Introduction: A heterotopic pregnancy is defined as the presence of a combined intrauterine and ectopic pregnancy. Its estimated incidence is accepted as between 1/7000 and 1/30,000 pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology, but Clomiphene Citrate which increases the rate of twinning, could be associated with a heterotopic pregnancy rate of 1/900, which is much less than using assisted reproductive technology. Heterotopic pregnancies are diagnostic and therapeutic challenges for obstetricians. If they continue without diagnosis, a life-threatening situation may occur even when surgical intervention with laparotomy is performed.
A true aneurysm is an abnormal widening of a blood vessel that involves all three layers of vessel wall. The basic defect is destruction of elastic fibers in the media, which permits the remaining fibrous tissue to stretch and leads to an increase in diameter. Aneurysms are fusiform with a segment of the vessel becoming diffusely dilated, its total circumference being involved. In contrast, saccular aneurysms affect a portion of the circumference and consist of an outpouching with a mouth.The most common underlying cause is arteriosclerosis, but cystic medial necrosis, trauma, and syphylis and other infections must also be considered as a cause.' The case reported here underlines the importance of ultrasound identification of the lesion.
CASE REPORTA 17-year-old young man was seen because of severe abdominal pain of sudden onset. The pain was constant and spread over the whole abdomen. His past history was positive for such pain, but less severe and without correlation to meals. He practiced karate but didn't mention recent abdominal trauma.Physical examination revealed a well developed, well nourished young man with thin skin. The sclera was slightly bluish. No lymphadenopathy was found. There was a round, mobile (partially) and pulsatile abdominal mass at the left epigastrium. Liver and spleen were not palpated. Hyperextensibility of the first metacarpophalangeal joint was noted, which was mentioned to have existed from childhood. Laboratory tests were all at normal range. Plain abdominal X-ray showed no abnormality.An abdominal ultrasonography was performed. The scanner used was EUB-40 ultrasound imaging system (Hitachi, Japan). The transducer was a 3.5 MHZ, convex type.Two dimensional B-mode images were obtained using standard planes and rules. The liver, gall bladder, biliary duct, and pancreas were all normal. The spleen was not enlarged. Evaluation of the retroperitoneal area revealed a well-defined, ovoid, echo-free lesion (27 mm long, 10 to 15 mm wide) adjacent t o the aorta ( Figure 1). The sagital view showed that it was a fusiform dilatation of the superior mesenteric artery (Figure 2). A selective superior mesenteric arteriogram (Figure 3) proved the diagnosis of an SMA aneurysm.
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