A potential role of ECG-gated CT for the diagnosis of pulmonary vein thrombus: an illustrative case report.

The presence of tumor thrombus in patients with lung cancer confers a risk of stroke and other end-organ ischemic events. This case highlights a potential role for electrocardiogram (ECG)-gated computed tomography (CT) in the diagnosis of this pathologic process. In this case, pulmonary vein thrombus was definitively identified by an ECG-CT following discordant results between CT and transthoracic echocardiogram. In addition, this case demonstrates how management decisions are affected by physician accessibility to and familiarity with specific imaging tests.

Safety of contemporary percutaneous peripheral arterial interventions in the elderly insights from the BMC2 PVI (Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention) registry.

OBJECTIVES: This study sought to evaluate the effect of age on procedure type, periprocedural management, and in-hospital outcomes of patients undergoing lower-extremity (LE) peripheral vascular intervention (PVI). BACKGROUND: Surgical therapy of peripheral arterial disease is associated with significant morbidity and mortality in the elderly. There are limited data related to the influence of advanced age on the outcome of patients undergoing percutaneous LE PVI. METHODS: Clinical presentation, comorbidities, and in-hospital outcomes of patients undergoing LE PVI in a multicenter, multidisciplinary registry were compared between 3 age groups: < 70 years, between 70 and 80 years, and ≥ 80 years (elderly group). RESULTS: In our cohort, 7,769 patients underwent LE PVI. The elderly patients were more likely to be female and to have a greater burden of comorbidities. Procedural success was lower in the elderly group (74.2% for age ≥ 80 years vs. 78% for age 70 to < 80 years and 81.4% in patients age < 70 years, respectively; p < 0.0001). Unadjusted rates of procedure-related vascular access complications, post-procedure transfusion, contrast-induced nephropathy, amputation, and major adverse cardiac events were higher in elderly patients. After adjustment for baseline covariates, the elderly patients were more likely to experience vascular access complications; however, advanced age was not found to be associated with major adverse cardiac events, transfusion, contrast-induced nephropathy, or amputation. CONCLUSIONS: Contemporary PVI can be performed in elderly patients with high procedural and technical success with low rates of periprocedural complications including mortality. These findings may support the notion of using PVI as a preferred revascularization strategy in the treatment of severe peripheral arterial disease in the elderly population.

Live/real time three-dimensional transthoracic echocardiographic findings in primary left atrial leiomyosarcoma.

We describe an adult patient with a primary left atrial leiomyosarcoma in whom live/real time three-dimensional transthoracic echocardiography showed echolucent areas within the mass consistent with necrosis or hemorrhage surrounded by dense band-like echo densities indicative of fibrosis or collagen giving a "doughnut" like appearance. These findings were consistent with histopathology, which showed areas of necrosis and dilated vascular channels within the fibrotic tumor. Our case further illustrates the usefulness of three-dimensional transthoracic echocardiography in characterizing the morphologic features of an intracardiac mass.