In cases of hemorrhage when the cause is not easily identified, or in cases of recurrence in spite of accurate embolization of pathological arteries, the presence of bronchial arteries of anomalous origin should be considered. Embolization is more difficult in these cases and there is an increased risk of complications.
cute hemothorax caused by intercostal artery aneurysm rupture is a life-threatening complication of type I neurofibromatosis (NF I), which was successfully treated with percutaneous embolization.
SUMMARYWe have presented a two year nonoperative follow-up of an asymptomatic 14-year-old girl with an unusual anomaly of the coronary arteries. Systolic and diastolic murmurs heard preoperatively did not change following severance of a patent ductus arteriosus. Postoperative selective coronary arteriography revealed (1) anomalous origin of the left anterior descending artery from the right aortic sinus of Valsalva crossing between the aorta and pulmonary artery, (2) aberrant circumflex artery origin from the pulmonary artery and (3) collaterals from the left anterior descending and right coronary arteries to the circumflex artery. This combination of coronary anomalies has never been described previously.ANOMALOUS ORIGIN of the coronary arteries from the aorta or pulmonary artery is infrequent. 1, 2 The presence of these anomalies is of some clinical interest since certain types are associated with an increased risk of sudden death.3 8 This paper describes a 14-year-old girl with a patent ductus arteriosus in whom (1) the left anterior descending coronary artery arises aberrantly from the right anterior aortic sinus of Valsalva and courses between the aorta and pulmonary artery and (2) the left circumflex artery arises from the pulmonary trunk and communicates with the left anterior descending and right coronary arteries via collaterals. This particular combination of anomalies has never been previously described.Case Report A 14-year-old Spanish girl was the product of a normal pregnancy and delivery. Childhood
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