ABSTRACT
Sinus of Valsalva aneurysm is a rare presenting feature of ST-elevation myocardial infarction. We describe such a case which resolved with thrombolysis, and on further investigation, the patient was found to have a large sinus of Valsalva aneurysm. Abnormal gross pathology at the time of surgery was suspected to be aortitis which was only confirmed on postmortem examination 6 months later. We highlight the importance of working closely with a pathologist when aortitis is suspected, because failure to treat it medically results in a poor outcome.
Subject(s)
Aneurysm, False/etiology , Aortic Aneurysm/etiology , Aortitis/etiology , Inferior Wall Myocardial Infarction/etiology , Sarcoidosis/complications , Sinus of Valsalva , Aneurysm, False/surgery , Aortic Aneurysm/diagnosis , Aortic Aneurysm/surgery , Aortitis/diagnosis , Aortitis/surgery , Aortography/methods , Autopsy , Diagnostic Errors , Fatal Outcome , Humans , Inferior Wall Myocardial Infarction/diagnosis , Inferior Wall Myocardial Infarction/therapy , Male , Middle Aged , Predictive Value of Tests , Sarcoidosis/diagnosis , Sinus of Valsalva/diagnostic imaging , Sinus of Valsalva/pathology , Sinus of Valsalva/surgery , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Questions abound regarding natural history and medicolegal implications of untreated peroneal tendon dislocation (PTD) associated with calcaneal fractures. METHODS: We retrospectively analyzed CT scans and anteroposterior ankle radiographs of 79 consecutive calcaneal fractures presenting over 4 years at a single institution. RESULTS: Nineteen patients (24%) had associated PTD, which was initially missed in 10 (53%). Bony fleck was present in 11 (13.75%). Soft tissue swelling at lateral malleolar level, present on radiographs of 18 tendon dislocators (95%), raises likelihood of PTD with increasing specificity the greater the swelling. In 6 patients, surgeons failed to identify on CT spontaneously relocated tendons that then peeped around the posterolateral fibula, a finding not appreciable on 3-dimensional volume-rendering. CONCLUSIONS: Despite a significant association of PTD with calcaneal fractures, it still passes unrecognized all too frequently. Anatomical fracture fixation does not guarantee stable tendon reposition. Further studies are required to elucidate functional outcome of untreated PTD.
