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Persistent Primitive Olfactory Artery Type 4 with Fusiform Aneurysm: A Case Report

방추형동맥류를 동반한 제4형 잔류 원시 후각동맥의 영상 소견: 증례 보고

  • Heecheol Park (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Jin Wook Baek (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Hae Woong Jeong (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Young Jin Heo (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Suyoung Yun (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Ji-Yeon Han (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine)
  • 박희철 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 백진욱 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 정해웅 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 허영진 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 윤수영 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 한지연 (인제대학교 의과대학 부산백병원 영상의학과)
  • Received : 2022.10.13
  • Accepted : 2023.04.15
  • Published : 2023.11.01

Abstract

The persistent primitive olfactory artery (PPOA) is a rare variant of the anterior cerebral artery, first reported in 1979. It reportedly has a high correlation with the development of aneurysms, owing to the hemodynamic stress induced by the structural characteristics of the hairpin turn. Herein, we present a rare case of PPOA type 4 with a fusiform aneurysm at the hairpin turn segment in a 46-year-old female with occasional headaches. Time-of-flight MR angiography and transfemoral cerebral angiography revealed an unusual branch arising from the left A1 segment, running anteromedially along the ipsilateral olfactory tract, and turning the hairpin posterior to the olfactory bulb. This branch continued into the left accessory middle cerebral artery, and a fusiform aneurysm was observed at the hairpin segment. No further treatment was performed, and follow-up imaging was recommended. Nevertheless, it is essential to recognize and diagnose these rare variations.

잔류 원시 후각동맥은 1979년에 처음 보고된 매우 드문 전대뇌동맥의 변이로, 급격하게 꺾이는 머리핀 회전의 구조적 특성에 의하여 혈역학적 스트레스가 유발되고, 이로 인하여 동맥류의 발생과 높은 연관성을 가지는 것으로 보고되고 있다. 우리는 간헐적 두통을 주소로한 46세 여성에서 우연히 발견된 머리핀 회전에서 동맥류를 동반한 제4형 잔류 원시 후각 동맥의 증례에 대하여 보고하고자 한다. 뇌 MRA와 유체속도강조 자기공명혈관조영술(time-offlight MR angiography)에서 왼쪽 전대뇌동맥의 A1 분절에서 시작되어 머리핀 회전을 형성한 후 부 중대뇌동맥으로 이어지는 비정상적인 주행을 보이는 동맥이 확인되었다. 또한 머리핀 회전 분절에서 방추형 동맥류도 확인이 되었다. 이러한 변이들은 극히 드물긴 하지만, 동맥류가 동반될 수 있음을 인지하고 진단하는 것이 중요하다.

Keywords

References

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