Browsing by Author "Figueiredo, Adriana"
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- A Giant Arteriovenous Malformation of the Abdominal WallPublication . Figueiredo, Adriana; Gueifão, Inês; Fidalgo, Helena; Tavares, Carolina; Amaral, Carlos; Ferreira, Rita; Borges, Nuno; Ferreira, Maria EmiliaINTRODUCTION: Arteriovenous Malformations (AVMs) are high-fow anomalous connections between the arterial and venous systems composed of dysplastic vessels resulting from aberrant angiogenesis. They are congenital and when symptomatic they rarely manifest before adolescence. Depending on the location, size, stage and severity of the symptoms, treatment options vary from conservative management to surgical resection. We report a case of a giant arteriovenous malformation of abdominal wall (tipe IIIb of Yakes Classifcation) treated with surgical resection after prior attempts of scleroembolization.. CLINICAL CASE: 54-year-old woman with known history of osteoarticular pathology and dyspepsia presented a mass on the left side of the abdominal wall with hard consistency, warm, slightly pulsating and tenderness to touch with several years of evolution. The mass showed infltration of the internal and external oblique muscles sparing the transverse muscle. Clinically she presented easy fatigue with efforts. Due to the risk of abdominal wall herniation after excision of the AVM, scleroembolization was considered frst-line treatment in this case. This strategy resulted in regression of the mass and symptoms improvement. Four years after the last intervention, the patient presented lesion growth, recurrence and worsening of symptoms with severe interference in the quality of life (QoL). After multidisciplinary discussion, she was proposed for complete resection of the AVM. She was frst submitted to scleroembolization with Onyx of identifed arterial afferents and sclerosis of the lesion nidus with 2% polidocanol. One month after she underwent successfully total resection of the AVM with the collaboration of General Surgery. CONCLUSION: No unifed agreement exists on the best treatment of these complex high fow lesions and it is diffcult to establish a comprehensive strategy given the pathology’s clinical variability, complex stratifcation and the risk of relapse. A case-by-case approach is needed in managing these types of lesions.
- Mycotic Aneurysm in an Immunocompromised Patient with Pneumonia and Spondylodiscitis: Who’s Guilty?Publication . Figueiredo, Adriana; Fidalgo, Helena; Tavares, Carolina; Gueifão, Inês; Gonçalves, Daniela; Alves, Gonçalo; Camacho, Nelson; Ferreira, Maria EmiliaBACKGROUND: Mycotic aneurysm is a rare entity with rapid progression, which can be fatal without adequate treatment. The incidence of rupture is greater than that of degenerative aneurysms and is associated with a high mortality rate. CASE REPORT: We report the case of a 58-year-old man with a known history of HIV infection with good immunovirological staging, treated squamous cell carcinoma of the anal canal and chronic gastritis, who presented with a six-day history of intense back pain, malaise, fever, and chills. After examination, he was hospitalized with a clinical suspicion of acute pyelonephritis. During hospitalization, he was diagnosed with pneumonia of the right pulmonary base, infectious spondylodiscitis, and mycotic aneurysm of the abdominal aorta, which involved the visceral plaque. The microbiological workup revealed only positive blood cultures for Klebsiella pneumoniae. After a multidisciplinary discussion of the case and six weeks of antibiogram-oriented antibiotic therapy, the patient underwent an aorto-aortic interposition via left thoracophrenolaparotomy without the need to reimplant visceral vessels due to the patch confguration of the proximal anastomosis. The procedure was performed under left heart bypass. The postoperative course was uneventful, and the patient was discharged four weeks later. At 18 months follow-up, she remained asymptomatic and free of recurrence. CONCLUSION: In this case, it remains to be defned whether the cause of the mycotic aneurysm was hematogenous dissemination from the identifed pneumonia or contiguity from the diagnosed spondylodiscitis. Given the morbidity and mortality associated with this entity, early diagnosis and adequate treatment with surgical correction and antibiotic therapy with suffcient duration and dose are important aspects for improving survival in these cases.