Cerebral Varix Simulating a Meningioma: Use of 3D Magnetic Resonance Venography for Diagnosis
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Varix
Venography
Magnetic resonance angiography
Although anorectal and colonic varices are not uncommon, bleeding from these varices is extremely rare [1] [2] [3]. However, when they do bleed, the bleeding may be massive and occasionally fatal [4]. Endoscopic variceal ligation (EVL) is a well-established procedure for emergency as well as elective ligation of esophageal varices. Although there have been a few reports of variceal ligation to arrest rectal variceal bleeding [5], there have been no reports of its use in bleeding colonic varices, so far as we are aware.
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Objectives/Hypothesis To establish risk of hemorrhage in patients with varices compared to those without, determine additional risk factors, and make evidence‐based treatment recommendations. Study Design Retrospective cohort study. Methods Patients who were vocal performers presenting for care during a 24‐month period were analyzed to determine incidence of hemorrhage. Patients with varices were compared to those without. Demographic information and examination findings (presence, location, character, and size of varices; presence of mucosal lesions or paresis) were analyzed to determine predictors of hemorrhage. Results A total of 513 patients (60.4% female, mean age 36.6 years ± 13.95 years) were evaluated; 14 patients presenting with hemorrhage were excluded. One hundred and twelve (22.4%) patients had varices; 387 (77.6%) did not. The rate of hemorrhage in patients with varices was 2.68% at 12 months compared to 0.8% in patients without. Cox proportional hazard regression analysis revealed a hazard ratio of 10.1 for patients with varix developing hemorrhage compared to nonvarix patients ( P < 0.0001). The incidence rate of hemorrhage was 3.3 cases per 1,000 person‐months for varix patients compared to 0.5 cases per 1,000 person‐months in the nonvarix group. There was no significant difference in the incidence of paresis, mucosal lesions, location of varix (left or right side; medial or lateral), or varix morphology (pinpoint, linear, lake) between patients who hemorrhaged and those that did not. Conclusion The presence of varices increases the risk of hemorrhage. Varix patients had 10 times the rate of hemorrhage compared to nonvarix patients, although the overall incidence is low. This data may be used to inform treatment of patients with varices. Level of Evidence 4. Laryngoscope , 126:1163–1168, 2016
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Paresis
Gastric varices
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Gastric varices
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To assess whether Valsalva9s manoeuvre might cause variceal bleeding, 22 patients with oesophageal varices were studied. In 12 patients who received no previous treatment to their varices the median pressure gradient across the varix wall at rest was 19 (6-36) mmHg, and in 10 patients whose varices were thrombosed at their distal end the median pressure gradient in the proximal patent varix was 8 (1-6) mmHg. In untreated patients groups, the pressure gradient rose by 6-12 mmHg during Valsalva9s manoeuvre in four patients, fell by 4-11 mmHg in five patients and was virtually unchanged in the remainder. These changes seem unlikely to cause variceal bleeding. Patients who repeated Valsalva9s manoeuvre showed similar changes on each occasion. Six patients in the untreated group also received hyoscinbutylbromide 20 mg iv. No change was seen in the pressure gradient in five patients, suggesting that it is of little value in preventing variceal bleeding.
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Valsalva maneuver
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Varces in the forearm following internal shunt formation are relatively common, however, those caused by other reasons are rare. In this paper a rare case of varices in the for arm which might not occur secondary to any origin but be caused by some congenital factors is described here. A 36-year-old man was admitted to the hospital because of engorged and tortuous veins with itching in the left forearm. Arteriography and venography indicated venous varices and surgical treatment was carried out. The varices arised in the areas of the cephalic and radical veins. Only varices in the cephalic vein area were removed. Histopathologically dilated lumen of the vein and vulnerability of the venous wall were confirmed. As a possible participation of some congenital factor is strongly suspected in this case, its consequent recurrence probably take place. Long-term follow-up would be mandatory.
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Varix
Lumen (anatomy)
Cephalic vein
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A rare case of giant cerebral varix with venous angioma and intracerebral hemorrhage, surgically treated with good outcome, is reported. Varices and venous angiomas are infrequent in the clinical practice and are usually asymptomatic. Giant venous varices are less rarely associated with vein of Galen aneurysms or high flow arteriovenous shunts, whereas isolated giant varices are exceptional. Association of varix and venous angioma has been reported only in three instances. The radiological diagnosis of the cerebral venous malformation is briefly discussed.
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Angioma
Vascular malformation
Arteriovenous malformation
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Valsalva maneuver
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Presentation (obstetrics)
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