Idiopathic thoracic aortic aneurysm at pediatric age.

A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

[Complications and course of Kawasaki disease in 23 patients]. / Complicaciones y evolución de la enfermedad de Kawasaki en 23 pacientes.

OBJECTIVES: A comprehensive description of clinical data, cardiological complications, evolution and treatment of patients who were diagnosed with Kawasaki disease in our hospital is presented. MATERIAL AND METHODS: A retrospective study of clinical and cardiological data, as well as laboratory tests collected from 23 patients who suffered from Kawasaki disease and were treated between January 1989 and December 1995 was performed. RESULTS: The mean age of the patients was 3 years and 6 months of age, ranging from 5 months to 6 years old. The ratio male/female was 1.5/1. Clinical features were typical of the disease: persistent fever (100%), bilateral conjunctivitis (87%), changes in lips and oropharynx (100%), rash (91%), periungual desquamation (83%) and laterocervical adenopathy (74%). The diagnosis was delayed in 7 cases due to some symptoms that appeared as the beginning of the illness: hydrops of the gallbladder (one case), adenophlegmon (two cases), aseptic meningitis (two cases), diarrhoea (one case) and "sunburn-like" skin rash (one case). Five patients (22%) showed cardiological sequelae, three of them also had coronary artery aneurysms. One of these, whose diameter measured more than 8 mm, was several times complicated with coronary thrombus. Every patient was treated with salicylates and 19 of them were also treated with intravenous gamma globulins. As of December 1995, no deaths had been reported. CONCLUSIONS: Whenever the first symptoms and the evolution of the disease are not classical, it is more difficult to diagnose the disease.

[Intracardiac mycetoma induced by central catheterization]. / Micetoma intracardíaco inducido por un catéter de vía central.

We report a case of an infective endocarditis presented as a right atrial mass which pathological study showed a big vegetation of candida albicans (mycetoma). We think its presence was related to a great central vein catheterization during the neonatal period. The clinical feature was completed with pulmonary fungal embolism and later tricuspid valve afectation. With this work we wish to remark the necessary careful management of patients with central vein catheters to avoid this severe complication. We review the pharmacological and surgical treatment of this uncommon entity.