1/26. Expeditious diagnosis of primary prosthetic valve failure.Primary prosthetic valve failure is a catastrophic complication of prosthetic valves. Expeditious diagnosis of this complication is crucial because survival time is minutes to hours after valvular dysfunction. The only life-saving therapy for primary prosthetic valve failure is immediate surgical intervention for valve replacement. Because primary prosthetic valve failure rarely occurs, most physicians do not have experience with such patients and appropriate diagnosis and management may be delayed. A case is presented of a patient with primary prosthetic valve failure. This case illustrates how rapidly such a patient can deteriorate. This report discusses how recognition of key findings on history, physical examination, and plain chest radiography can lead to a rapid diagnosis.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/26. Aortobronchial fistula after coarctation repair and blunt chest trauma.A 34-year-old man had development of an aortobronchial fistula 17 years after patch aortoplasty for correction of aortic coarctation and 5 years after blunt chest trauma, an unusual combination of predisposing factors. The clinical presentation, characterized by dysphonia and recurrent hemoptysis, and the surgical findings suggested the posttraumatic origin of the fistula, which was successfully managed by aortic resection and graft interposition under simple aortic cross-clamping, associated with partial pulmonary lobectomy. When hemoptysis occurs in a patient with a history of an aortic thoracic procedure, the presence of an aortobronchial fistula should be suspected. early diagnosis offers the only possibility of recovery through a lifesaving surgical procedure.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
3/26. Crushed stents in benign left brachiocephalic vein stenoses.Two hemodialysis patients presenting with left venous arm congestion due to benign catheter-induced stenosis of the left brachiocephalic vein were treated by angioplasty and stent placement. External compression of the stents was responsible for rapid recurrence of the symptoms. No osseous or vascular malformation could be identified. Mechanical constraints induced by respiratory chest wall motion and aortic arch flow-related pulsation are proposed to explain this observation. This potential hazard should be considered when stent placement into the left brachiocephalic vein is advocated.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/26. Pseudoaneurysm formation after infected modified Blalock-Taussig shunt: echocardiographic findings.The modified Blalock-Taussig (B-T) shunt is well recognized as a palliative procedure for cyanotic congenital heart disease in infants. Pseudoaneurysm formation after a modified B-T shunt is a rare complication. We present the case of a 9-month-old girl with tetralogy of fallot who had undergone a modified left B-T shunt at 5 months of age and developed a pseudoaneurysm after an episode of infective endocarditis as detected by echocardiography. Compression of the left bronchus, displacement of the mediastinum to right chest, and paralysis of the left hemidiaphragm were found. Magnetic resonance images, computed tomography scans, aortograms, and selective angiograms demonstrated the presence of a large pseudoaneurysm. The compression syndrome gradually disappeared after aneurysmectomy.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/26. Pleural flap for treating perigraft leak after a modified Blalock-Taussig shunt.Plasa oozing through the graft after a modified Blalock-Taussig shunt is a troublesome complication. We encountered a massive leak following a modified Blalock-Taussig shunt in a 2 1/2 year-old-girl which required reexploration. The leak was treated by wrapping the polytetrafluoroethylene shunt with the parietal pleura flap harvested from the adjacent chest wall. The patient had an uneventful recovery. Covering of the polytetrafluoroethylene shunt with parietal pleura appears to stop plasma leak through the graft following a modified Blalock-Taussig shunt.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/26. Excessive prosthetic valve motion: a sign of dehiscence.Prosthetic valve malfunction can be suspected frequently and dehiscence suspected occasionally from chest radiography. The wide availability of chest radiography makes recognition of the radiographic findings associated with valvular dehiscence important. This case highlights that partial valve dehiscence can be diagnosed occasionally by chest radiography.- - - - - - - - - - ranking = 3keywords = chest (Clic here for more details about this article) |
7/26. Presumptive infection of a total hip prosthesis by mycobacterium tuberculosis: a case report.infection of a total hip prosthesis by mycobacterium tuberculosis (MT) is an uncommon complication. We report a patient with septic loosening of a total hip prosthesis with a presumptive diagnosis of MT infection. His previous history was negative to any form of tuberculosis, and there was no evidence of a primary focus on the radiological study of the chest. He was diagnosed initially as presenting aseptic loosening and revision surgery was performed. Six months after surgery, septic loosening was diagnosed. The prosthesis was then removed. The histological study showed caseum granulomas and acid-fast bacilli, and routine cultures of the synovial fluid were negative. Since only a positive Lowenstein culture would have confirmed the diagnosis with certainty, a presumptive diagnosis of MR infection was made based on the findings in the histological study. Tuberculostatic treatment was administered for 9 months. At six years follow-up no signs of infection are present, neither by clinical or radiological criteria.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/26. Transesophageal echocardiographic evaluation of perioperative systolic murmur in aortic pathology.Development of a new systolic murmur in patients following a Bental procedure with a prosthetic or homograft aortic valve usually indicates an aortic valve-related complication. Here, we report new etiologies of a loud systolic murmur in patients with aortic disease. One patient developed a new loud systolic murmur as an initial manifestation of acute type A aortic dissection without any complication, and two patients developed a loud systolic murmur as the major manifestation of aortic graft failure following aortic root surgery. auscultation of a new loud systolic murmur in the upper chest in patients with known aortic disease should alert one to a complication within the ascending aorta.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/26. Appropriateness of MRI scanning in the detection of ruptured implants used for breast reconstruction.This case report highlights the problems associated with ruptured silicone breast implants used for breast reconstructive purposes. The patient originally presented with vague symptoms and signs to her GP and was extensively investigated over a period of years for left-sided chest/abdominal pain. Two separate scanning modalities were used prior to her being seen by either of the main authors and although none were employed specifically to assess for implant rupture, neither detected any free silicone around the hemithorax. The authors suggest that patients who have undergone breast reconstruction with a silicone implant may present in a manner not suggestive of implant damage. In such cases, where the silicone can extend over larger anatomical distances and where side-effects can be damaging the investigation of choice should be MRI scanning which has a greater accuracy for detecting free silicone and defining the extent of spread.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/26. Intravascular ultrasound imaging for detection of pseudoaneurysm with aortobronchopulmonary fistula after graft replacement of descending aorta.A 63-year-old man had undergone graft replacement of the descending aorta due to dissection of aortic aneurysm nine years before and closure of an aortobronchopulmonary fistula two years before. He was admitted to our hospital because of massive hemoptysis. Angiography and chest computed tomography (CT) revealed a pseudoaneurysm on the proximal end caused by graft detachment. Intravascular ultrasound clearly revealed half round detachment on both ends of the graft. Replacement of the ascending, arch and distal aorta including the graft was performed, and the patient's postoperative course has been satisfactory. We have concluded that intravascular ultrasound is a useful method for detecting pseudoaneurysm after graft replacement which is not evident on cineangiography, CT or distal subtraction angiography.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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