Archive for the ‘Subclavian Artery’ Category


Diverse Presentation of Aberrant Origin of the Right Subclavian Artery: DiscussionIn this article, we present two complications of aberrant origin of the right subclavian artery that were seen in our institution within a 2-month period. The first case represented a difficult diagnostic dilemma; only after repeated presentation was the diagnosis of endarteritis made. Pericarditis, endocarditis, and acute aortic dissection were considered because of the rapid progression of symptoms, and the first case represents the only report of pericarditis occurring in relation to an aberrant right subclavian artery. Transesophageal echocardiography was an important initial step in evaluation of this patient as it showed diffuse soft tissue and vascular irregularities in the area of the origin of the aberrant right subclavian artery. Hemolytic streptococcal endarteritis is very rare in the modern era and appears to have arisen as a consequence of turbulent blood flow associated with the vascular anomaly in this case. The second case posed more therapeutic uncertainty, in a patient with a number of medical complaints not clearly attributable to the aberrant right subclavian artery. Reports of aortic arch anomalies in association with aberrancy of the right subclavian artery are found in only the pediatric literature, and treatment usually consisted of surgical correction at an early age. In this adult case, coexistent pulmonary hypertension and an atrial septal defect further complicated the therapeutic decisions. canadian-familypharmacy.com
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  • The patient was treated widi oxygen to improve her pulmonary hypertension; her systemic hypertension was controlled with an angiotensin-converting enzyme inhibitor. It was suggested that she consider moving to a lower altitude in die hope of decreasing her pulmonaiy vascular resistance. Altiiough it was thought that the patient would likely require aortic valve replacement in the future, it was unclear if correction of her other vascular abnormalities would be warranted. The presence of an aberrant origin of her right subclavian artery was probably unrelated to her pulmonary symptoms; it was unclear whether repair of die anomaly would be of benefit either in terms of improvement of symptoms or in survival benefit. Prophylaxis for subacute bacterial endocarditis, as indicated for her aortic valvular disease, was prescribed. (more…)

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  • Diverse Presentation of Aberrant Origin of the Right Subclavian Artery: Case 2The patient was taken to the operating room where findings included the aberrant subclavian artery, purulence at the level of the aneurysm, and dense inflammation of the periaortic tissue. The aberrant artery was ligated and the aortic arch repaired with a Hemashield graft (Meadox Medical; Oakland, NJ). Microscopic examination of the resected artery showed Gram-positive cocci in chains, as well as numerous polymorphonuclear WBCs. A subsequent culture showed S pyogenes. The patient remained stable for the first several days but was noted to have decreased urine output on the 5th postoperative day. He subsequently experienced an acute deterioration of his neurological function and developed fixed, dilated pupils. A CT scan of the head showed diffuse anoxic brain injury, obstructive hydrocephalus secondary to cerebellar infarct, and transverse sinus thrombosis. The diagnosis of brain death was confirmed and, in consultation with the patient’s family, further care was discontinued. The patient died on the 8th postoperative day. tadanafil
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  • The patient returned to the emergency department 1 week later noting return of his back pain and mild general fatigue. His temperature was elevated to 38.1°C and the WBC count was elevated at 19,600/μL. Because of the patient’s elevated temperature and leukocytosis, blood cultures were obtained. The patient was released from the emergency department at his request, after obtaining relief of the pain with intramuscular injection of ketorolac, 30 mg. (more…)

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  • Diverse Presentation of Aberrant Origin of the Right Subclavian ArteryTwo Case Reports
    An aberrant origin of the right subclavian artery occurs in approximately 1% of the population and is the most common congenital anomaly of the aortic arch. In these patients, the aberrant right subclavian artery most frequently arises from a point distal to the left subclavian artery and passes behind the esophagus to the right arm. Rarely, it will pass between the esophagus and the trachea. Because of its proximity to the esophagus, dysphagia is the most common symptom in affected patients, although it only comprises 37.5% of the presenting complaints. Other complaints include chest pain, coughing, and right arm discomfort. (more…)

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