We describe a rare case of multiple arteriovenous fistulae of the spinal cord (SCAVF) in the same myelomer in a five-year-old boy. This case report consists of a trifocal SCAVF at the Th12 myelomeric level without communication between the three different fistulae. Two AVF were located posteriorly, bilateraly, in the spinal cord, fed by left and right posterior radiculopial arteries and one anteriorly in the anterior spinal axis. The venous drainage was independent for each lesion. The patient presents associated lesions characterized by cutaneous stain and inferior limb asymmetry. A metameric distribution is the explanation for the multiplicity of these lesions in a syndromic association related to Cobb syndrome. The patient was treated by transarterial embolization using glue with occlusion of the three different fistulae. The patient achieved a good improvement in neurological status.
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AbstractIntroduction: Liver injuries occur in 16% of all poly-trauma patients. The American Association of Surgery of Trauma uses computer tomography findings to classify them into grades I through VI. Grade I, II and III lesions have better prognosis, and may be successfully treated with conservative clinical approaches. Grade IV through VI typically require surgical intervention. The present article presents the efficacy of endovascular treatment of Grade V liver injury in the medium and long terms, describing the clinical stabilization in acute phases and maintenance of hepatic function during a 6-month follow-up. Case Report: A 26-year-old male victim of blunt abdominal trauma and grade V liver injury had a successful hemodynamical stabilization after being subjected to arteriographic selective embolization. A surgical approach was necessary later on to remove intraabdominal clots, with adequate post-surgical evolution. The patient kept under follow up at the outpatient clinic for six months after the traumatic event, with full recovery of liver function and enzymes. Conclusion: Non-surgical treatment of grade V hepatic lesion may be used in selected cases in centers with hemodynamic and intensive care units.
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