Thrombosis and Dissection of the Abdominal Arteries Associated with Infarcts of Solid Organs in a Patient with COVID-19: A Novel Clinical Entity

The clinical spectrum of patients with coronavirus disease 2019 (COVID-19) ranges from asymptomatic cases to severe pneumonia with acute respiratory distress syndrome. COVID-19 is associated with an increased risk of thromboembolic complications, notably pulmonary embolism and deep vein thrombosis. Arterial cardiovascular complications and myocarditis have also been described in association with COVID-19, but appear to be less prevalent. In this report of a 57-year-old man with multiple splanchnic infarctions, arterial dissections and COVID-19 as the sole potential trigger, we describe a novel type of complications and put it in the context of a growing literature on this topic.

Segmental Arterial Mediolysis: An Under-Recognized Cause of Chronic Abdominal Pain

Segmental arterial mediolysis (SAM) is a non-inflammatory, non-atherosclerotic vasculopathy mostly involving the abdominal arteries. SAM was recently recognized as a more prevalent aetiology of abdominal pain than initially thought by healthcare providers. It is still a commonly missed diagnosis in patients with recurrent emergency room (ER) visits for abdominal pain. Most published case reports in the past have highlighted catastrophic sequelae such as intra-abdominal haemorrhage requiring surgical intervention. We report a case of SAM where the diagnosis was initially missed. After diagnosis, conservative medical management was offered which led to clinical improvement.

Sedation effect of midazolam, ketamine, and butorphanol on spectral Doppler ultrasound values in femoral and large abdominal arteries in cats

Informações em tempo real da direção e tipo de fluxo sanguíneo podem ser obtidas com ultrassonografia com Doppler. Existe na literatura dados relativos a esses parâmetros, em gatos não sedados, obtidos das artérias: aorta, renal, ilíaca e femoral; no entanto não foram encontrados na literatura dados relativos às artérias celíaca e mesentérica cranial. Além disso, ocasionalmente há necessidade de sedar animais inquietos ou agressivos, para que seja possível a realização deste exame. O objetivo do trabalho foi avaliar os aspectos quantitativos da onda espectral formada pelo fluxo sanguíneo das artérias: celíaca, mesentérica cranial, renal, ilíaca externa, femoral e aorta abdominal de gatos hígidos e compará-los aos obtidos dos mesmos animais submetidos à sedação com midazolam, cetamina e butorfanol. A frequência cardíaca também foi mensurada. Foram avaliados 20 gatos SRD adultos e saudáveis. Os valores encontrados em animais não sedados na artéria celíaca de índice de resistividade foi 0,62 ± 0,10 e índice de pulsatilidade 1,29 ± 0,55, enquanto da artéria mesentérica cranial, 0,68 ± 0,11 e 1,37 ± 0,39, respectivamente. Apesar da frequência cardíaca mais elevada nos animais sedados, não foram encontradas diferenças estatisticamente significativas dentre os demais parâmetros avaliados, exceto na velocidade diastólica final e velocidade média da artéria celíaca, e índice de resistividade e de pulsatilidade da artéria ilíaca. Dessa forma, foram fornecidos parâmetros dopplervelocimétricos da artéria celíaca e mesentérica cranial e conclui-se que o protocolo utilizado não alterou os valores encontrados por ultrassonografia Doppler nos vasos selecionados, exceto da artéria celíaca e da ilíaca.

Middle Aortic Syndrome: Pathogenesis, Visceral Manifestations, and Management

Middle aortic syndrome (MAS) is characterized by severe narrowing of the abdominal aorta, frequently involving the great abdominal vessels. Although increasingly implicated in primary hypertension, up to one-third of cases affect the mesenteric vasculature, and the resultant manifestations may be underrecognized. Early intervention with interdisciplinary medical management and invasive arterial reconstruction affords preservation of end-organ function and improvement in patient survival. This article reviews the embryology of the thoracoabdominal aorta and major abdominal arteries, as well as the pathogenesis, clinical manifestations, and management of the nonatherosclerotic abdominal coarctation otherwise known as MAS.

Novel Pathogenic Variant in TGFBR2 Confirmed by Molecular Modeling Is a Rare Cause of Loeys-Dietz Syndrome

Loeys-Dietz syndrome (LDS) is a connective tissue disorder characterized by vascular findings of aneurysm and/or dissection of cerebral, thoracic, or abdominal arteries and skeletal findings. We report a case of a novel pathogenic variant in TGFBR2 and phenotype consistent with classic LDS. The proband was a 10-year-old presenting to the genetics clinic with an enlarged aortic root (Z-scores 5-6), pectus excavatum, and congenital contractures of the right 2nd and 3rd digit. Molecular testing of TGFBR2 was sent to a commercial laboratory and demonstrated a novel, likely pathogenic, variant in exon 4, c.1061T>C, p.(L354P). Molecular modeling reveals alteration of local protein structure as a result of this pathogenic variant. This pathogenic variant has not been previously reported in LDS and thus expands the pathogenic variant spectrum of this condition.