ABSTRACT
A pulmonary thromboembolism (PTE) causes a dramatic pressure overload to the right heart. Previous case reports have shown that elevated right atrial pressure secondary to a PTE can cause right-to-left shunting in the presence of an atrial septal aneurysm (ASA). A 57-year-old female with diabetes, hypertension, and an old cerebral infarction was admitted to our hospital with acute PTE. Initial transthoracic echocardiography (TTE) showed an ASA swing from the right side to the left side, and right-to-left shunting was detected immediately in the agitated saline test. However, definite signs of pressure overload of the right heart were not detected in the TTE. This educational case shows that right-to-left shunting via a patent foramen ovale in the ASA can cause normal right atrial pressure, thus masking the pressure overload of the right heart in a patient with PTE.
Subject(s)
Female , Humans , Middle Aged , Aneurysm , Atrial Pressure , Cerebral Infarction , Dihydroergotamine , Echocardiography , Foramen Ovale, Patent , Heart , Hypertension , Masks , Pulmonary EmbolismABSTRACT
A pulmonary thromboembolism (PTE) causes a dramatic pressure overload to the right heart. Previous case reports have shown that elevated right atrial pressure secondary to a PTE can cause right-to-left shunting in the presence of an atrial septal aneurysm (ASA). A 57-year-old female with diabetes, hypertension, and an old cerebral infarction was admitted to our hospital with acute PTE. Initial transthoracic echocardiography (TTE) showed an ASA swing from the right side to the left side, and right-to-left shunting was detected immediately in the agitated saline test. However, definite signs of pressure overload of the right heart were not detected in the TTE. This educational case shows that right-to-left shunting via a patent foramen ovale in the ASA can cause normal right atrial pressure, thus masking the pressure overload of the right heart in a patient with PTE.
Subject(s)
Female , Humans , Middle Aged , Aneurysm , Atrial Pressure , Cerebral Infarction , Dihydroergotamine , Echocardiography , Foramen Ovale, Patent , Heart , Hypertension , Masks , Pulmonary EmbolismABSTRACT
Infections associated with Enterococcus durans have been rare in humans until now. E. durans is a frequent component of the intestinal flora of several domestic animal species and may cause septicemia and encephalomalacia in chicks. We report a case of ventriculoperitoneal shunt infection caused by vancomycin-resistant E. durans in a 17-year-old woman with Dandy-walker syndrome. To the best of our knowledge, this is the first human case of ventriculitis caused by vancomycin-resistant E. durans.
Subject(s)
Adolescent , Female , Humans , Animals, Domestic , Dandy-Walker Syndrome , Encephalomalacia , Enterococcus , Sepsis , Vancomycin Resistance , Ventriculoperitoneal ShuntABSTRACT
Infections associated with Enterococcus durans have been rare in humans until now. E. durans is a frequent component of the intestinal flora of several domestic animal species and may cause septicemia and encephalomalacia in chicks. We report a case of ventriculoperitoneal shunt infection caused by vancomycin-resistant E. durans in a 17-year-old woman with Dandy-walker syndrome. To the best of our knowledge, this is the first human case of ventriculitis caused by vancomycin-resistant E. durans.