ABSTRACT
Introduction: A paucity in data exists regarding the expected growth rate of myxomas given the prompt transition to surgical intervention on initial discovery. Most case reports describe an initial normal echocardiogram compared with a subsequent echocardiogram revealing a myxoma at the time of diagnosis [1-3]. Uniquely, our case follows the sequential monitored growth of an atrial myxoma with transoesophageal images over a 19-month period. Case: This case describes a 71-year-old woman with a history of hypertension and hypercholesterolaemia admitted with a provoked deep vein thrombosis. This was complicated by bilateral pulmonary emboli and a presumed paradoxical embolus through a patent foramen ovale (PFO) resulting in a middle cerebral artery stroke. She was thrombolysed, then managed with rivaroxaban. During PFO closure, intraoperative transoesophageal echocardiogram (TOE) revealed a new left-sided atrial mass 1.0cm x 0.6cm in size, resulting in procedure abandonment. Uncertainty around diagnosis in addition to delays related to the COVID-19 pandemic led to serial imaging. The mass was monitored via TOE at 5, 11 and 19 months, revealing an initially stable then unexpected rapid progression to a size of 3.6cm x 2.9cm in the final 8 months. The patient had prompt excision of her myxoma and patch closure of interatrial septum. Discussion: This case exhibits a rare opportunity to appreciate the visual progression of an atrial myxoma and the unpredictable rapid growth over an 8-month period, highlighting the importance of interval monitoring of undifferentiated atrial lesions. [Formula presented]
ABSTRACT
Aims The aim of this study is to assess the safety of performing various emergency ENT procedures in a single institution during the COVID-19 pandemic and the impacts on patients and healthcare workers that potentially would have risen from aerosol generating procedures. Methods We retrospectively reviewed patients that underwent any ENT procedure in the ENT Casualty department of South Infirmary University Hospital Cork, from the month of December 2019 until April 2020. Patients were contacted via telephone call and symptoms of COVID-19 were enquire as per standard questionnaire. Two time periods were defined;Period 1 from 1st December 2019 to 28th February 2020 and Period 2 from 29th February to 23rd April 2020. Results 332 patients were included in this study. 226 (80.1%) patients attended in Period 1 and 66 (19.9%) attended in Period 2. In Period 1, 12 (4.5%) patients reported COVID-19 symptoms within 2 weeks of attending and 5 (7.6%) patients reported symptoms in Period 2 of which, 2 of those underwent swabs. Both swabs were negative. None of the clinical staff developed COVID-19 during the study. Conclusion With appropriate PPE and social distancing measures, ENT Casualty services were safe to proceed during the COVID-19 pandemic.