Two cases of ruptured mycotic aneurysms in intravenous drug abusers are presented. The pathogenesis, clinical presentation, radiological diagnosis, and management of mycotic aneurysms are discussed. Early diagnosis and therapy are required to salvage these patients.

Leg ulcers are a well recognized complication of sickle cell disease that has been attributed to venous insufficiency. We studied 16 patients with sickle cell disease and active ulcers using venous pulse volume recordings and photoplethysmography (Doppler studies). Based on hemodynamic monitoring, all 16 patients exhibited rapid refilling times, findings that imply venous insufficiency but are also compatible with high-output syndrome or arteriovenous shunting. Direct invasive venous pressure measurements of these patients demonstrated normal pressures in all of the four patients tested. A different set of four patients underwent venography, which also failed to demonstrate venous incompetence. We hypothesize that anemia results in an increase in peripheral arteriovenous shunting in the extremities and that this, together with the high-output syndrome of sickle cell disease, produces plethysmography readings that may be confused with findings observed in venous insufficiency. We conclude that measurements of vascular stasis, as recorded by plethysmography, are usually misinterpreted in sickle cell disease. Normal manometric pressure readings and normal venographic studies suggest that venous insufficiency is not a primary factor in sickle cell leg ulcer formation.

Of the patients with penetrating neck wounds treated between 1979 and 1986, 61 patients with 65 injuries had arteriography during their evaluation. Twenty-seven patients had stab wounds and 34 had gunshot wounds, with a relatively equal distribution between the zones of injury. Fifty-seven arteriograms were normal and six were abnormal. Of the six arteriographic defects, three were thought to be spurious on subsequent review, two were clinically insignificant, and one required surgery. No significant arterial injuries were identified by arteriography in the absence of suggestive physical findings. No major arterial injuries were discovered during neck surgery that were missed preoperatively. Neither abnormal nor normal angiograms significantly altered the course of management, including the approach to neck exploration. These data suggest that arteriography for penetrating neck trauma is usually unnecessary for observation of patients in stable condition without suggestive physical findings. Thorough neck exploration with dissection of the carotid sheath in patients with physical diagnostic criteria for surgery eliminates the need for angiography in most cases and avoids the consequences of a possible false-negative study.

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This case report illustrates the angiographic demonstration of a hemopericardium in aortic dissection. A dense collection of contrast and/or a "halo" sign may be seen in the pericardial cavity.