Lymphatic vessel-related diseases include various pathophysiologic conditions, among which lymphatic reconstructions are indicated in lympho-rrhea/-cyst (LR/LC) with lymphatic vessel rupture, and lymphedema (LE) with lymph flow obstruction. In both pathologic conditions, precise lymph flow evaluation is a key to successful management. It is recommended to reconstruct lymph flow of identified ruptured lymphatic vessels with lymphatico-lympahtic anastomosis (LLA) or lymphaticovenular anastomosis (LVA) for the treatment for intractable LR/LC. LVA is considered for mild LE cases with less lymphosclerotic change, while vascularized lymph node transfer (LNT) for progressed LE with severe lymphosclerosis. Lymph-interpositional-flap transfer (LIFT) should be considered for cases with soft tissue and lymphatic defect. According to pathophysiology of lymphatic vessel-related diseases, appropriate treatments, such as LLA/LVA/LNT/LIFT, should be applied.
A 45-year-old male was referred to our hospital due to multiple saccular ascending aortic aneurysms, and underwent replacement of the ascending aorta at an early stage. During operation, we observed multiple saccular aneurysms (projection length 5 to 25 mm) without infection. Histopathological examination of the aneurysmal wall showed a true aneurysm, which had fibrous thickening of the intima and adventitia, and medial thinning with necrosis and inflammatory cell infiltration. These findings were compatible with Takayasu arteritis. Multiple saccular ascending aortic aneurysms are very rare, and this is the first report that showed multiple saccular ascending aortic aneurysms associated with Takayasu arteritis.
Kawasaki disease is characterized by the inflammation of middle-sized vessels. This disease typically affects infants and toddlers and causes systemic vasculitis. The serious cardiac lesions are coronary aneurysms, which are associated with an unfavorable prognosis. An autopsy revealed systemic vasculitis as a cause of sudden death. We describe an autopsy case of a 6 months infant with Kawasaki vasculitis.
A 66-year-old male patient was referred to our hospital for suspected inferior vena cava (IVC) perforation. He had a history of lower left extremity swelling; a previous angiography revealed a thrombus from the left iliac vein to the femoral vein. Since he was diagnosed with central deep vein thrombosis, an IVC filter was inserted at the previous facility. The thrombus disappeared while the patient was on anticoagulant treatment. The previous cardiologist tried to retrieve the IVC filter; however, due to the suspected IVC perforation, he was referred to our facility. We thoroughly examined the filter structure before its surgical retrieval.