Patient With Missed Right Ventricular Rupture From Blunt Trauma Remains Hemodynamically Stable for 3 Days.

Cardiac chamber rupture from blunt trauma is rare but can be fatal. Surprisingly, in some subsets of patients, it can be subtle and rather easily missed. Rapid recognition and management are essential. Percutaneous closure can be successful in iatrogenic chamber perforation (during pericardiocentesis) but possibly not in traumatic chamber rupture. (Level of Difficulty: Intermediate.).

A Unique Case of a Right Atrial Myxoma Infected With Escherichia coli.

A 70-year-old white male, with past medical history of coronary artery disease, peripheral arterial disease status-post bilateral femoral artery stents, insulin-dependent diabetes mellitus, hypertension, hyperlipidemia, arthritis, tobacco use, and alcohol use, presented with shortness of breath and an abnormal finding on a recent transesophageal echo. This had revealed a large, fixed mass in the right atrium. Our differential diagnosis had included thrombus, endocarditis, myxoma, papillary fibroelastoma, sarcoma, and metastatic tumor. The cardiothoracic surgeon excised this mass, which upon culturing, revealed what we found to be the only reported case of an atrial myxoma infected with Escherichia coli. In addition to surgical excision, the patient was treated with six weeks of intravenous cefepime.

Rapidly enlarging mycotic coronary artery aneurysm caused by bacterial seeding involving methicillin-sensitive Staphylococcus aureus and Klebsiella pneumoniae.

Coronary artery aneurysms are uncommon. A rare subcategory caused by infectious etiologies are called mycotic coronary artery aneurysms (MCAA), which have an exceedingly high mortality rate. In this report, we present a rare case of a rapidly expanding MCAA involving Staphylococcus aureus and Klebsiella pneumoniae affecting the left circumflex artery. Per our literature review, MCAA involving K. pneumoniae co-infection or superinfection have rarely, if ever, been documented. The aneurysm was discovered when the patient underwent coronary angiography for non-ST-elevation myocardial infarction. She was treated for bacteremia and upon reevaluation the aneurysm had grown approximately three times the original size. The patient had an aneurysmectomy with coronary artery bypass grafting due to the enlargement and size of the aneurysm. By highlighting this life-threatening disease, we hope to shed light on rare causes of MCAA and the importance of appropriate treatment. .