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Journal of Cancer Research and... 2023Pediatric chest wall tumors are unusual and can arise from bone structures or from adjacent soft tissues. Osteochondroma is a benign cartilaginous tumor arising from the...
Pediatric chest wall tumors are unusual and can arise from bone structures or from adjacent soft tissues. Osteochondroma is a benign cartilaginous tumor arising from the metaphysis of bone; however, it is more common in extremity rather than in membranous bone. Although benign, osteochondroma of the rib may lead to fatal complications such as pneumothorax, hemothorax, fractures, and pleural or pericardial effusion. Therefore, some form of surgical management becomes necessary to treat these lesions. We present a case of 7-year-old female child with solitary osteochondroma of the rib. The tumor was surgically excised and the child is asymptomatic on follow-up.
Topics: Female; Humans; Child; Thoracic Wall; Hemothorax; Bone Neoplasms; Osteochondroma; Ribs
PubMed: 37787320
DOI: 10.4103/jcrt.jcrt_679_21 -
Frontiers in Surgery 2023The principal benefit of employing percutaneous vertebroplasty (PVP) for managing osteoporotic vertebral compression fractures lies in its capacity to facilitate early...
The principal benefit of employing percutaneous vertebroplasty (PVP) for managing osteoporotic vertebral compression fractures lies in its capacity to facilitate early mobilization in elderly patients, thereby effectively avoiding the potential catastrophic complications associated with prolonged bedridden states. However, bone cement leakage, as the most common complication of PVP, may have fatal consequences. Here, we report a case involving an 85-year-old male patient with L1 vertebral compression fracture who underwent PVP at our hospital and was discharged on the same day of the surgical intervention. Subsequently, the patient experienced symptoms of chest tightness and palpitations. Cardiac ultrasound examination revealed pericardial effusion, while pulmonary computed tomographic angiography (CTA) demonstrated a strip high-density shadow in the right ventricular area. Finally, it was determined that the perforation of the right ventricular wall was caused by bone cement embolism. Through this comprehensive case report, we aim to deepen the understanding of orthopedic doctors on the importance of preventing bone cement leakage.
PubMed: 37732163
DOI: 10.3389/fsurg.2023.1227056 -
International Journal of Legal Medicine Nov 2023During autopsies, weighing the heart is a standard procedure. In addition to myocardial pathologies, heart size, and ventricular wall thickness, heart weight is a common...
During autopsies, weighing the heart is a standard procedure. In addition to myocardial pathologies, heart size, and ventricular wall thickness, heart weight is a common parameter to describe cardiac pathology and should be recorded as accurately as possible. To date, there exists no standard for recording heart weight at autopsy, although some authors recommend weighing the heart after dissection and removal of blood and blood clots. In the study presented, the hearts of 58 decedents were weighed after being dissected out of the pericardial sac (a), after dissection using the short-axis or inflow-outflow method with manual removal of blood and blood clots (b), and after rinsing and drying (c). Depending on the dissection method, the heart weight was 7.8% lower for the inflow-outflow method and 11.6% lower for the short-axis method after dissection compared to before and correspondingly 2.9% to 5% lower again after rinsing and drying respectively. Accordingly, the heart should be dissected, blood and blood clots removed, rinsed with water, and dried with a surgical towel after dissection, before weighing.
Topics: Humans; Autopsy; Female; Male; Organ Size; Middle Aged; Aged; Adult; Myocardium; Dissection; Heart; Aged, 80 and over; Forensic Pathology
PubMed: 37723344
DOI: 10.1007/s00414-023-03089-9 -
International Journal of Surgery Case... Oct 2023Lymphoma can either be Hodgkin or non-Hodgkin (NHL) with diffuse large B cell lymphoma (DLBL) being a type of the latter with an aggressive behavior. Although NHL...
INTRODUCTION AND IMPORTANCE
Lymphoma can either be Hodgkin or non-Hodgkin (NHL) with diffuse large B cell lymphoma (DLBL) being a type of the latter with an aggressive behavior. Although NHL involvement of the heart in late stages is not uncommon, disease that primarily originates from the heart is rare and therefore poses a diagnostic challenge.
CASE PRESENTATION
Herein, we report the case of a 52-year-old patient who presented to the hospital with non-specific signs and symptoms and was found to have a heterogeneous echogenic irregular mass across the tricuspid valve in the right atrium and right ventricle. The majority of the mass was located in the right atrium, with the tip attached to the right ventricular free wall near the tricuspid annulus. Initially thought to be an atrial myxoma but later confirmed histologically to be diffuse large B cell Lymphoma, and the patient underwent right atrial mass resection, followed by chemotherapy. The patient showed improvement following treatment.
CLINICAL DISCUSSION
Primary cardiac lymphoma (PCL) is a rare form of lymphoma that is confined exclusively to the heart and/or pericardium, without the involvement of other lymph nodes or extra-nodal tissues or organs. Pathological analysis confirms PCL as either non-Hodgkin's lymphoma (NHL) or Hodgkin's lymphoma (HL). PCL accounts for approximately 1.3 % of primary cardiac tumors and 0.5 % of extra-nodal lymphomas.
CONCLUSION
Our case report provides valuable insights for clinicians to better understand this uncommon disease and reduce the incidence of misdiagnosis.
PubMed: 37716063
DOI: 10.1016/j.ijscr.2023.108702 -
Ochsner Journal 2023Most pericardial effusions that occur in the setting of ST-segment elevation myocardial infarction (STEMI) are small, simple, and without symptomology. However, in its...
Most pericardial effusions that occur in the setting of ST-segment elevation myocardial infarction (STEMI) are small, simple, and without symptomology. However, in its most severe form, pericardial effusion can precipitate cardiac tamponade, and when untreated, can cause abrupt hemodynamic instability. Pericardial effusion may be a manifestation of left ventricular free-wall rupture, hemorrhagic pericarditis, or aortic dissection involving a coronary artery. We describe the case of a 65-year-old male who experienced chest pain for several days prior to admission but delayed seeking care because he wished to avoid coronavirus disease 2019 exposure. Upon arrival, he was hemodynamically unstable. Electrocardiogram was consistent with anterior STEMI. Bedside echocardiogram demonstrated a hypertrophic left ventricle with preserved function and a large, complex pericardial effusion with cardiac tamponade physiology. Computed tomography of the chest identified hemopericardium but was unable to delineate etiology. The patient underwent emergent thoracotomy because of persistent shock, and during the surgery, left ventricular free-wall rupture was identified and repaired. Coronary artery bypass grafting to the patient's left anterior descending artery was also performed. The patient remained asymptomatic at 2-year follow-up. The differential for hemodynamic compromise in a patient with STEMI is broad, but quickly distinguishing pump failure from other life-threatening causes of shock is imperative to dictate time-sensitive management decisions. The presence of a hemorrhagic pericardial effusion in the setting of STEMI is a surrogate marker for a severe infarct and can help the bedside physician determine whether a patient will be better served in the catheterization lab for revascularization or in the operating room for surgical repair.
PubMed: 37711482
DOI: 10.31486/toj.23.0023 -
Asian Journal of Surgery Jan 2024The reinforcement of the suture lines in acute type A aortic dissection include the treatment of proximal and distal anastomoses. The intima of the proximal site is...
TECHNIQUE
The reinforcement of the suture lines in acute type A aortic dissection include the treatment of proximal and distal anastomoses. The intima of the proximal site is transected circumferentially, approximately 1.0 cm above the sinotubular junction. The adventitia is folded outwards along the cutting edge of the intima, and the eversion forms an overlap. An autologous pericardial strip is placed inside the aorta as a mattress and secured with 4-0 prolene running sutures to the adventitial eversion overlap to reinforce the proximal cuff without any glue.The distal aortic cuff is trimmed and retained at 1.5 cm longer than the stent graft.The autologous pericardial strip is placed between the aortic intima and the stent graft and secured with 4-0 prolene running sutures to the adventitial eversion overlap to reinforce the distal cuff and completely obliterate the distal false lumen.
RESULTS
The modified sandwich technique using adventitial eversion combined with an autologous pericardial strip achieved complete hemostasis at the anastomosis site and effectively obliterated the false lumen of the proximal and distal aorta.
CONCLUSIONS
The adventitial valgus technique combined with autologous pericardial strip reinforcement can be inexpensive and effective for the surgical treatment of acute type A aortic dissection, especially in patients with fragile aortic wall.
Topics: Humans; Adventitia; Polypropylenes; Blood Vessel Prosthesis Implantation; Aortic Dissection; Aorta, Thoracic; Treatment Outcome; Suture Techniques
PubMed: 37673740
DOI: 10.1016/j.asjsur.2023.08.163 -
BMC Cardiovascular Disorders Aug 2023Left ventricular free wall rupture, particularly the blowout type, is still one of the most lethal complications of myocardial infarction and can cause catastrophic...
BACKGROUND
Left ventricular free wall rupture, particularly the blowout type, is still one of the most lethal complications of myocardial infarction and can cause catastrophic cardiac tamponade. Extracorporeal membrane oxygenation (ECMO) is often used to treat haemodynamic instability due to cardiac tamponade. However, elevated pericardial pressure can cause collapse of the right atrium, resulting in inadequate ECMO inflow and preventing the stabilisation of the circulation. Further, it can interfere with the venous return from the superior vena cava (SVC), increasing the intracranial pressure and reducing cerebral perfusion levels.
CASE PRESENTATION
A 65-year-old man was hospitalised for out-of-hospital cardiac arrest. We used ECMO for cardiopulmonary resuscitation. After the establishment of ECMO, transthoracic echocardiography and left ventriculography revealed massive pericardial effusion. The treatment was supplemented with pericardial drainage since ECMO flow was frequently hampered by suction events. However, the blowout rupture led to the requirement of constant drainage from the pericardial catheter. To tend to this leak, we connected the venous cannula of ECMO and the pericardial drainage catheter. The surgery was performed with stable circulation without suction failure of ECMO. During the course of the intensive care management, the neurological prognosis of the patient was revealed to be poor, and the patient was shifted to palliative care. Unfortunately, the patient died on day 10 of hospitalisation.
CONCLUSION
We present a case wherein the combination of pericardial drainage and ECMO was used to maintain circulation in a patient with massive pericardial effusion due to cardiac rupture.
Topics: Male; Humans; Aged; Extracorporeal Membrane Oxygenation; Cardiac Tamponade; Pericardial Effusion; Vena Cava, Superior; Drainage
PubMed: 37653391
DOI: 10.1186/s12872-023-03477-4 -
Frontiers in Physiology 2023The review focuses on the mechanism of ventricular interdependence, a frequently encountered phenomena, especially in critically ill patients. It is explained by the... (Review)
Review
The review focuses on the mechanism of ventricular interdependence, a frequently encountered phenomena, especially in critically ill patients. It is explained by the anatomy of the heart, with two ventricles sharing a common wall, the septum, and nested in an acutely inextensible envelope, the pericardium. In pathological situation, it results in abnormal movements of the interventricular septum driven by respiration, leading to abnormal filling of one or the other ventricle. Ventricular interdependence has several clinical applications and explains some situations of hemodynamic impairment, especially in situations of cardiac tamponade, severe acute asthma, right ventricular (RV) overload, or more simply, in case of positive pressure ventilation with underlying acute pulmonary hypertension. Ventricular interdependence can be monitored with pulmonary arterial catheter or echocardiography. Knowledge of this phenomena has very concrete clinical applications in the management of filling or in the prevention or treatment of RV overload.
PubMed: 37614759
DOI: 10.3389/fphys.2023.1232340 -
CASE (Philadelphia, Pa.) Aug 2023• High echoic partition could appear around the LAA wall. • The pericardium attached to the lung has very strong intensity reflection. • The pericardium attached...
• High echoic partition could appear around the LAA wall. • The pericardium attached to the lung has very strong intensity reflection. • The pericardium attached to the lung mimics the LAA wall. • Reflection artifact could also mimic the LAA wall. • These phenomena should be considered when evaluating LAA morphology.
PubMed: 37614695
DOI: 10.1016/j.case.2023.04.008