U-shape kissing chimney thoracic endovascular aneurysm repair for a traumatic arch rupture in a polytraumatized patient

An 18-year-old male patient was admitted to our hospital because of a high impact trauma. A computed tomography scan showed massive mediastinal bleeding due to a posteriorly located rupture of the aortic arch with formation of a pseudoaneurysm. Although urgent repair was indicated, open cardiac surgery was not feasible, as this would involve full heparinization in a patient with subarachnoid bleeding. The chosen solution was to perform a percutaneous thoracic endovascular aneurysm repair (TEVAR) and a kissing chimney procedure using a U-shape configuration

The diagnostic challenge of extrapulmonary tuberculosis : esophageal perforation, mediastinitis, pneumopericardium, and pericardial abscess formation

We describe the case of extrapulmonary tuberculosis complicated by esophageal perforation, pneumopericardium, and pericardial abscess formation. This case illustrates the difficulty in diagnosing extrapulmonary tuberculosis, as the occurrence of tuberculosis is rare in the developed world. The appropriate treatment strategy and 6-month follow-up results are discussed. (Level of Difficulty: Advanced.