Spontaneous adrenal haemorrhage after catheter ablation of supraventricular tachycardia.

Catheter ablation is established as a first-line therapy for most patients with recurrent supraventricular tachycardia (SVT), with high success rates and very low complication rates. A 60-year-old woman developed severe right flank pain following straightforward catheter ablation for SVT. This was caused by a spontaneous right adrenal haemorrhage, which, after much delay, was eventually recognised as the cause of her symptoms. Adrenal haematomas are rare and, to the best of our knowledge, this is the first reported case of spontaneous adrenal haemorrhage occurring after any interventional cardiac procedure. Clinicians should be aware of this rare but potentially serious complication and consider it as a differential diagnosis in any patient with severe flank pain following interventional cardiac procedures, to prevent delays in diagnosis.

Acute unilateral facial nerve palsy.

Mrs PS, 78 years of age, presented with acute left-sided otalgia, ear swelling and subsequent unilateral facial paralysis (Figure 1). She denied any otorrhoea or hearing loss. Past medical history relevant to the presenting complaint included: * Bell palsy diagnosed 20 years ago with no residual effect * biopsy confirmed benign parotid lump (diagnosed 3 years previously). Histopathology revealed a pleomorphic adenoma. Mrs PS declined surgical intervention at the time * chicken pox as a child * normal fasting blood glucose 1 month previously and no known immune compromise. Examination revealed yellow crusts and small vesicles on the external acoustic meatus (Figure 2). A 10 mm well defined firm and nontender nodule was palpable at the ramus of the mandible.