Uterine didelphys with transverse vaginal septum in a 16-year-old female: the third case report in the medical literature.

Müllerian duct anomalies (MDAs) are congenital disorders of the female genital tract resulting from abnormal embryological development of the Müllerian ducts. These abnormalities occur in approximately 0.5%-5.0% of the general population. The case involves a 16-year-old Middle Eastern female referred to the clinic due to primary amenorrhea and lower abdominal pain. Upon evaluation, we identified a congenital anomaly known as uterine didelphys with a transverse vaginal septum. Uterine didelphys is a type of Müllerian duct anomaly characterized by the complete duplication of the uterus, cervix, and sometimes the vagina. Our case is exceptional, as most reported instances feature a longitudinal vaginal septum with uterine didelphys, and it is rare to find both longitudinal and transverse vaginal septa. The combination of uterine didelphys with only a transverse vaginal septum is extremely rare. To the best of our knowledge, this is only the third reported case of its kind.

Navigating complex cardiac complications: A case report of alcoholic cardiomyopathy and right atrial thrombosis.

RATIONALE: Alcoholic cardiomyopathy (ACM) is associated with various cardiac complications, but the development of isolated right atrial (RA) thrombus without deep vein thrombosis is rare and presents diagnostic challenges. PATIENT CONCERNS: A 53-year-old Hispanic male presented with shortness of breath, chills, cough, bilateral lower extremity edema, and distended abdomen. DIAGNOSES: The patient was diagnosed with ACM, liver cirrhosis, and a large RA thrombus. Initial transthoracic echocardiography showed severe left ventricular systolic dysfunction but failed to detect the RA mass. Subsequent computed tomography scan and transesophageal echocardiography revealed a large oval mass in the RA, measuring 40 mm × 22 mm × 18 mm. INTERVENTIONS: The patient received guideline-directed medical therapy for heart failure and anticoagulation with enoxaparin. He underwent cardiac catheterization for mechanical thrombectomy, which was minimally successful. OUTCOMES: The patient's condition was managed with the prescribed interventions. Regular follow-up was planned to assess thrombolysis. LESSONS: RA thrombosis is an uncommon complication of ACM. A multimodal imaging approach, with a low threshold for transesophageal echocardiography, is crucial in evaluating patients with ACM who present with cardiac complications. This approach enables accurate diagnosis and management of rare conditions like isolated RA thrombosis.

Hyperacute epidural hematoma following ventriculoperitoneal shunt placement: A fatal case presentation and discussion of management strategies.

INTRODUCTION: An Epidural hematoma following a Ventriculoperitoneal shunt is a critically rare complication. Due to that rarity and potential dangers, we present a case where the patient became symptomatic 8 h after shunting requiring craniotomy for evacuation of the hematoma. The literature and treatment options were discussed. CASE PRESENTATION: A 40-year-old male arrived to the emergency department in a comatose state with dilated pupils, 8 h post-ventriculoperitoneal shunt placement. Computed tomography showed a massive hyperacute epidural hematoma causing severe midline deviation and subfalcine herniation, leading to emergency craniotomy. Despite surgical intervention and intensive care, the patient's condition did not improve, resulting in his death. DISCUSSION: Epidural hematomas (EDHs) are an infrequent complication of ventricular drainage procedures, occurring at a documented frequency of 0.4 %, often presenting with symptoms mimicking shunt malfunction or mass lesions. Diagnosis involves computed tomography (CT) scans, but magnetic resonance imaging (MRI) may be more sensitive. Treatment options include conservative management and surgical intervention, with prognosis heavily dependent on the patient's neurological status at the time of surgery, with mortality rates varying based on level of consciousness. CONCLUSION: This study presents a rare case of fatal hyperacute epidural hematoma following Ventriculoperitoneal shunt (VPS) placement in a 40-year-old man, highlighting the importance of early detection and intervention. The hypotheses suggests overloaded pressure on the dura during ventricular end insertion. Despite available treatment options, patient prognosis depends on neurological status at the time of surgery, emphasizing the need for further research into effective management strategies for this complication.