Failure of gated SPECT and echocardiography to detect large apical aneurysm secondary to hyperdynamic left ventricular wall at the aneurysm neck

We present a patient with a history of coronary artery disease and exertional angina after an acute anterior myocardial infarction. Angiography and ventriculography revealed multivessel coronary artery disease and a large apical aneurysm. Echocardiography and gated SPECT studies were performed for further evaluation of ischemia and assessment of left ventricular function. Gated SPECT and echocardiography failed to detect a large apical aneurysm due to a hyperdynamic left ventricular wall at the neck of the aneurysm. This case demonstrates the importance of using multiple imaging modalities in the evaluation of ventricular function in the setting of coronary artery disease.     

Systolic cessation of the flow in the mid stent segment of the previously stented ostial vein graft with normal flow during diastole. A case report and brief review.

We present a case of intermittent cessation of blood flow through stent struts during systole, with normal flow during diastole in the previously stented ostial vein graft. After reviewing the initial procedure, we discovered that the operator had difficulty in positioning the stent. After stent deployment, the ostial stent was malpositioned and was protruding more than 50% into the aorta. During systole, the contrast in the stent struts, which are situated in the aorta, was being washed off by systolic blood flow, while in the diastole, the flow of contrast was normal. This is the first case report of this observation with a brief review.     

In situ demonstration of Epstein-Barr viral genomes in viral-associated B cell lymphoproliferations.

Thirteen cases of benign and malignant Epstein-Barr viral (EBV)-associated B cell lymphoproliferations were examined by in situ hybridization studies performed on formalin-fixed, paraffin-embedded tissue sections. EBV nucleic acids were identified in a minority of lymphoid cells in five of six cases of benign infectious mononucleosis studied in tonsil or lymph node specimens. No evidence of EBV was found in two splenectomy specimens from patients with infectious mononucleosis. EBV nucleic acids were identified in one case of fatal, infectious, mononucleosislike immunoblastic proliferation, and were especially concentrated in areas where there were sheets of immunoblasts associated with necrosis. EBV nucleic acids were identified in all four cases of EBV-associated post-transplant lymphoproliferations, including three cases of non-Hodgkin's lymphoma in which a majority of the neoplastic cells contained EBV nucleic acids.     

A leg ulcer as manifestation of metastatic squamous cell vaginal carcinoma

Cutaneous metastasis of vaginal carcinoma is extremely rare. So far, the total number of reported skin metastasis of vaginal carcinoma is only one. We present another case with an unusual manifestation of vagina carcinoma metastasis: skin metastasis presenting as a leg ulcer on the lower leg.