Introduction The Kasabach-Merritt phenomenon (KMP) is a severe complication of kaposiform hemangioendothelioma (KHE). The risk factors for KMP need further investigation. Methods The medical records of patients with KHE were reviewed. Univariate and multivariate logistic regression models were used for the risk factors for KMP, and the area under the receiver operator characteristic (ROC) curve was used to assess the predictive power of risk factors. Results Three hundred thirty-eight patients with KHE were enrolled. The incidence of KMP was 45.9%. Age of onset (P < 0.001, odds ratio [OR] 0.939; 95% confidence interval [CI] 0.914–0.966), lesion size (P < 0.001, OR 1.944; 95% CI 1.646–2.296), mixed type (P = 0.030, OR 2.428; 95% CI 1.092–5.397), deep type (P = 0.010, OR 4.006; 95% CI 1.389–11.556), and mediastinal or retroperitoneal lesion location (P = 0.019, OR 11.864; 95% CI 1.497–94.003) were correlated with KMP occurrence through multivariate logistic regression. ROC curve analysis revealed that the optimal cutoffs were 4.75 months for the age of onset (P < 0.001, OR 7.206, 95% CI 4.073–12.749) and a lesion diameter of 5.35 cm (P < 0.001, OR 11.817, 95% CI 7.084–19.714). Bounded by a lesion size of 5.35 cm, we found significant differences in tumor morphology, age of onset, treatments and hematological parameters. Using an onset age of 4.75 months as a cutoff, we found significant differences in tumor morphology, lesion size, hematological parameters and prognosis. Conclusion For KHE patients with an onset age < 4.75 months and/or lesion diameter > 5.35 cm, clinicians should be wary of the occurrence of KMP. Active management is recommended to improve the prognosis.

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Cystic adventitial disease (CAD) is a rare vascular disorder predominantly seen in adults without cardiovascular risk factors. We report a case of CAD involving the common femoral vein in a 38-year-old female presented with right lower extremity swelling that was initially misdiagnosed as deep vein thrombosis (DVT). A computed tomography revealed a cystic structure that compressed the right common femoral vein with resultant severe stenosis of the vascular lumen. Complete evacuation of the cyst with excision of the cyst wall was performed, and the patient remained symptom-free at 3 year follow-up. This case highlighted that the rare venous CAD should be incorporated in the differential diagnosis of unilateral lower extremity swelling suspicious for a DVT. Complete evacuation and surgical excision of the cyst often conferred favorable clinical outcome.

Pleural mesothelioma (PM) with pericardial involvement is extremely rare. We now report a rare case of malignant PM with constrictive pericarditis as the first presentation. A 59-year-old male diagnosed with constrictive pericarditis underwent pericardiectomy and pericardial pathology revealed mesothelial hyperplasia. Eight months after surgery, the patient was admitted to the hospital with chest tightness and wheezing for 5 days. Computed tomography scan of the chest showed a left lung expansion insufficiency, limited bilateral pleural thickening, pericardial thickening with a small amount of pericardial effusion, and multiple enlarged lymph nodes in the mediastinum, bilateral supraclavicular fossa, bilateral cervical roots, and right axilla. The pleural malignancy should be possibly considered. Pathology after pleural puncture showed malignant PM. Pathology after left supraclavicular lymph node puncture biopsy showed metastatic malignant mesothelioma. The diagnosis of this patient was clear. Although malignant PM rarely involves the pericardial constriction, we cannot ignore the fact that malignant PM involves the pericardium. The patient has been diagnosed with constrictive pericarditis, accompanied by pleural thickening and pleural effusion. Without other pathogenic factors, pleural biopsy should be aggressively performed in patients with constrictive pericarditis to determine the cause. K E Y W O R D S constrictive pericarditis, malignant pleural mesothelioma, pericardium How to cite this article: He C-P, Tu D-W, Zhang T-W, et al. Malignant pleural mesothelioma with constrictive pericarditis as the first manifestation: A case report.

Purpose: To evaluate the efficacy and safety of selective aneurysmal sac neck-targeted embolization in patients undergoing endovascular aneurysm repair (EVAR) with hostile neck anatomy. Materials and Methods: We enrolled 28 patients with hostile neck anatomy who underwent EVAR with a low-profile stent graft between October 2020 and June 2022. Before excluding the entire aneurysm during the procedure, a buddy wire was loaded prophylactically into the sac through the contralateral limb side. When type Ia endoleak persist despite adjunctive treatment, this preloaded wire could be utilized as an access to enable a catheter to reach the space between the stent graft and sac neck to perform coil embolization. In the absence of type Ia endoleak, the wire was simply retracted. The primary outcome of this study was freedom from sac expansion and endoleak-related reinterventions during the follow-up period; secondary outcomes included technical success, intraoperative and in-hospital postoperative complications. Results: Out of the 28 patients with hostile neck morphology, 11 of them (39.5%) who had type Ia endoleak received intra-procedure treatment with sac neck-targeted detachable coil embolization. The preloaded wire was removed from 17 patients (60.7%) who did not show type Ia endoleak. The coiling group had longer operating durations (81.27±11.61 vs. 70.71±7.17 minutes, P<0.01) and utilized more contrast than the non-coiling group (177.45±52.41 vs. 108.24±17.49 ml, p<0.01). In the entire cohort, technical success was 100% and there were no procedure-related complications. At a mean follow-up of 18.6±5.2 months (range 12-31), there was no sac expansion(19 sac regression, 67.86%; 9 stability, 32.14% ) and endoleak-related reintervention. Conclusions: Selective aneurysmal sac neck-targeted embolization for the treatment of type Ia endoleak in patients with hostile neck anatomy undergoing EVAR is safe and could reduce type Ia endoleak and prevent related sac expansion after EVAR.