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Rupture of the central veins with venous pseudoaneurysm formation is an unusual complication of central venous catheterization. Only seven cases of brachiocephalic venous pseudoaneurysm have been reported in the literature (among these only one was secondary to central venous catheterization). Plain radiographic examination of the chest may show widening of the mediastinum, pleural effusion (haemothorax), and/or opacity overlying the hemithorax of the injured vein. Further evaluation using either computed tomography or magnetic resonance imaging can be performed. Venography is considered an important tool, especially when an intervention is planned. We present the first reported case of brachiocephalic vein pseudoaneurysm treated solely with thrombin injection. The imaging, other treatment options, and literature review of brachiocephalic venous pseudoaneurysm are also discussed.

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Original article can be found at : http://pmj.bmj.com/ Copyright BMJ Publishing Group [Full text of this article is not available in the UHRA]A male smoker in his 60s with hypertension and hyperlipidaemia presented with progressive swelling of his left leg, abdominal discomfort and oliguria. He was obese and had an extensive left deep vein thrombosis (DVT) clinically. Blood tests revealed acute renal failure, and the clinical suspicion was of a urological malignancy causing an obstructive nephropathy and DVT. A CT scan showed a large (9.5??9.8 cm) infra-renal abdominal aortic aneurysm, which had a fistulous connection to the left common iliac vein (fig 1). Retrograde filling of the venous system and obstruction to venous return led to engorgement of the left leg, mimicking a DVT (fig 2). The renal arteries were patent, but contrast was also seen filling the renal veins with no cortical renal enhancement, suggesting retrograde high-pressure flow, with obstruction to venous return and consequent venous infarction, as a mechanism for acute renal failure. The patient rapidly deteriorated, developed multiorgan failure, and died before emergency surgery

established. Method(s): Retrospective review of all post sleeve gastrectomy leak collection CT guided percutaneous drainage from February 2011-September 2018 done in our institution. our institution is well known center of excellent for post sleeve gastrectomy leak management. Result(s): 53 patients underwent CT guided percutaneous drainage for post sleeve gastrectomy leak collection (23 females and 30 males; average 33.8 range 18-65). All procedures were done using CT guidance and Seldinger technique. Drains size range from 10-14 Fr. Technical and clinical success was 100 %. 1 patient had bleeding complication that was treated by embolization. 10 patients need drain change or adjustment. No patient underwent surgery for collection management. indwelling drain time average of 70 days. All patient underwent endoluminal stent placement. Conclusion(s): CT guided percutaneous drainage of post sleeve gastrectomy leak is safe and effective treatment.