A 42-year-old man with recurrent myocardial infarction and normal appearing coronary arteries.

We report the occurrence of a coronary mural thrombus and recurrent myocardial infarction in a patient with normal-appearing epicardial coronary arteries and small-vessel coronary artery disease. The current case emphasizes the importance of permanent medical treatment with anti-platelet and vasodilators in patients with small-vessel coronary artery disease.     

A rare presentation of a bronchogenic cyst: presternal, subcutaneous and 42-year-old man

Bronchogenic cysts are generally detected shortly after birth or in early childhood. Most lesions are found in the mediastinum, along the tracheobronchial tree or in the lung parenchyma. Cutaneous or subcutaneous bronchogenic cysts are rarely reported. Our patient was the second case in the English literature who had a cyst over the manubrium sterni in adult life. Surgical total excision is the definitive treatment of extrathoracic bronchogenic cysts, needle aspiration management should not be tried because of association with malignant lesions as mucoepidermoid carcinoma and malign melanoma have been reported to arise from them.     

A 67-year-old man with hepatitis C virus infection and a liver tumor

A 67-year-old man with no known liver disease was found to have an incidental tumor in the right liver lobe. His serum liver enzyme and alphafetoprotein were within normal limits, but he was found to be reactive for anti-HCV. The tumor was an intrahepatic cholangiocarcinoma. Since the only risk factor in this patient was hepatitis C infection, this case appears to support the recently suggested role of hepatitis C virus in the development of intrahepatic cholangiocarcinoma.     

A 25-year-old man with a large hepatic tumor and multiple nodular lesions

A 25-year-old man without a prior history of liver disease presented with an 18-cm tumor of the right hepatic lobe, which was associated with multiple nodular lesions in the remaining parenchyma. The histologic and immunohistochemical features of the neoplasm were those of a poorly differentiated leiomyosarcoma with epithelioid features. The nodular lesions measured up to 4 cm in greatest dimension and had gross and microscopic features of focal nodular hyperplasia. This case suggests that multiple focal nodular hyperplasia may occasionally represent a parenchymal reaction to abnormal blood supply developing within the liver as a consequence of an enlarging malignant tumor.     

A novel variant of transthyretin (Glu42Asp) associated with sporadic late-onset cardiac amyloidosis.

A sixty-three year old French man presented with isolated late-onset amyloid cardiomyopathy proven by endomyocardial biopsy. There was no known family history of amyloidosis. Immunohistochemistry of cardiac deposits suggested that amyloi fibrils were derived from transthyretin. DNA sequencing revealed a point mutation in exon 2 of the transthyretin gene responsible for a novel amyloidogenic variant Asp42.     

Total anomalous pulmonary venous return. Successful total correction in a 44-year-old man with subtotal absence of interatrial septum, tricuspid insufficiency, and cardiac dextroversion.

A case of total anomalous pulmonary venous return, virtual absence of the interatrial septum, cardiac dextroversion, and tricuspid insufficiency with total correction at age 44 years is presented. Repeat catheterization four months after surgery showed normal hemodynamics and pulmonary vascular resistance. The physiologic and anatomic factors allowing survival and total surgical correction at such a late age are reviewed.