Large Right Atrial Myxoma Presenting As Bilateral Pulmonary Embolism.

Myxoma is a rare benign tumor of the heart. Cardiac myxomas are the most common primary cardiac tumor in adults, commonly found within the left atrium. It can occur at any age and is more common in females than males. This case report aims to identify the clinical symptoms of cardiac myxoma, which can be life-threatening if neglected. Here, we present the case of a 30-year-old female with past smoking history. For the past three to four weeks before this hospitalization, her symptoms worsened including shortness of breath with exertion, dry cough, and pleuritic chest pain. Outpatient treatment with antibiotics and nebulizers did not relieve her symptoms. She went to the emergency room and underwent computed tomography of the chest with contrast showing bilateral lower lobe pulmonary emboli and a large mass in the right atrium. Intravenous unfractionated heparin was initiated. A transthoracic echocardiogram confirmed a 3.76 cm × 4.95 cm mass in the right atrium. The patient underwent surgical resection of the right atrial mass the following day and was discharged four days later in a stable condition. Pathology of the mass confirmed atrial myxoma.

Third Cranial Nerve Palsy Due to COVID-19 Infection.

Coronavirus disease 2019 (COVID-19) is known to be primarily a viral infection affecting the pulmonary system leading to severe pneumonia and acute respiratory distress syndrome. COVID-19 has also been found to affect the neurological system causing various nerve palsies. While some studies have suggested these neurological manifestations may indicate severe disease, cranial nerve palsies in the setting of COVID-19 infection have been linked to improved patient outcomes and mild viral symptoms. We present a case of a 55-year-old male with confirmed COVID-19 infection presenting with third cranial nerve palsy. Since his hospital course remained unremarkable, he was treated supportively for his COVID-19 infection and remained stable on room air during his hospitalization. No causative factors other than COVID-19 were identified as a cause for his cranial three nerve palsy which resolved spontaneously during outpatient follow-up. Although different cranial nerve palsies associated with COVID-19 infection have been identified in the literature, the pathogenesis and prognosis of cranial nerve palsy is still unclear. This case emphasizes the need for continued symptom monitoring and identification in patients diagnosed with COVID-19.

Anti-synthetase syndrome: a rare and challenging diagnosis for bilateral ground-glass opacities-a case report with literature review.

BACKGROUND: Anti-synthetase syndrome (ASS) is an uncommon immune-mediated entity characterized by myositis, interstitial lung disease (ILD), non-erosive arthritis, and less common features such as fever, Raynaud's phenomenon, and skin changes in association with anti-aminoacyl-transfer-RNA antibodies, most commonly anti-Jo-1 antibodies. CASE PRESENTATION: We present a challenging and rare case of ASS-associated ILD presenting with unexplained respiratory symptoms and bilateral infiltrates on chest imaging during the COVID-19 pandemic. High clinical suspicion for ASS with early appropriate therapy with corticosteroids and immunosuppressive agents led to marked clinical improvement. CONCLUSION: High index of suspicion for ASS is mandated in patients with unexplained ILD. A comprehensive autoimmune work-up is important as an early treatment with corticosteroids with or without immunomodulators improves patient outcomes and survival in an otherwise poor prognostic disease.

Pulmonary Embolism in COVID-19 Treated with VA-ECLS and Catheter tPA.

BACKGROUND: Novel coronavirus 2019 (COVID-19) has been the focus of the medical world since being declared a pandemic in March 2020. While the pathogenesis and heterogeneity of COVID-19 manifestations is still not fully understood, viral evasion of cellular immune responses and inflammatory dysregulation are believed to play essential roles in disease progression and severity. CASE PRESENTATION: We present the first case of a patient with COVID-19 with massive pulmonary embolism treated successfully with systemic thrombolysis, VA-ECLS, and bail out catheter directed thrombolysis. He was discharged from the hospital after an eventful hospital course on therapeutic anticoagulation with warfarin. CONCLUSIONS: We present the first case of a patient with COVID-19 with massive pulmonary embolism (PE) treated successfully with systemic thrombolysis, VA-ECLS and bail out catheter directed thrombolysis. In our experience catheter directed thrombolysis comes with an acceptable bleeding risk despite use of mechanical circulatory support, particularly with meticulous attention to vascular access and dose response monitoring.

Life-Threatening Psoas Hematoma due to Retroperitoneal Hemorrhage in a COVID-19 Patient on Enoxaparin Treated With Arterial Embolization: A Case Report.

Respiratory failure is presumptively caused by microvascular thrombosis in some patients with coronavirus disease 2019 (COVID-19) requiring therapeutic anticoagulation. Anticoagulation treatment may cause life-threatening bleeding complications such as retroperitoneal hemorrhage. To the best of our knowledge, we report first case of a COVID-19 patient treated with therapeutic anticoagulation resulting in psoas hematoma due to lumbar artery bleeding. A 69-year-old patient presented with fever, malaise and progressive shortness of breath to our hospital. He was diagnosed with COVID-19 by RT-PCR. Due to an abnormal coagulation profile, the patient was started on enoxaparin. Over the course of hospitalization, the patient was found to have hypotension with worsening hemoglobin levels. Computed tomography scan of the abdomen and pelvis revealed a large psoas hematoma. Arteriogram revealed lumbar artery bleeding which was treated with embolization. Anticoagulation therapy, while indicated in COVID-19 patients, has its own challenges and guidelines describing dosages and indications in this disease are lacking. Rare bleeding complications such as psoas hematoma should be kept in mind in patients who become hemodynamically unstable, warranting prompt imaging for diagnosis and treatment with arterial embolization, thus eliminating need of surgical intervention.

Successful Maternal and Fetal Outcomes in COVID-19 Pregnant Women: An Institutional Approach.

BACKGROUND Novel Coronavirus 2019 (COVID-19) has been defined as a pandemic infecting millions of individuals with a significantly high mortality and morbidity rate. Treatment and management for pregnant patients infected with COVID-19 has been poorly described in the literature. Furthermore, vertical transmission of COVID-19 to the fetus has been poorly described. The purpose of this case series is to present 3 patients in their trimester who underwent emergent cesarean sections and were successfully managed in the intensive care unit. CASE REPORT We present the cases of 3 patients diagnosed with COVID-19 via RT-PCR in their third trimester of pregnancy. All patients underwent emergent cesarean sections and were managed on mechanical ventilation in the intensive care unit and eventually discharged in stable condition. CONCLUSIONS Early cesarean section and aggressive management with mechanical ventilation has been shown to be very beneficial for mothers diagnosed with COVID-19 and their infants. All 3 patients were successfully extubated, and all 3 infants tested negative for COVID-19, suggesting no vertical transmission; although, further studies are needed to confirm this finding.

Cocaine-Induced Giant Bullous Emphysema.

BACKGROUND: Emphysematous bullae, defined as airspaces of greater than or equal to one centimeter in diameter, have a variety of etiologies such as tobacco use and alpha-1 antitrypsin being the most common. Emphysematous bullae have also been reported in patients using cocaine usually involving the lung periphery and sparing the central lung parenchyma. We present a case of a male with a history of cocaine abuse found to have a singular giant emphysematous bulla occupying >95% of the right hemithorax requiring video-assisted thoracic surgery (VATS) with a favorable outcome. Case Presentation. A 50-year-old male with a history of chronic cocaine abuse was found unresponsive in the field and given multiple doses of naloxone without any improvement in mental status. On presentation to the emergency department, chest X-ray as well as CT scan of the chest were performed which were suggestive of an extensive pneumothorax of the right lung requiring placement of a chest tube. The patient was subsequently intubated and underwent bronchoscopy with right chest VATS which found a giant bulla encasing the entire right pleural cavity. During the procedure, he underwent resection of the bullae and a partial right pleurodesis. After the procedure, patient's respiratory status significantly improved, and he was discharged in a stable condition. CONCLUSION: Cocaine use is a rare but identifiable factor that can cause giant bullous emphysema (GBE) resulting in severe complications and even death. The purpose of this case presentation is to support early identification and treatment of GBE using bullectomy with VATS, improving outcomes and decreasing morbidity and mortality.

An Unusual and Fatal Cause of Miliary Nodules on Chest Radiography.

Foreign body granulomatosis has many etiologies, including the injection of oral medications intravenously. The insoluble filler materials that are used in the medications can lodge in pulmonary arterioles and capillaries, which can trigger foreign body giant cell reaction, chronic inflammation, thrombosis, and fibrosis, resulting in pulmonary hypertension, progressive shortness of breath, and, potentially, fatal conditions. On imaging, this may present with multiple miliary mottling’s/nodules. The use of a bronchoscopy with biopsy can be an excellent way to establish a diagnosis in appropriate clinical settings. Here, we present a case of a 37-year-old old male found to have multiple miliary densities on imaging due to intravenous use of oral medication.