A thymic cyst presenting as first episode 'status epilepticus'.

Introduction: and importance: We report a rare case of unusual initial neurologic presentation of congenital thymic cyst, which generally is asymptomatic and therefore require additional radiological evaluation. The diagnosis, however, is by histological confirmation after surgical excision. Case presentation: Our patient presented with first time status epilepticus from an infected congenital thymic cyst, resulting in acute cerebral edema. Although initially missed, a careful re-evaluation of chest X-ray provided the diagnostic clue of a mediastinal mass effect on cerebral venous drainage. Cyst excision resulted in clinical and radiological resolution of cerebral edema. Clinical discussion: Although superior mediastinal masses are known to cause convulsions from cerebral edema, congenital thymic cysts rarely cause neurological symptoms and are therefore least expected to present in the emergency department with first time status epilepticus. However, a careful evaluation of the superior mediastinum on chest radiographs is helpful to identify such an example of extra-cranial etiology of this neurological emergency. Conclusion: Acute increase in pressure and or size from localized cyst infection of a congenital thymic cyst may cause acute cerebral edema from acute SVC obstruction, with resultant acute neurological symptoms.

A Rare Case of Traumatic Innominate-Innominate Arteriovenous Fistula.

BACKGROUND This report presents a rare case of a traumatic innominate artery to left innominate vein fistula following a stab wound to the base of the neck. CASE REPORT We report a case of a 23-year-old patient with a traumatic innominate-innominate arteriovenous fistula, after being stabbed in the suprasternal notch area 3 years prior. The patient presented with fatigue, and shortness of breath on exertion. Examination revealed a wide pulse pressure, bounding pulses, and a continuous murmur on the upper sternal area. Chest X-rays, echocardiography, CT angiography, and cardiac catheterization were useful to aid in diagnosis and work-up for fistula repair. A complex 8-mm fistula between the left innominate vein and the proximal innominate artery was noted, with multiple tortuous channels and demonstrating a reversible left-to-right shunt. After medical optimization, successful surgical ligation and division of the fistula was done through median sternotomy without cardiopulmonary bypass. The postoperative recovery was uneventful. CONCLUSIONS Traumatic innominate-innominate arteriovenous fistulas are rare and can pose a diagnostic challenge. High index of suspicion, careful history, examination, and radiologic evaluation usually result in correct diagnosis. Endovascular and surgical approaches are the mainstay treatment.

Lessons from fatal re-expansion pulmonary oedema: case series.

The goal of this study was to investigate the extent of the alveolar-capillary membrane porosity in patients with severe re-expansion pulmonary oedema. The biochemistry of airway fluid of two patients who died of re-expansion oedema was compared to their blood biochemistry. The airway fluid was comparable to plasma, while no blood cells were observed across the alveolar-capillary membrane. The membrane was linked to a fishnet that traps cells on one side, while plasma sieved through.

Traumatic Aortopulmonary Fistula: An Acquired Type 1 Aortopulmonary Window.

We report a patient with an acquired traumatic aortopulmonary window. The patient presented with an aortopulmonary fistula between the proximal ascending aorta and pulmonary trunk, which was missed on the initial hospital admission. The 26-year-old patient presented with high-output cardiac failure and examination features of a diastolic runoff. Patch closure of the defect using a sandwich technique was undertaken, with resolution of symptoms.

Outcome of concomitant left atrial ablation during valvular heart surgery: an African perspective.

OBJECTIVES: The aim of this study was to determine the success rates of left atrial radiofrequency cardiac ablation for atrial fibrillation during heart valve surgery. METHODS: This was a three-year retrospective study of 53 patients who had valve surgery and cardio-ablation. Immediate and long-term overall outcomes were analysed at three, six, nine, 12 and 24 months. The results were tested for significance by comparing to a chance outcome (50:50 probability) using the Z-test for the normal approximation of the binomial distribution. RESULTS: A total of 56.9% of patients converted immediately to sinus rhythm, with that number increasing over time. Pre-operative poor ejection fraction was the only predictor of low success rates following ablation. Long-term rhythm was determined by the patient's rhythm between three and six months. CONCLUSIONS: Concomitant left atrial ablation during valve surgery is effective in treating atrial fibrillation. Routine use of anti-arrhythmic medication after surgical ablation is not recommended.

Hybrid management of aneurysmal vascular ring and a Kommerell's diverticulum in an adult: Case report.

INTRODUCTION AND IMPORTANCE: Congenital vascular rings are rare in adults. The management is challenging when vascular rings present with concomitant aortic aneurysm and Kommerall's diverticulum. CASE PRESENTATION: We present a 68year old patient with a congenital vascular ring in the form of right sided aortic arch, with a retroesophageal left subclavian artery arising from an aneurysmal Kommerell's diverticulum. In addition, the patient had aneurysmal distal aortic arch and proximal descending aorta, causing severe symptomatic tracheal compression. The patient was successfully managed by debranching and reimplantation of head neck vessels to the ascending aorta through a median sternotomy, and concurrent endovascular stenting of the aneurysmal aorta. CLINICAL DISCUSSION: A combination of complete vascular rings and aortic arch aneurysm poses a potentially higher surgical risk. The use of the less invasive endovascular stenting of the aorta as well as a limited open surgical approach offers a lesser risk, especially in poor pre-operative states. CONCLUSION: A multidisciplinary team effort is key. Hybrid management of aneurysmal congenital vascular rings in high risk adults offers an attractive management alternative to conventional surgery.