Ruptured Thyrocervical Trunk Aneurysm in a Patient with Type I Neurofibromatosis

Abstract

Foam sclerotherapy is a recognised safe treatment modality for low flow vascular malformations. Complications are uncommon. We report the complication of vasospasm in a nineteen year old female with a low flow (venous) malformation of her thenar eminence, leading to dusky discolouration with pain, coolness, numbness and reduced power following foam injection. Treatment with intravenous vasodilators enabled full clinical recovery, preventing irreversible complications.

Ruptured left external carotid artery aneurysm presenting as upper airway obstruction in von Recklinghausen’s disease

“…The most common clinical presentation is renovascular hypertension associated with renal artery stenosis in the childhood [1] , [3] . The renal artery is the most frequently involved, but abdominal aortic coarctation, internal carotid artery aneurysms, and cervical vertebral arteriovenous malformations have also been described [1] , [4] . Spontaneous ruptures from subclavian, intercostal arteries, thyro-cervical, costo-cervical trunk, and peripheral arteries have been documented [2] , [4] , [5] , [8] , [9] , [10] .…”

“…An endovascular approach is possible using stent grafts or exclusion of the aneurysm with coils or glue; it is preferable in higher risk patients and in those with extension of the aneurysm to the distal cervical carotid artery, where operative exposure is judged to be difficult [1] , [7] . In some instances a combination of open surgical and endovascular methods are indicated [4] . The choice of conduit is somewhat controversial because of the potential risk of aneurysmal degeneration with vein grafts in younger patients and the risk of complications with an endovascular approach.…”

“…Vascular abnormalities affect medium- and large-sized vessels and are recognized manifestations of NF-I [1] . Stenotic lesions predominate, while aneurysms are less common [4] , [5] . The renal artery is the most frequent site of involvement [1] , [3] .…”

An unusual cause of a mediastinal mass

“…These aneurysms usually present as incidental findings or as complications secondary to rupture or bleeding. Thus, so far there have been two case reports of thyrocervical artery aneurysm rupture associated with neurofibromatosis causing spontaneous haemothorax 4 5. Current management options include conservative management, coil embolisation and open surgery.…”