Prenatal diagnosis of a right coronary artery to right atrial fistula with a giant coronary artery aneurysm: A case report

Coronary artery fistula (CAF) is a rare cardiac anomaly. Here, we diagnosed a right coronary artery-right atrium fistula with giant coronary artery aneurysm (CAA) via fetal echocardiography at 35 weeks' gestation. An urgent caesarean delivery was performed at 36 weeks' gestation because CAA caused mitral obstruction, and fetal atrial flutter was present. Following delivery, we performed aneurysm ligation because the new-born developed atrial tachycardia. The intraoperative findings confirmed the sonographic findings. To the best of our knowledge, prenatal ultrasound diagnosis of CAF and giant CAA has not been reported in the literature. We focus on the ultrasonic characteristics and differential diagnosis in this literature.     

右肺动脉左房瘘1例

患者，男，23岁．因反复咳血5天于当地医院就诊，行胸部CT示右下后纵隔肿瘤样病变就诊。查体：口唇青紫．杵状指．双肺呼吸音清，无啰音．心律齐，无杂音。血常规：RBC8．29×10^12／L，HRG184．1g／L。血气Pa 44．8mmHg，SO2 82．3％．考虑是否合并心脏病，追问病史，患者有家族发绀病史。     

Cardiac arrest due to massive aspiration from a broncho-esophageal fistula: A case report

BACKGROUNDTracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARYWe present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt. He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit. The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest. Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.CONCLUSIONThe aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression. We aim to illustrate pitfalls in the endoscopic examination and provide further awareness on critical care monitoring and management strategies to reduce its morbidity and mortality.     

超声心动图诊断先天性左心耳瘤1例

正患者女,53岁,因发作性胸闷痛半个月就诊。体格检查:神志清楚、精神好,心率80次/min,律齐,各瓣膜听诊区未闻及病理性杂音。心电图提示:窦性心律。经胸超声心动图(TTE):各房室腔内径正常范围;各瓣膜未见明显异常,三尖瓣轻度反流;左室壁节段性运动未见异常;房、室间隔连续完整;大动脉起源、连接正常;肺静脉未见异常引流;左室射血分数62%;左房后外侧探及囊性包块,大小约3.9 cm×4.3 cm,与左房相通,开口处径线3.9 cm(图1)。经食管超声心动图(TEE)检查:左心耳菲薄,呈瘤样扩张膨凸,开口处径线3.3 cm,深度4.6 cm,瘤腔内见云雾状回声,未见血栓形成(图2,3)。TEE联合TTE诊断:左心耳瘤,瘤腔内未见血栓形成。由于患者左心耳瘤未压     

Laparoscopic surgery for sigmoidocutaneous fistula due to diverticulitis: A case report

Sigmoidocutaneous fistulas due to sigmoid colon diverticulitis are very rare. Here we report a case in which laparoscopic sigmoidectomy was used to successfully treat a sigmoidocutaneous fistula due to diverticulitis. A 41‐year‐old man was admitted to our hospital because of redness and swelling of the left inguinal skin. Enhanced abdominal CT revealed a subcutaneous abscess in the left lower abdomen. Percutaneous drainage was performed, and fistulography revealed a fistula between the sigmoid colon and left inguinal skin. Therefore, a sigmoidocutaneous fistula was diagnosed, and laparoscopic sigmoidectomy and fistulectomy were performed. The sigmoid colon had several diverticula, and a pathological examination revealed that the sigmoidocutaneous fistula was due to diverticulitis. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. In cases of sigmoidocutaneous fistula, laparoscopic treatment can be safely performed.     

Echocardiographic features of atrial myocarditis with giant cells: a case report.

We report a case of restrictive cardiomyopathy in which a distinct endothelial thickening of the atrial wall and pulmonary vein orifices was noted on transesophageal echocardiography. Echocardiographically guided endomyocardial biopsy of the thickening revealed an inflammatory infiltrate that was rich in giant cells and provided important clues about an underlying immune mechanism for the pathogenesis. Positive results from the antineutrophil cytoplasmic autoantibody assay supported the diagnosis of Wegener's granulomatosis. After immunosuppressive therapy, the endomyocardial thickening completely resolved, but the restrictive cardiomyopathy did not reverse.     

右冠状动脉右房瘘并冠状动脉瘤1例

患者男,45岁。劳累后心悸、气短9个月,近1周逐渐出现咳嗽、夜间不能平卧及颜面浮肿。查体:一般状态尚可,血压110/160mmHg。心界向左下扩大,胸骨左缘第2、3肋间闻及双期连续性杂音,肺动脉第二音亢进。双侧股动脉枪击音及毛细血管征阳性。胸片:心脏呈主动脉瓣型,心胸比率为0.68,左心室段延长,心尖饱满、圆钝。右前斜吞钡食管中段未见受压移位改变,左前斜位片见心前缘上部呈半圆形状突出(图1)。心电图示:右心室肥厚。心脏彩超:右冠状动脉起始处呈瘤样扩张,开口处内径22mm,向外走行瘤体内径54mm,范围67mm,向右呈管状结构纡曲走行,远侧内径为13m…     

Pyoderma gangrenosum confused with congenital preauricular fistula infection: A case report

BACKGROUND Pyoderma gangrenosum resulting from or associated with congenital preauricular fistula is rarely reported.CASE SUMMARY We report a rare case of pyoderma gangrenosum misdiagnosed as preauricular fistula infection.To our knowledge,this is the first report to describe pyoderma gangrenosum originating from the site of preauricular fistula.The lesion continued expanding even after combined treatment of systemic antibiotics and thorough debridement.Taking into account the possibility of pyoderma gangrenosum,we applied soft care with normal saline and Vaseline gauze dressing.Systemic corticosteroids were not used until intestinal Clostridium difficile was controlled.No local recurrence was noted at the 12-mo follow-up.CONCLUSION This case highlights the necessity of considering rare diseases,such as pyoderma gangrenosum,when the preauricular sinus deteriorates with general management.The treatment strategy is mutually conflicting between pyoderma gangrenosum and infection of the preauricular sinus.     

Accidental esophageal intubation via a large type C congenital tracheoesophageal fistula: A case report

BACKGROUNDTracheoesophageal fistula (TEF) is a congenital anomaly characterized by interruptions in esophageal continuity with or without fistulous communication to the trachea. Anesthetic management during TEF repair is challenging because of the difficulty of perioperative airway management. It is important to determine the appropriate position of the endotracheal tube (ETT) for proper ventilation and to prevent excessive gastric dilatation. Therefore, the tip of the ETT should be placed immediately below the fistula and above the carina.CASE SUMMARYA full-term, one-day-old, 2.4 kg, 50 cm male neonate was diagnosed with TEF type C. During induction, an ETT was inserted using video laryngoscope and advanced deeply to ensure that the tip passed over the fistula, according to known strategies. The passage of the ETT through the vocal cords was confirmed via video laryngoscope. However, after inflating the ETT cuff, breath sounds were not heard on bilateral lung auscultation. Instead, gastric sounds were heard. Considering that a large fistula (approximately 6.60 mm × 4.54 mm) located 10.2 mm above the carina was confirmed on preoperative tracheal computed tomography, the possibility of unintentional esophageal intubation was highly suspected. Therefore, we decided to uncuff and withdraw the ETT carefully for repositioning, while monitoring auscultation and end-tidal CO₂ simultaneously. At a certain point (9.5 cm from the lip), clear breath sounds and proper end-tidal CO₂ readings were suddenly achieved, and adequate ventilation was possible.CONCLUSIONPreanesthetic anatomical evaluation with imaging studies in TEF is necessary to minimize complications related to airway management.     

Spontaneous pneumomediastinum due to achalasia: a case report

Spontaneous pneumomediastinum (SPM) is a rare and benign clinical entity characterized by free air around mediastinal structures. Precipitating factors include violent cough, asthma, inhalational drugs, labor and exercise. We report a case of SPM due to achalasia which to the best of our knowledge, has never been reported. In achalasia, Valsalva maneuver might accompany severe vomiting. This causes alveolar rupture due to elevated intrabronchial and intra-alveolar pressure. Air tracks along the mediastinal spaces cause SPM. In our patient, there was no evidence of esophageal perforation. Tension pneumomediastinum and pneumothorax are complications of SPM.     

房颤性肾梗死1例

患者男,55岁.3天前因进食不洁出现脐周持续性隐痛,阵发性绞痛,予以山莨菪碱等对症治疗可缓解,伴恶心、呕吐2次,无腹泻、发热.     

肝动脉门静脉瘘相关肺动脉高压1例报告

1 病例资料 1.1 病 史 患者女性,67 岁,1 年前无明显诱因出现登楼后心悸、气短,无明显胸闷、胸痛,无咳嗽、咯痰,无头晕、黑矇等不适.患者于2019 年4 月15 日来院就诊,心超示:左房增大,余腔室形态、功能未见明显异常,肺动脉收缩压31 mmHg(1 mmHg=0.133 kPa).     

Fenofibrate-induced rhabdomyolysis in a patient with chronic renal failure due to nephrotic syndrome: a rare case report

ObjectivesFenofibrate is a fibric acid derivative that is used alone or combination with statins in the treatment of hyperlipidemia. These drugs have potential risks, including rhabdomyolysis and acute renal failure. Despite reports of rhabdomyolysis with the use of fenofibrate alone or with statin-fibrate combinations, there have been no cases of rhabdomyolysis described when fenofibrate was used alone to treat patients with chronic renal failure owing to nephrotic syndrome.Design and methodsWe report on a 26-year-old male who presented with fenofibrate-induced rhabdomyolysis with chronic renal failure due to nephrotic syndrome.ResultsAfter the discontinuation of fenofibrate, the patient was treated with intravenous fluid replacement and urine alkalization. Subsequently, his clinical and biochemical findings improved.ConclusionsBefore starting fenofibrate therapy, the causes of secondary hyperlipidemia, especially nephrotic syndrome, should be investigated. In the presence of chronic renal failure and hypoalbuminemia, the fenofibrate dose should be adjusted. Physicians should be aware of the potential toxicities of fenofibrate, and patients should be informed about its potential side effects.