ABSTRACT
Isolated right atrial compression occurred 31 months after aortic valve replacement. Aortic bleeding contained by adjacent pericardium produced a pseudoaneurysm and local atrial tamponade. Transthoracic echocardiography could not distinguish the extracardiac hematoma from an intra-atrial thrombus, temporarily misleading investigators.
Subject(s)
Aneurysm, False/etiology , Aortic Valve/surgery , Cardiac Tamponade/etiology , Heart Aneurysm/etiology , Heart Atria , Heart Valve Prosthesis/adverse effects , Hemorrhage/etiology , Adult , Humans , Male , Time FactorsABSTRACT
Two years and eight months after having had hyperalimentation during an infection, a 4-year-old boy was readmitted to the hospital with a viral syndrome. A chest X-ray film showed calcification over the right heart. After treatment of the viral problem, the boy was readmitted for evaluation of the calcifications. Percutaneous angiography demonstrated right atrial filling defects in the areas of calcification. The inferior vena caval pressures were normal. An echocardiogram showed a normal left atrium and mitral valve but did not reveal the masses within the right atrium. An electrocardiogram showed mild right ventricular hypertrophy. The patient subsequently underwent resection of 75% of the right atrial wall, which was involved with the growth, and this was reconstructed by using pericardium. The final pathological report described marked endocardial fibrosis infiltrated by chronic inflammatory cells consistent with organized mural thrombus. This case represents a complication of central venous catheterization secondary to traumatization of the endocardium by constant action of the heart against an indwelling catheter.
ABSTRACT
The charts of 663 patients who had cholecystectomy were reviewed to determine the usefulness of preoperative radiologic examination of the upper gastrointestinal tract. In 14% of the patients a positive finding was reported. However, slightly less than half of these findings were confirmed at surgery. Only 2.9% of the patients had a procedure in addition to cholecystectomy. It is felt that routine examination of the upper GI tract is not indicated in the preoperative evaluation of patients with gallbladder disease unless the clinical history is equivocal and one suspects coincidental disease.