Successful outcome of medical therapy in a case of acute massive pulmonary thromboembolism presenting with saddle thromboembolus.

Antemortem diagnosis of acute massive pulmonary thromboembolism (PTE) with a large thromboembolus at the bifurcation of the pulmonary trunk (saddle thromboembolus) is difficult, as most patients either die or are too ill for any diagnostic imaging. We report a case of massive PTE where constrast enhanced computed tomographic (CECT) scan of chest detected a saddle thromboembolus and showed its resolution with anticoagulant treatment. In our case, the presenting feature was unusual massive PTE as there was no haemodynamic instability or hypoxaemia.

Emphysematous pyelonephritis.

Emphysematous pyelonephritis is a rare life-threatening suppurative necrotising infection of the renal parenchyma and perirenal tissue producing abscess formation and intrarenal gas. It is almost always seen in diabetics, making it a concern of the physician. A high index of suspicion is required for diagnosis and a combined approach has significantly reduced the mortality.

Gerbode's defect--a rare type of ventricular septal defect.

We report on an elderly lady in the sixth decade of life with congenital Gerbode's defect who refused surgery. She has atrial fibrillation, massive cardiomegaly and repeated episodes of lower respiratory tract infection.