Giant right atrial diverticulum: an unusual cause of Wolff-Parkinson-White syndrome.

A case of a giant right atrial diverticulum associated with neonatal supraventricular tachycardia is reported. The electrocardiogram in sinus rhythm showed pre-excitation that may have been caused by the right atrial diverticulum adhering to the right ventricle.     

Right atrial diverticulum associated with the Wolff-Parkinson-White syndrome in a child

A child with Wolff-Parkinson-White syndrome showed large right atrial diverticulum overlying the right ventricle and the right coronary artery at CT angio with right atrial appendage as a separate structure. The accessory pathway was located at the diverticulum. Catheter ablation was not regarded feasible and surgery was indicated. A broad muscular connection between the right atrium and ventricle was interrupted by transsection and cryoablation as confirmed by disappearance of preexcitation. This precisely CT documented case represents a rarely reported right atrial diverticulum posing a high risk of life-threatening arrhythmias.     

Giant cell hepatitis: an unusual cause of fulminant liver failure

Giant cell hepatitis is a very rare disease of unknown origin. It has been hypothesized that drugs, viral infections, or autoimmune reactions may play a pathogenetic role. Here, we describe a 33 year old patient with bacterial bronchitis who was treated with doxycycline (100 mg/d) for one week. Furthermore the patient complained of malaise and a distinct jaundice. Liver parameters increased dramatically (AST 4670 U/l, ALT 5350 U/l, bilirubin 226 μmol/l) and liver function was impaired (INR = 1,45). The ultrasound scan showed a hepatomegaly with no signs of cirrhosis, normal spleen size and normal bile ducts; liver perfusion was normal. No evidence of Wilson's disease, hemochromatosis, autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis, hepatitis A, B, C and E, HIV, CMV, VZV, adenoviral infections, or paracetamol intoxication was found. Subsequently, the patient developed acute liver failure (AST 2134 U/l, ALT 2820 U/l, bilirubin 380 μmol/l, INR 3.0) and a beginning renal failure. Therefore, he was transferred to our transplant center. Due to increasing confusion and somnolence due to cerebral edema mechanical ventilation was needed. Because of an acute renal failure and severe hepatic encephalopathia MARS-hemodialysis was performed. Three weeks after the appearance of the jaundice he underwent liver transplantation (MELD 40). Surprisingly, in the explanted liver the diagnosis of giant cell hepatitis was made. Today--2 years after successful liver transplantation--the patient is in very good condition with normal liver function. In conclusion, giant cell hepatitis is a rare cause of acute liver failure that is often recognized only histologically.     

Giant right atrial aneurysm: case report

A 15-month-old boy with atrial fibrillation was found to have gross cardiomegaly on a chest radiography; further evaluation by echocardiography showed a giant right atrial aneurysm which is in the form of a cyst like lesion. The patient underwent successful surgical reduction of the right atrium converting his heart rhythm to normal. The operative measure was taken to prevent thrombus formation in the right atrium and lower the risk of atrial arrhythmias. The morphologic features of the resected atrial tissue showed a thin wall with a central aneurysm and focal endocardial fibrosis without inflammatory response consistent with a diagnosis of idiopathic dilatation of the right atrium.     

Giant vesical diverticulum： A rare cause of defecation disturbance

Vesical diverticula frequently result from bladder outlet obstructions. However, giant vesical diverticula which cause acute abdomen or intestinal obstruction are very rare. Our review of the English medical literature found 3 cases of bladder diverticula which caused gastrointestinal symptoms. Here, we present a 57-yearold man with a giant diverticulum of the urinary bladder who complained of abdominal pain, nausea and vomiting, constipation, no passage of gas or feces, and abdominal distension for 3 d. A 20 cm x 15 cm diverticulum was observed upon laparotomy. The colonic obstruction was secondary to external compression of the rectum against the sacrum by a distended vesical diverticulum. We performed a diverticulectomy and primary closure. Twelve months postoperatively, the patient had no difficulty with voiding or defecation.     

Brugada syndrome: an unusual cause of convulsive syncope

A patient who presented with a new apparent seizure was found to have abnormal electrocardiographic findings, with classic features of the Brugada syndrome. He had spontaneous episodes of nonsustained ventricular tachycardia, easily inducible ventricular fibrillation at electrophysiological study in the absence of structural heart disease, and a negative neurological evaluation. These findings suggested that sustained ventricular arrhythmias known to be associated with the Brugada syndrome and resultant cerebral hypoperfusion, rather than a primary seizure disorder, were responsible for the event. Patients with the Brugada syndrome often present with sudden death or with syncope resulting from ventricular arrhythmias. In consideration of its variability in presentation sometimes mimicking other disorders, primary care physicians and internists should be aware of its often transient electrocardiographic features.     

Massive right atrial myxoma: an unusual presentation in an elderly patient

Primary heart tumors are rare with an estimated incidence ranging 0.0017-0.19%. Myxoma is the most prevalent primary heart tumor. The right atrium is an unusual location, occurring only in the 15-20% of myxoma cases. We describe the case of a massive right atrial myxoma causing right ventricular inflow and tricuspid valve obstruction. The tumor was detected by echocardiography and confirmed by abdomen-thoracic tomography. It was resected along with a section of tricuspid septal leaflet, followed by primary repair. In 2-year follow-up the patient is asymptomatic.     

Wolff-Parkinson-White syndrome presenting certain unusual features

A case of Wolff-Parkinson-White syndrome occurring in a young man is presented. It is left the electrocardiographic findings which are described may serve to assist in the elucidation of some of the unsettled problems concerning the exact mechanism of this abnormality.     

Hemoptysis as an unusual manifestation of right atrial myxoma

Atrial myxoma is the most frequent tumor of the heart, though right-side locations and initial clinical manifestation in the form of hemoptysis are infrequent. We describe the case of a young woman with right atrial myxoma diagnosed by transthoracic echocardiography and presenting hemoptysis as the most important manifestation. The symptomatology disappeared after surgical removal of the lesion.     

Atypical hepatic vein leiomyoma extending into the right atrium: an unusual cause of the Budd-Chiari syndrome

A 14-year-old male presented with a one week history of weakness, lightheadedness and vomiting. Bilateral pleural effusions were evident on chest radiography; electrocardiogram revealed decreased voltages. Echocardiogram, abdominal ultrasound and magnetic resonance imaging revealed a mass in an hepatic vein and the inferior vena cava extending up to and filling the right atrium. Under deep hypothermia and extracorporeal circulation the mass was removed en bloc. It originated from the hepatic vein. Pathology revealed a smooth muscle tumour intermediate between benign and malignant (atypical leiomyoma). This is the first reported pediatric primary leiomyoma of the hepatic vein. It caused the Budd-Chiari syndrome, a rare pediatric entity.     

Giant right atrial thrombus in Noonan syndrome combined with Eisenmenger's complex

A 54-year-old woman with the Noonan syndrome was admitted with congestive heart failure and a giant right atrial thrombus with atrial septal defect detected by two-dimensional echocardiography. The thrombus vanished on oral anticoagulant therapy with warfarin. The thrombus is considered to result from hemostasis in the right atrium due to congestive heart failure and to her specific skeletal characteristics. This report describes the first case of Noonan syndrome with right atrial thrombus.