Dual left anterior descending coronary artery originating from left main stem and right coronary sinus / 영남의대학술지

Congenital abnormalities of the coronary arteries are found in 0.6% to 1.3% of patients in coronary angiography. Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is incidentally detected during coronary angiography. We report a case of a 65-year-old female with a rare coronary anomaly who was diagnosed with dual LAD via coronary computed tomography and coronary angiography. The imaging studies revealed dual LAD originating from the left main stem and right coronary sinus. These angiographic findings were considered to be consistent with the type IV variety of dual LAD by Spindola-Franco classification. Recognition of dual LAD is important to prevent errors of interpretation of the coronary angiogram and for optimal surgery.

Spontaneous Pneumomediastinum, Pneumopericardium, and Pneumothorax with Respiratory Failure in a Patient with AIDS and Pneumocystis jirovecii Pneumonia

Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneous pneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiency virus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) and P. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax with respiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed by performing methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinum and pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia.

Massive Pulmonary Thromboembolism Treated with Heparin and Extracorporeal Membrane Oxygenation During Cardiogenic Shock

A 48-year-old woman visited the emergency department, complaining of syncope and chest pain. Her initial vital signs were unstable and her blood pressure was manually uncheckable. Despite inotropics and fluid replacement, the patient collapsed and required cardiopulmonary resuscitation (CPR). During the first CPR, emergent echocardiography revealed severe right ventricular dysfunction. Under clinical suspicion of massive pulmonary thromboembolism (PTE), heparin was administered and extracorporeal membrane oxygenation (ECMO) implanted by the femoral vessels during resuscitation. ECMO was removed on the third hospital day and the patient was discharged under a tolerable state. We report the survival of a patient from massive PTE by treatment with heparin therapy and ECMO.