symptoms correlated to the CAA and to the CAF we decided to avoid invasive interventions and to treat the patient with medical therapy. Caterina Milici, Daniella Bovelli, Valentino Borghetti, Georgette Khoury, Marco Bazzucchi, Massimo Principi, Marcello Dominici, and Enrico Boschetti Copyright © 2013 Caterina Milici et al. All rights reserved. Acute Thoracic Aortic Dissection (Stanford Type B) Complicated with Acute Renal Failure Tue, 12 Nov 2013 15:58:43 +0000 We report a recent case and review some literatures of acute aortic dissection (AAD) Stanford type B complicated with late onset of acute renal failure. The patient underwent preoperational peritoneal dialysis followed by thoracic endovascular aortic repair (TEVAR) and was fully recovered and discharged soon after surgery. We conclude that an AAD case is difficult to achieve a timely diagnosis, but with attention to systemic symptoms and dedication thorough treatment plan, a full recovery and positive prognosis are expected. Li Li, ShunJiu Zhuang, ShaoHong Qi, JiaSheng Cui, JunWen Zhou, Huaqi Zhu, Wan Zhang, Ming Li, and Weiguo Fu Copyright © 2013 Li Li et al. All rights reserved. Aortic Dissection Occurring 18 Months after Successful Endovascular Repair in an Anatomically Difficult Case of Abdominal Aortic Aneurysm Mon, 04 Nov 2013 13:41:03 +0000 We report an autopsy case of aneurysm dissection that occurred 18 months after the implantation of a Zenith stent graft. A 94-year-old woman, who had undergone an endovascular repair with postoperative reintervention, died of shock due to retroperitoneal hematoma. An autopsy indicated that the stent graft remained firmly fixed to the native aorta, whereas the dissection occurred near the proximal edge of the stent graft but not at the point of attachment between the suprarenal stent hook and the aorta. The luminal surface of the stent graft was almost completely covered with a transparent film with an endothelial cell lining, which might reflect the tissue regeneration observed on histological examination. This was a rare case of acute aortic dissection that occurred 18 months after EVAR, in which the autopsy indicated interesting microscopic findings and the mechanisms underlying the aortic dissection. We believe that aggressive reintervention at the proximal site in elderly women might cause the dissection of the native aorta. Satoshi Yamamoto, Katsuyuki Hoshina, Yutaka Takazawa, Hiroyuki Okamoto, Kunihiro Shigematsu, Tetsuro Miyata, and Toshiaki Watanabe Copyright © 2013 Satoshi Yamamoto et al. All rights reserved. Surgical Extirpation of Glomus Tumor from Rare Localization on the Upper Extremity Wed, 25 Sep 2013 08:47:30 +0000 Objective. To report on a very rare case of a glomus tumor manifested on the upper arm in a healthy young male patient. Case Presentation and Intervention. A 22-year-old male patient presented with bluish multifocal venous malformation on the left upper arm and was admitted for venous malformation excision. Pain, discomfort, and upper arm paraesthesia had been present for almost 6 years. Ultrasonography revealed septet tumor without blood flow in the subcutaneous region of anterior aspect of the upper arm. A multifocal venous malformation approximately 5–10 mm in diameter was excised. Histological examination showed dilated vascular area with proliferated glomus cells with round nucleus in the wall of dilated vascular structures. Based on histological examination, the final diagnosis was made as “glomangioma.” Conclusion. Histological examination is the only method that can establish final diagnosis. Currently, the only available treatment for this type of tumor is surgical excision. Jan Hrubý, Robert Novotný, Miroslav Špaček, Petr Mitáš, Jaroslav Hlubocký, David Janák, Ctibor Povýšil, and Jaroslav Lindner Copyright © 2013 Jan Hrubý et al. All rights reserved. Onyx Embolization of Ruptured Intracranial Aneurysm Associated with Behçet's Disease Tue, 24 Sep 2013 18:20:39 +0000 Introduction. Intracranial aneurysms associated with Behçet's disease (BD) are a rare occurrence. They are fragile, thin-walled pseudoaneurysms, which have high tendency to rupture and present a therapeutic challenge. Case Presentation. We report a 26-year-old male with BD presented with subarachnoid hemorrhage due to ruptured middle cerebral artery aneurysm. Additionally, two unruptured aneurysms were identified. He underwent endovascular embolization using Onyx with successful obliteration of the ruptured aneurysm. Medical therapy resulted in regression of one and resolution of the other aneurysms. Conclusion. We describe the first report of the application of Onyx for obliteration of ruptured cerebral aneurysm in BD as a feasible and safe therapeutic option for patients who are not candidates for other techniques. Maher Kurdi, Saleh Baeesa, Mohammed Bin-Mahfoodh, and Khalil Kurdi Copyright © 2013 Maher Kurdi et al. All rights reserved. A Giant Pseudoaneurysm of the Forearm as Unusual Complication of Bacterial Endocarditis Mon, 23 Sep 2013 11:55:43 +0000 A 59-year-old man with fever was diagnosed with endocarditis due to Streptococcus bovis. Two weeks after antibiotic therapy was started, he presented with red and painful swelling of the forearm without any sign of systemic inflammation. A giant hematoma connected to the radial artery was detected with ultrasound. Surgical intervention with the removal of multiple, sterile clots from the hematoma was performed, and the multiple lacerations of the artery detected were corrected. This is the first case reporting rupture of the radial artery as a complication of infective endocarditis. Michele Arcopinto, Teresa Russo, Antonio Ruvolo, Antonio Cittadini, Luigi Saccà, and Raffaele Napoli Copyright © 2013 Michele Arcopinto et al. All rights reserved. Percutaneous Embolization of Congenital Portosystemic Venous Fistula in an Infant with Down Syndrome Thu, 19 Sep 2013 16:54:40 +0000 Congenital intrahepatic portosystemic venous shunts are rare vascular malformations often associated with severe complications. We describe a term male infant with Down syndrome with high output heart failure secondary to a congenital arterial to portal venous fistula that was diagnosed by Doppler ultrasound. Percutaneous embolizations of the left hepatic vein, portal vein, and communicating fistulas were performed without complications, resulting in clinical improvement. A subsequent hepatic ultrasound demonstrated resolution of the pathologic fistulous communication and shunting effects. Pattaraporn Tanya Chun, Terrence Chun, Matthew Files, Nghia Vo, and Ryan M. McAdams Copyright © 2013 Pattaraporn Tanya Chun et al. All rights reserved.