ABSTRACT
AIM: To evaluate the referrals with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC) and compare cardiac MR (cMR) findings against clinical diagnosis. METHODS: A retrospective analysis of 114 (age range 16 to 83, males 55% and females 45%) patients referred for cMR with a suspected diagnosis of ARVC between May 2006 and February 2010 was performed after obtaining institutional approval for service evaluation. Reasons for referral including clinical symptoms and family history of sudden death, electrocardiogram and echo abnormalities, cMR findings, final clinical diagnosis and information about clinical management were obtained. The results of cMR were classified as major, minor, non-specific or negative depending on both functional and tissue characterisation and the cMR results were compared against the final clinical diagnosis. RESULTS: The most common reasons for referral included arrhythmias (30%) and a family history of sudden death (20%). Of the total cohort of 114 patients: 4 patients (4%) had major cMR findings for ARVC, 13 patients (11%) had minor cMR findings, 2 patients had non-specific cMR findings relating to the right ventricle and 95 patients had a negative cMR. Of the 4 patients who had major cMR findings, 3 (75%) had a positive clinical diagnosis. In contrast, of the 13 patients who had minor cMR findings, only 2 (15%) had a positive clinical diagnosis. Out of the 95 negative patients, clinical details were available for 81 patients and none of them had ARVC. Excluding the 14 patients with no clinical data and final diagnosis, the sensitivity of the test was 100%, specificity 87%, positive predictive value 29% and the negative predictive value 100%. CONCLUSION: CMR is a useful tool for ARVC evaluation because of the high negative predictive value as the outcome has a significant impact on the clinical decision-making.
ABSTRACT
Pulmonary artery pseudoaneurysms (PAP) may result in life threatening haemoptysis but are fortunately uncommon. Most are caused by trauma, iatrogenic injury or infection. We describe a case of large PAP secondary to fungal infection in an immunocompromised patient, which was successfully treated percutaneously using Amplatzer embolisation plugs. The technical considerations and advantages of these new devices are explained.
ABSTRACT
A 60-year-old lady was admitted in the hospital with the complaints of burning sensation during micturition and abdominal pain. She was diagnosed to have moderate hydronephrosis with left lower 1/3rd ureteric calculus for which ureteroscopy and lithotripsy were done. Her pre-operative random blood sugar was normal. On the 7th postoperative day the patient developed diabetic keto-acidosis which was followed by an acute onset of right sided peri-orbital oedema, proptosis and facial pain. Subsequently she developed diminished vision and lower motor neurone type of Ill, IV and VI cranial nerves paralysis on right side, disorientation and minimal left sided hemiparesis. ENT examination revealed black eschar nasal turbinates, nasal septum and palate and a provisional diagnosis of rhino-orbital cerebral mucormycosis was made. Extensive debridement was done for the patient and the specimen culture showed growth of mucor species. Patient was started on intravenous amphotericin-B and she started improving dramatically. This case of rhino-orbital cerebral mucormycosis with diabetic keto-acidois is presented here for its rarity.
