The challenging management of cardiac involvement in systemic sarcoidosis.

A 34 year-old young man came to our attention after an occasional finding of complete AV block. We made the diagnosis of systemic sarcoidosis with cardiac involvement through an FDG-PET even with a normal CMR. We started corticosteroid therapy and we decided to follow-up the patient through an implantable loop recorder (ILR). Beyond an initial regression of the AV block, after 8 months the ILR revealed AV block and pauses more than 3 s during the day; a new FDG-PET evidenced FDG uptake in new areas of left ventricle. Hence we started infliximab and implanted a dual chamber ICD.

Magnetic resonance imaging of pure ovarian dysgerminoma: a series of eight cases.

BACKGROUND: Imaging findings have a prominent role in early and correct identification of ovarian dysgerminoma, the most common ovarian malignant germ cell tumor (OMGCT). Despite Computed Tomography (CT) is widely used, Magnetic Resonance Imaging (MRI) has proved to be superior in adnexal masses characterization. Limited data and small series are available concerning MRI aspects of dysgerminoma. CASE PRESENTATION: From January 2012 to December 2018, a database of solid ovarian masses was retrospectively reviewed. Eight patients with histologically proven pure ovarian dysgerminoma and complete imaging available were identified and analyzed. Imaging findings were evaluated separately by two radiologists expert in female genito-urinary MRI. CONCLUSIONS: MRI findings of a lobulated, purely solid, encapsulated mass with hyper-intensity of lobules and hypo-intensity of septa on T2w images contribute to differentiate dysgerminomas from other ovarian neoplasms.

A giant isolated right coronary aneurism.

A previously healthy 32-year-old female hailing from Mexico presented to the emergency department with rectorrhagia. Caseating granulomas were detected on histopathological analysis from cecum ulcerative lesions. A purified protein derivative skin test resulted positive. In order to exclude pulmonary tubercolosis, a CT lung scan was performed: a rounded and voluminous mass, located above the right atrioventricular cardiac junction, was unexpectedly revealed. Further, a cardiac magnetic resonance and a coronary angiography disclosed a giant (5 × 4,8 cm) isolated aneurysm of proximal right coronary artery with severe thrombotic layering. The patient was treated with isoniazid, rifampin, ethambutol, and pyrazinamide; after approximately 2 months of treatment, she had complete resolution of cecal lesions. Anticoagulant oral therapy with warfarin was started and the patient was submitted to coronary artery grafting bypass surgery.

Electrocardiogram and Imaging: An Integrated Approach to Arrhythmogenic Cardiomyopathies.

Cardiovascular imaging has radically changed the management of patients with arrhythmogenic cardiomyopathies. This article focuses on the role of echocardiography and MRI in the diagnosis of these structural diseases. Cardiomyopathies with hypertrophic pattern (hypertrophic cardiomyopathy, restrictive cardiomyopathies, amyloidosis, Anderson-Fabry disease, and sarcoidosis), cardiomyopathies with dilated pattern, inflammatory cardiac diseases, and right ventricular arrhythmogenic cardiomyopathy are analyzed. Finally, anatomic predictors of arrhythmias and sudden cardiac death are discussed. Each paragraph is attended by clinical cases that are discussed on the electrocardiogram, after integrated with the anatomic, functional, and hemodynamic modifications of cardiovascular imaging.

CT angio for the evaluation of graft patency.

Invasive coronary angiography (ICA) is the traditional method for the follow-up of graft patency in coronary artery bypass graft (CABG) patients. Nevertheless, the advent of multidetector computed tomography (MDCT) opened new perspectives for using a noninvasive, equally reliable method to study CABG patients. This review article will analyze the current feasibility of modern multi-slice MDCT, as well as its future perspectives.

Thoracic splenosis. Report of a case and review of the diagnostic workup.

UNLABELLED: Splenosis is the autoimplantation of splenic tissue to ectopic sites after spleen injury. Although splenosis most commonly occurs in the abdomen, it may occur in the thorax in case of diaphragm rupture. Thoracic splenosis (TS) is often asymptomatic and is diagnosed incidentally in the course of chest examination. We describe the case of a man, with a history of thoracoabdominal trauma, undergoing routine chest radiography with the evidence of radio-opaque images close to the inferior left curvature of the cardiac shadow, which resulted to be nodules of TS at the contrast enhanced CT scan. CT scan or MRI and an accurate anamnesis are usually sufficient to diagnose TS, otherwise scintigraphy with 99mTc is needed. Imaging-guided biopsy and thoracoscopy should be performed if scintigraphy is unavailable or results are inconclusive. It is not usually necessary to remove the TS because the splenic tissue is slow growing, non-invasive and benign. Rarely surgery may be required for symptomatic TS (hemoptysis, cough or pleuritic chest pain). TS may be difficult to diagnose, especially if features suggesting TS are not recognized and the anamnesis in not known. This may lead to an extensive work-up and unnecessary invasive diagnostic procedures (including biopsy, thoracoscopy, up to thoracotomy). In the workup of thoracic nodules TS should be considered in patients with a history of trauma and spleen injury. KEY WORDS: Thoracic splenosis, Spleen, Mediastinal nodules, Thoracoabdominal trauma.

Symptomatic annular pancreas in adult: Report of two different presentations and treatments and review of the literature.

Annular pancreas (AP) in adults is a rare embryologic abnormality detected after development of complications or as incidental finding. Diagnosis and treatment strategies for symptomatic adult AP remain controversial. We describe two different presentation of AP: a woman with a specific upper abdominal pain treated with medical therapy and a man with upper gastroenteric obstructive symptoms which underwent surgical duodeno-jejunal by-pass. English language literature about annular pancreas etiology, diagnosis and treatment was reviewed. No specific guidelines and protocols exist about management of AP, therefore, treatment and operative approaches must be individualized. In consideration of the possible post-operative complications, surgical treatment should be reserved in case of failure of conservative medical therapies.

Noninvasive midterm follow-up of radial artery bypass grafts with 16-slice computed tomography.

BACKGROUND: The standard invasive procedure to evaluate graft patency is selective coronary angiography. The recent introduction of a new generation of multidetector row computed tomography made possible the noninvasive study of grafts with excellent results in terms of visualization and resolution. We used computed tomography to study all patients with a radial artery graft operated on in 2002. METHODS: Between April and October 2005, we reviewed all patients operated on by coronary artery bypass grafting at our institution between January and December 2002. A total of 62 patients received a radial artery graft. Of these, 22 were lost at the time of follow-up. The other 40 patients were enrolled for a multidetector row computed tomography study. Demographic and instrumental data were collected for all the patients. A total number of 145 grafts were studied, with complete and excellent visualization. RESULTS: The scans revealed a 97.77% (44 of 45) patency rate for left internal mammary arteries, 90.57% (48 of 53) for vein grafts, and 73.91% (34 of 46) for radial arteries (mammary artery plus vein grafts versus radial artery patency, p < 0.001). If analyzed for target vessel, we found the poorest result of radial grafts when placed on the right coronary artery (40% [2 of 5] patency rate). CONCLUSIONS: Noninvasive control of previously bypassed patients is feasible, with no discomfort for them and excellent visualization of grafts. The use of the radial artery as a conduit for bypass graft can be achieved with good results, after a careful choice of the target vessel.