I-131 uptake in the breast from fat necrosis.

Radioactive iodine I-131 whole-body scintigraphy is used to monitor thyroid cancer metastases after total thyroidectomy. We present a case of a woman who was diagnosed with papillary thyroid cancer and underwent a total thyroidectomy. I-131 scintigraphy revealed abnormal accumulation of radioactive iodine in the right breast causing concern for thyroid cancer metastasis. Mammographic studies confirmed that the abnormal radiotracer accumulation was due to fat necrosis in the breast. I-131 uptake in fat necrosis is a poorly understood process that is not clearly defined in the literature. This case highlights that false-positive uptake of I-131 can mimic metastases of thyroid carcinoma.

Massive Diffuse Calcification of the Ascending Aorta and Minimal Focal Calcification of the Abdominal Aorta in Heterozygous Familial Hypercholesterolemia.

A 41-year-old woman, the mother of 3 offspring, with likely heterozygous familial hypercholesterolemia, had been asymptomatic until age 38 when angina pectoris and exertional dyspnea appeared leading to the discovery of severe multivessel coronary artery disease and a massively calcified ascending aorta. Coronary bypass grafting using the right and left internal mammary arteries did not alleviate the symptoms. Evidence of overt heart failure subsequently appeared and that led to heart transplantation at age 41. She died 22 days later. The occurrence of massive diffuse calcification of the ascending aorta and minimal focal calcification of the abdominal aorta is rare and in the patient described it appears to be the consequence of heterozygous familial hypercholesterolemia.

Syphilis as a Cause of Thoracic Aortic Aneurysm.

In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. The aim of the present study was to emphasize that syphilis remains a major cause of ascending aortic aneurysm. From January 1, 2009, to December 31, 2014, we studied additional 23 patients who had resection of an ascending aortic aneurysm that again histologically had classic features of syphilitic aortitis. All 23 patients were found to have syphilitic aortitis grossly and histologically. The aneurysm involved the ascending portion of aorta in all 23, the arch portion in 12, and the descending thoracic portion in 10. In conclusion, syphilis has far from disappeared. It remains a major cause of ascending aortic aneurysm.

Computed Tomographic and Morphologic Features of Syphilis of the Aorta.

This report describes certain computed tomographic and morphologic features of syphilitic aortitis in 2 patients in whom the process involved the entire thoracic aorta.

Electrocardiographic Total 12-Lead QRS Voltage in Patients Having Operative Resection of Syphilitic Aortic Aneurysm.

Electrocardiographic voltage has been used to determine the presence of left ventricular hypertrophy for about 70 years. Varying electrocardiographic criteria have been applied. We have found total 12-lead QRS voltage to be most useful in this regard. We measured total 12-lead QRS voltage in 24 patients in whom an ascending aortic aneurysm was resected and histologic study of its wall was classic of syphilitic aortitis. In these 24 patients total 12-lead QRS voltage ranged from 57 to 161 mm, averaging 120 ± 32 in the 11 men and 106 ± 24 mm in the 13 women. If normal 12-lead QRS voltage in adults is considered to be >175 mm not a single one of the 24 patients had normal voltage. Indeed, most were in the low normal area. Thus, this study provides some evidence via this indirect means that the heart itself is infrequently involved by syphilitic aortitis which produces an ascending aortic aneurysm of sufficient size to warrant resection.

Clinical and morphologic features of acute, subacute and chronic cor pulmonale (pulmonary heart disease).

Described are certain clinical and morphologic features of one patient with acute, another with subacute, and one with chronic cor pulmonale. All 3 had evidence of severe pulmonary hypertension. The patient with acute cor pulmonale 4 days after coronary bypass for unstable angina pectoris suddenly developed severe breathlessness with cyanosis and had fatal cardiac arrest and necropsy disclosed massive pulmonary embolism. The patient with subacute cor pulmonale had severe right-sided heart failure for 5 weeks and necropsy disclosed microscopic-sized neoplastic pulmonary emboli from a gastric carcinoma without parenchymal pulmonary metastases. The patient with chronic cor pulmonale had evidence of right-sided heart failure for years, the result of primary or idiopathic pulmonary hypertension almost certainly present from birth because the pattern of elastic fibers in the pulmonary trunk was that seen in newborns where the pressure in the pulmonary trunk and ascending aorta are similar. The patient with chronic cor pulmonale had plexiform pulmonary lesions indicative of irreversible pulmonary hypertension. Neither the acute nor the subacute patient had chronic pulmonary vascular changes. All 3 patients had dilated right ventricular cavities and non-dilated left ventricular cavities and only the patient with chronic cor pulmonale had right ventricular hypertrophy.