We report a rare 16-year-old male case of Klippel-Feil anomaly associated with fetal alcohol syndrome exhibiting complex congenital vascular anomalies. The congenital vascular anomalies observed were the absence of a left internal carotid artery, a left vertebral artery arising from the subclavian artery in a very high cervical location and a bovine arch. The vascular and vertebral anomalies were evaluated using CT and MRI before cervical surgery.

Peripheral arteriovenous malformations (AVMs) are rare vascular anomalies characterized by abnormal connections between arteries and veins that bypass the capillary system. This case report details a three-year-old female child who presented with an enlarging swelling on her knee\'s medial side. AVM was diagnosed using computed tomography (CT) angiography and surgically excised. The case highlights the importance of early detection and timely intervention of AVMs to prevent complications.

Follow-up examinations using magnetic resonance imaging or digital subtraction angiography are mandatory after flow diverter treatment of cerebral aneurysms. However, flow diverter features metal artifacts on magnetic resonance imaging and ischemic complications with digital subtraction angiography. Ultra-high-resolution computed tomography systems have recently become available in clinical practice. The combined use of ultra-high-resolution computed tomography and a reconstruction technique called model-based iterative reconstruction is expected to replace follow-up magnetic resonance imaging and digital subtraction angiography of flow diverter placement. Here, we report a case of ultra-high-resolution computed tomography with model-based iterative reconstruction after flow diverter treatment.

A rare and locally aggressive vascular tumor, juvenile nasopharyngeal angiofibroma (JNA) mostly affects male teenagers. This paper describes a 14-year-old male patient who presented with lethargy and recurrent nasal bleeding, which are symptoms of JNA. CT and MRI scans confirmed a vascular mass with a significant local invasion originating from the sphenopalatine foramen. After a CT angiography, which revealed the tumor\'s large blood supply and helped with efficient excision, a focused surgical strategy was designed. Histopathology verified the benign nature of the tumor, and the operation was successful and the patient had a smooth recovery. This case adds to the little literature on JNA. It highlights the need for healthcare professionals to be aware of the requirement of early identification and careful presurgical preparation in managing the illness.

Coronary arteriovenous fistulas (CAVFs) are congenital or acquired communications between the coronary arteries and coronary venous system, and they can also include other cardiac structures or vasculature. We discuss a case of a large fistula between the left main coronary artery and the right atrium in a geriatric patient with a history of gastrointestinal arteriovenous malformations (AVM). The occurrence of CAVFs, an uncommon cardiac irregularity, is particularly infrequent among older adults. Typically, it is discovered by chance when investigating symptoms such as shortness of breath or chest pain, where coronary angiography is necessary to determine the most effective treatment strategy. This case highlights the possible utility of evaluating CAVFs in patients with a history of gastrointestinal AVM who similarly present with clinical symptoms of high-output heart failure. Once identified, this could simplify the treatment approach and improve communication between healthcare providers to minimize the risk of harm to the patient.

BACKGROUND: Pulmonary arteriovenous malformation (PAVM), also known as pulmonary arteriovenous fistula, is a rare vascular developmental anomaly. Most cases of PAVM are associated with hereditary hemorrhagic telangiectasia (HHT). Hemothorax associated with PAVM is even rarer, and management concerning this complication still challenges.
METHODS: A 55-year-old man with sudden onset of dyspnea and chest pain was admitted to our hospital. He had a medical history of epistaxis, intraperitoneal germ cell tumor and PAVM. Chest unenhanced CT revealed the left-sided pleural effusion together with partial passive atelectasis and gradual increase at the interval of six days. Diagnostic thoracocentesis further revealed hemorrhagic effusion. CT angiography (CTA) showed tortuously dilated lumen of the left lower pulmonary artery and PAVM with the formation of aneurysm. Due to his family\'s refusal of surgery, the patient underwent transcatheter embolization therapy. However, the left pleural effusion did not significantly reduce and there was a slow drop in hemoglobin value even after interventional treatment, indicating the possibility of ongoing active bleeding. Eventually, the patient received lobectomy of the left lower lobe with a satisfactory outcome.
CONCLUSIONS: Massive hemothorax resulting from PAVM rupture into the pleural space can lead to fatal outcomes. CTA can accurately diagnose this pathologic condition. Transcatheter embolization is frequently used in the treatment of PAVM, but it may be challenging to achieve the desirable effect in patients with hemothorax. Combined with our case and literature review, direct radical surgery can lead to a successful outcome when PAVM complicated with hemothorax and a large diameter of the draining vein.

A coronary artery fistula (CAF) is an abnormal, direct connection between the coronary arteries and cardiac chambers, systemic circulation, or pulmonary circulation without an intervening capillary network. We report a case of a CAF observed in an elderly female. Congenital CAFs are indeed relatively rare, with an incidence of 0.002% to 0.3% in the general population. Over the past few decades, coronary angiography and multi-detector computed tomography have become more widely available, leading to an increased detection of asymptomatic patients with CAFs. By accurately characterizing the CAF\'s anatomy and understanding the risk factors for complications, clinicians can make more informed decisions about the most appropriate treatment strategy.

A 55-year-old man developed ischemic stroke in the bilateral cerebellar hemispheres and bilateral occipital lobes. He was admitted to our hospital 17 months later with recurrent ischemic stroke in the posterior circulation. The left vertebral artery (VA) was occluded on brain magnetic resonance angiography but was visualized with a delay on continuous three-phase CT angiography (CTA). Conventional angiography confirmed a to-and-fro blood flow pattern at the distal end of the left VA, therefore the patient was diagnosed with VA stump syndrome (VASS). VASS is a recurrent posterior circulation ischemic stroke caused by thrombi in an occluded unilateral VA. VASS should be suspected in patients with unilateral VA occlusion and repeated posterior-circulation ischemic stroke. The diagnostic criteria for VASS include confirmation of VA occlusion and the presence of an antegrade flow component at the distal end. In this case, the presence of collateral circulation in the VA was suspected based on CTA findings, leading to the diagnosis of VASS. It was thus suggested that devising the imaging method of CTA may help diagnose VASS.

Middle aortic syndrome (MAS), an uncommon cause of secondary hypertension, is defined by obstructive narrowing of the abdominal aorta and ostia of its major branches like the renal and splanchnic arteries. Most of the cases of MAS are categorized as idiopathic; however, genetic disorders like Williams syndrome, mucopolysaccharidosis, neurofibromatosis type 1 (NF1), and Alagille syndrome, and acquired inflammatory diseases such as Takayasu arteritis and other nonspecific arteritis can also lead to MAS. MAS is commonly seen in children and young adults presenting with severe hypertension, congestive heart failure, renal failure, or severe leg claudication. The diagnosis of MAS on CT, MR, and conventional angiography is fairly straightforward. However, the spectrum of sonographic findings in MAS can be varied. Since ultrasound is frequently utilized as a first-line investigation for secondary causes of hypertension, it is especially crucial to understand the sonographic features of MAS. Here, we report a case of a young female who presented to our hospital with severe hypertension. On the Renal Doppler scan, the only clue of the renovascular etiology of her secondary hypertension was the \"tardus-parvus waveform\'\' in the intrarenal arteries.

Locoregional flap options for reconstructing defects of the anterolateral distal thigh/knee region are limited. The distal profunda artery perforator island (PAPI) flap is a local fasciocutaneous propeller-type flap that utilizes the most distal perforator of the profunda femoris artery. The aim of this study is to conduct a CT-based angiographic analysis of the perforator system of the profunda femoris artery and present outcomes on the application of the PAPI flap in the management of post-oncologic defects of the distal thigh and knee.
CT angiograms were utilized on the lower limbs of 25 healthy patients (mean age, 57 years; 76% male) and the number and location of septocutaneous perforators with a diameter greater than 1 mm were measured. A case series of patients undergoing reconstruction of post-ablative defects which involved the anterolateral and posterior knee performed by the senior author were reviewed.
CT angiography demonstrated a robust collection (mean 3.5, range 2 to 5) of septocutaneous perforators from the profunda femoris artery with the most distal perforator located 3.3 cm from the superior patella border. The PAPI flap was successfully used in 10 patients (6F; 4M; mean age 60.6 years; range 30 to 88 years) with a mean defect size of 87.5 cm2 (range 48 to 150 cm2 ). Hand-held Doppler was used to detect the perforator. No flap loss was encountered, and no knee function limitation was noted at follow-up. Minor complications include seroma (1) and intra-articular infection (2).
We conclude that the distal PAPI flap is a reliable and versatile flap that has potentially wide applications.