A 72 year old woman with ALCAPA

ALCAPA syndrome (anomalous origin of the left coronary artery from the pulmonary artery), which causes the left coronary artery to grow with an anomalous origin from the pulmonary artery, is a rare disease which may result in myocardial infarction, congestive heart failure, and sometimes death during the early infantile period. A 72 year old woman with ALCAPA syndrome is presented. The asymptomatic patient presented with a cardiac murmur which was discovered during a routine check up for a gynaecological intervention. Coronary cineangiography established the diagnosis. Although surgical correction is the usual treatment for such cases, medical treatment was preferred for this patient because she was asymptomatic without clinical signs of heart failure.


Keywords: coronary vessel anomalies; ALCAPA syndrome     

A thirty-eight year old woman with overwhelming sepsis

Stenographic reports, edited by Richard Aach, M.D. and John Kissane, M.D. of weekly clinicopathologic conferences held in the Barnes and Wohl Hospitals, are published in each issue of the Journal. These conferences are participated in jointly by members of the Departments of Internal Medicine and Pathology of the Washington University School of Medicine and by Junior and Senior medical students.     

A 28 year old woman with ventricular tachycardia and an abnormal chest radiograph

A 28 year old white woman with no medical history presented to the emergency room with symptomatic non-sustained ventricular tachycardia. She was asymptomatic up to a few days before presentation. Her physical examination was essentially normal and hence did not help with the differential diagnosis of the problem. Bronchoscopic transbronchial biopsy led to the final diagnosis of cardiac sarcoidosis.     

Cardiac computed tomography of an asymptomatic 48‐year‐old woman with ALCAPA syndrome

Untreated ALCAPA cases most often die in infancy. Adults with untreated ALCAPA commonly present with mitral regurgitation, severe left ventricular dysfunction, and sometimes myocardial infarction. Herein, we present an asymptomatic adult female with ALCAPA recognized through cardiac computed tomography (CT). In ALCAPA, like other coronary anomalies, cardiac CT is often instrumental in providing unique noninvasive and clinically relevant evaluation. Herein, we present an atypical presentation of an asymptomatic middle‐aged adult female with ALCAPA.     

肾上腺髓质增生一例

1病历摘要 患者,女性,64岁,因发作性头晕、眼花10年,加重伴头痛、出汗3年于2002年7月1日入院.患者1992年无明显诱因出现发作性头晕,无头痛,持续数分钟至数小时不等.     

Recurring myocardial infarction in a 35 year old woman

A 35 year old woman presented with acute myocardial infarction without any of the usual risk factors: she had never smoked; she had normal blood pressure; she did not have diabetes; plasma concentrations of total cholesterol and high and low density lipoprotein cholesterol, fibrinogen, homocysteine, and Lp(a) lipoprotein were normal. She was not taking oral contraceptives or any other medication. Coronary angiography showed occlusion of the left anterior descending coronary artery but no evidence of arteriosclerosis. Medical history disclosed a previous leg vein thrombosis with pulmonary embolism. Coagulation analysis revealed protein C deficiency. The recognition of protein C deficiency as a risk factor for myocardial infarction is important as anticoagulation prevents further thrombotic events, whereas inhibitors of platelet aggregation are ineffective.     

A 96 year old woman with cough,dyspnea and vomiting (The third case)

1　病历摘要　　患者 ,女性 ,96岁。因咳嗽、咳痰、气憋、乏力、恶心、呕吐 1周 ,于 2 0 0 1年 4月 2 2日急诊入院。患者于 1年前因高龄不能行走而卧床。 1周前无明显诱因出现咯嗽、气憋、无力咯痰 ,恶心、呕吐 ,呕吐物为胃内容物 ,大小便失禁 ,大便 1～ 2次 ｄ,黄色、黑便交替。家属代诉既往病史不祥 ,有高血压、冠心病、老年心脏瓣膜病、胆囊切除术病史。入院查体 :体温3 6℃ ,脉搏 80次 ｍｉｎ ,呼吸 1 8次 ｍｉｎ ,血压 1 2 0 80 ｍｍＨｇ(1ｍｍＨｇ =0 .1 3 3 3ｋＰａ)。发育正常 ,营养较差 ,被动体位 ,不能回答问题。右侧背部外侧、…     

Bilateral virilizing adrenal tumor in a 17 year old woman

We report on a 17 year old female patient with amenorrhea, hirsutism and slight acne. Hormonal blood analyses showed markedly increased levels for dehydroepiandrosteronesulfate, testosterone and androstenedione. Ultrasound investigation revealed a large tumor above the left kidney and a small area above the right kidney, suspicious for a tumor on the contralateral side. This was confirmed by angiography. During surgery, bilateral tumors were removed. Pathological diagnosis was made as bilateral adenomas of the adrenal cortex. Postoperatively, an impressive normalization was observed, accompanied by a rapid decrease of the elevated hormone concentrations. This case is the first report of a bilateral occurrence of a virilizing tumor of the adrenal cortex.     

Type Ia tricuspid atresia with extensive coronary artery abnormalities in a living 22 year old woman

Type Ia tricuspid atresia, with extensive coronary artery abnormalities, is identified in the oldest living patient with this condition, a 22 year old woman. Clinical characteristics include severe cyanosis, effort dyspnea, myocardial infarction in the past and persistent angina pectoris. "Ideal" pulmonary flow and adequate left ventricular function, despite an akinetic apical segment, are substantive factors for this exceptional longevity. Coronary abnormalities consist of: 1) total proximal occlusion of the left anterior descending coronary artery; and 2) partial diversion of coronary artery flow to a segmental pulmonary artery branch. Nonvisualization of the coronary sinus is also noted. Factors other than atherosclerosis may account for total proximal occlusion of the left anterior descending coronary artery. Survival is threatened by adverse effects of ongoing ischemic coronary events.     

Congenitally corrected transposition of the great arteries in an 80 year old woman

Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease characterised by atrioventricular as well as ventriculoarterial discordance. It is usually associated with a variety of severe intracardiac defects. Few patients with this abnormality survive past 50 years. An 80 year old woman was admitted to the hospital because of mild congestive heart failure. Cardiac examination revealed a 4/6 holosystolic and a 2/6 decrescendo diastolic murmur at the left sternal border. Radiography, echocardiography, and computed tomography confirmed newly diagnosed CCTGA without associated intracardiac defects.