Low tension breast hydatid cyst-A case report

Features of low tension in breast hydatid cyst and symptoms secondary to cyst dying and disintegration are unique and not yet reported in the literature. An young woman of 30 years complained about pain and vague swelling in the right breast during follow-up with albendazole therapy following second laparotomy for post-surgical residual cavity of hydatid cyst in the left lobe of the liver. Breast ultrasound was diagnostic. Segmental breast excision revealed a large dead hydatid cyst. Postoperative course was uneventful. Breast hydatid cyst may become symptomatic and hypotensive after start of albendazole therapy

Visceral manifestations of von Hippel-Lindau disease: value of ultrasound and CT imaging.

Visceral manifestations of von Hippel-Lindau disease (VHLD) are generally asymptomatic and their early detection is of considerable help in the management. This communication documents the usefulness of imaging studies in detecting visceral manifestations in two cases of VHLD.

Coronary artery ectasia: angiographic, clinical profile and follow-up.

Out of 3200 coronary angiograms we reviewed, there were 144 cases of coronary ectasia--an incidence of 4.5 percent. Among these, 122 were associated with atherosclerotic coronary artery disease, i.e. coronary stenosis more than 50 percent (group A) and 22 not associated with coronary artery disease (group B). The patients in groups A and B were compared with age- and sex-matched patients (group C) (n=100) who had coronary artery disease alone without ectasia. The incidence of ectasia was not increased in patients with thoracoabdominal aortic aneurysm i.e. 2/154 (1.8%) or in patients with peripheral occlusive vascular disease i.e. 5/161 (3.1%). Ectasia was typed according to a modified version of the criteria proposed by Markis et al. Type II was the commonest, followed by type I, III and IV. Right coronary artery was the most commonly involved vessel by ectasia followed by left circumflex, left anterior descending artery and left main coronary artery. Diffuse ectasia was seen more frequently in right coronary artery and localised ectasia in left anterior descending artery. Patients in groups A and B had similar epidemiological characteristics, though more patients with ectasia alone (group B) had better left ventricular function and negative stress tests. The patients in group A had a similar incidence of previous myocardial infarction, coronary risk factor profile, treadmill exercise test status and severity of coronary artery disease when compared to group C. On a mean follow-up of 3+/-1.2 years, all the three groups had similar event rates.

Saccular coronary aneurysms: angiographic and clinical profile and follow-up of 22 cases.

Saccular coronary aneurysms are defined as aneurysms with the transverse dimension at least 1.5 times the longitudinal dimension. Out of 3,200 coronary angiograms reviewed, there were 22 patients (20 males) with saccular coronary aneurysms (totalling 25 aneurysms). The morphology of the aneurysms, the extent and severity of associated coronary lesions, the clinical profile and follow-up data of these patients were analysed. Aneurysms were located in left main coronary artery 3 (12%), left anterior descending coronary artery 13 (52%), right coronary artery 5 (20%) and left circumflex 4 (16%). There were 5 large aneurysms (> 15 mm in diameter) (1 in left main coronary artery, 2 each in right coronary artery and left anterior descending coronary artery) averaging 32 mm in size. Fifteen aneurysms had significant coronary artery stenosis located proximal to it, supporting the theory of post-stenotic dilatation as the aetiology of aneurysm formation. Two patients had associated muscle bridges distal to the aneurysm; 20 had atherosclerotic coronary artery disease and one had coronary artery ectasia. Five patients were lost to follow-up, which ranged from 1 year to 19 years (mean 5.3 +/- 4.1 years). No patient had history suggestive of rupture of the aneurysm on follow-up. Two patients had myocardial infarction in the territory of the vessel with the aneurysm. Rest of the patients were in NYHA class I/II. One large right coronary artery aneurysm was subjected to aneurysmectomy due to symptoms of tricuspid valve obstruction. One left main coronary artery aneurysm measuring 12 mm, on follow-up of 19 years increased in size to 45 mm, in addition the patient developed a right coronary artery aneurysm. Coronary risk factor profiles in the 20 patients with atherosclerotic coronary artery disease and aneurysms were similar to age- and sex-matched control population with atherosclerotic coronary artery disease without aneurysms.

Clinical and angiographic profile and follow-up of myocardial bridges: a study of 21 cases.

Myocardial bridging describes an angiographic entity, which is any degree of systolic narrowing of a coronary artery observed in at least one angiographic projection. Among the cineangiograms of 3200 patients reviewed, there were 21 cases (19 males) of myocardial bridges--incidence of 0.6 percent. Of these, seven had hypertrophic cardiomyopathy, six had atherosclerotic coronary artery disease and remaining eight had no evidence of either. All 21 patients had myocardial bridges in proximal or mid left anterior descending coronary artery. In addition, one case of hypertrophic cardiomyopathy had whole posterior descending coronary artery under a myocardial bridge. Another case of hypertrophic cardiomyopathy had a short normal segment of 5 mm inside a long myocardial bridge of 35 mm (tandem myocardial bridges). The length of the bridges varied from 10 to 35 mm (mean 24.5 +/- 4.5 mm) and diameter stenosis during systole varied from 40-90 percent (mean 70 +/- 8%). Two patients had large saccular coronary aneurysms proximal to the muscle bridge. Four of the eight patients who had neither hypertrophic cardiomyopathy nor coronary artery disease presented with acute anterior wall myocardial infarction and three of them had regional wall motion abnormality of left descending territory. Of the six patients who had coronary artery disease, one had 60 percent left descending artery lesion and two had recanalized segments proximal to the bridge. Five of the above six patients had significant stenosis of other coronary vessels. Four patients were lost to follow-up (mean period 3.4 +/- 2 years). In the coronary artery disease group, one patient underwent coronary artery bypass graft surgery for 3-vessel disease including graft to left descending artery and one developed inferior wall myocardial infarction. The patients in the hypertrophic cardiomyopathy group and "no hypertrophic cardiomyopathy-no coronary artery disease" group were free of events at last follow-up. Long-term prognosis of isolated myocardial bridges appears to be excellent. Degree of systolic narrowing or length of myocardial bridge does not correlate with event rates on follow-up.