[HSF] Image of the week _ Pediatric aortic aneurysm

[Nasser F. Abou'Seada]

Magnificent case Prasanna .... any further news as to the histology results
?

NFA

On 4/26/07, prasannasimha <prasannasimha at gmail.com> wrote:
>
> 6 year old 15 Kg child with h/o glomerulonephritis previously.
> Now has had multiple aneurysms -One large  infrarenal aneurysm which had
> pushed up left kidney and spleen . Multiple internal iliac aneurysms and
> one very small aneurysmal dilatation of right common iliac.
> I needed to approach the aneurysm  through a thoracoabdominal approach
> as looping the neck was going to be difficult due to the cephalad
> deviation of the kidney and spleen.
> I could place a 14 mm graft in the aneurysm . Since the inferior
> mesentric origin was near the neck, I managed to put it into the
> proximal anastomosis.
> I ligated the internal iliac and gel foam embolized it
> intraoperatively.(There was quite a lot of inflammatory fibrosis making
> dissection there a bit difficult). I left the minuscule right iliac
> aneurysm alone (in fact it was looking very insignificant  when I
> exposed it). I put the 14 mm graft though the neck was actually around
> 11 -12 mm as I thought that it would thus not be obstructive with growth
> and also enabled me to make a cuff of both the proximal aorta with the
> adjacent mesentric origin which was very close by.
> I have taken a lymph node biopsy and  aortic wall biopsy and also
> cultures swab of the aorta as well as a piece of the aortic wall for
> culture.
> The previous work up was supposed to have a low probability for
> Kawasaki's (though I was inclined towards this diagnosis)
> Any thoughts and ideas ? Any other additional work up could be suggested ?
> Prasanna
>
>
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC