scholarly journals Acute ischemia of the lower limb due to non-bacterial thrombotic endocarditis with recent venous thromboembolic disease as the initial manifestation of lung adenocarcinoma: A case report

2021 ◽  
Author(s):  
Julien Polo ◽  
Daniele Raufast ◽  
Dimitri Cornand ◽  
Antoine Elias
Keyword(s):  
Mitral Valve ◽  
Lung Adenocarcinoma ◽  
Popliteal Artery ◽  
Lower Limb ◽  
Thrombotic Event ◽  
Rare Condition ◽  
Transoesophageal Echocardiography ◽  
Pet Scan ◽  
Acute Ischemia ◽  
Initial Manifestation

Abstract Background Non-bacterial thrombotic endocarditis (NBTE) is a rare condition. Optimal management is based on early diagnosis which remains difficult. Case summary A 75-year-old male patient was admitted to the hospital with acute ischemia of the left lower limb due to popliteal artery occlusion despite anticoagulation with rivaroxaban for pulmonary embolism diagnosed two weeks earlier. Transoesophageal echocardiography (TEE) showed a mobile vegetation with mild mitral valve regurgitation. Positron emission tomography (PET) scan did not show hyperfixation at the mitral valve but rather lymphadenopathy hyperfixation at different sites. Biopsy of a lymph node from Barety’s space identified a bronchopulmonary adenocarcinoma. The outcome was favorable after popliteal artery thrombectomy and low-molecular-weight heparin treatment. The patient was referred to the department of onco-pneumology for further care. Discussion Upon clinical presentation, the combination of an arterial and prior venous thrombotic event suggested that the origin could be either a patent foramen ovale (PFO) or a thrombosis from an underlying cancer. A transthoracic echocardiography and TEE excluded a PFO and demonstrated a mobile echogenic mass at the mitral valve site together with a mild regurgitation. The diagnosis of non-bacterial thrombotic endocarditis was suggested given the absence of clinical and biological infectious signs, negative blood cultures and serology for endocarditis, the presence of both arterial and venous thrombosis, as well as the presence of intra-thoracic lymphadenopathy hyperfixation on the PET scan for which a biopsy demonstrated lung adenocarcinoma.

scholarly journals Utility of 3-dimensional transoesophageal echocardiography for mitral annular sizing in transcatheter mitral valve replacement procedures: a cardiac computed tomography comparative study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Coisne ◽  
F Pontana ◽  
S Aghezzaf ◽  
S Mouton ◽  
H Ridon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Cardiac Computed Tomography ◽  
Transoesophageal Echocardiography ◽  
3 Dimensional ◽  
Ct Measurements ◽  
Good Ability ◽  
Transcatheter Mitral Valve Replacement

Abstract Funding Acknowledgements Type of funding sources: None. Background.  3-dimensional transoesophageal echocardiography (3D-TEE) is frequently used as an initial screening tool in the evaluation of patients who are candidates to Transcatheter Mitral Valve Replacement (TMVR). However, little is known about the imaging correlation with the gold-standard computed tomography (CT) imaging. We aimed at testing the quantitative differences between these two modalities and finding the best 3D-TEE parameters for TMVR screening. Methods. We included 57 patients referred to our Heart Valve Clinic for TMVR with prostheses specifically designed for the mitral valve. Mitral annulus (MA) analyses were performed using commercially available software in 3D-TEE and CT. Results. 3D-TEE was feasible in 52 patients (91%). Although 3D-TEE measurements were slightly lower than in CT, both measurements of projected MA area and perimeter showed excellent correlation with small differences between the two modalities (r = 0.88 and r = 0.92 respectively, p < 0.0001). Correlations were significant but lower for MA diameters (r = 0.68 to 0.72, p < 0.0001) and mitro-aortic angle (r = 0.53, p = 0.0001). ROC curve analyses showed that 3D-TEE had a good ability to predict TMVR screening success defined by constructors based on CT measurements with a range of 12.9 to 15cm² for MA area (AUC = 0.88-0.91, p < 0.0001), 128 to 139mm for MA perimeter (AUC = 0.85-0.91, p < 0.0001), 35 to 39mm for anteroposterior diameter (AUC = 0.79-0.84 p < 0.0001) and 37 to 42mm for posteromedial-anterolateral diameter (AUC = 0.81-0.89, p < 0.0001) (Figure 1). Conclusion. 3D-TEE measurements of MA dimensions display strong correlation with CT measurements in patients undergoing TMVR screening process. 3D-TEE should be proposed as a reasonable alternative to CT in this vulnerable population. Abstract Figure.

scholarly journals Four-dimensional modelling of the mitral valve by real-time 3D transoesophageal echocardiography: proof of concept

2014 ◽  
Vol 20 (2) ◽  
pp. 200-208 ◽  
Author(s):  
Thilo Noack ◽  
Chirojit Mukherjee ◽  
Philipp Kiefer ◽  
Fabian Emrich ◽  
Marcel Vollroth ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Real Time ◽  
Transoesophageal Echocardiography ◽  
Proof Of Concept

scholarly journals Sarcoid-like reaction associated with lung adenocarcinoma: A case report

2018 ◽  
Vol 28 (1) ◽  
pp. 68-70
Author(s):  
Qiao Li Tan ◽  
Leong Chai Leow ◽  
Salahudeen Mohamed Haja Mohideen ◽  
Duu Wen Sewa
Keyword(s):  
Lung Adenocarcinoma ◽  
Lower Lobe ◽  
Rare Condition ◽  
Disease Recurrence ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Transbronchial Needle Aspiration ◽  
Surveillance Imaging ◽  
Bilateral Hilar Lymphadenopathy ◽  
History Of

A 71-year-old woman with a history of left lower lobe lobectomy 4 years ago for adenocarcinoma of the lung presented with new mediastinal and bilateral hilar lymphadenopathy on surveillance imaging, suspicious for disease recurrence. She underwent an endobronchial ultrasound-guided transbronchial needle aspiration of the lymph nodes and histology yielded non-necrotizing epithelioid granulomas with no evidence of malignancy. A diagnosis of sarcoid-like reaction associated with lung adenocarcinoma was made. The significance of this rare condition is discussed.

scholarly journals LIMB SALVAGE AND THE MORTALITY OF ACUTE ISCHEMIA OF THE LOWER LIMB

1996 ◽  
Vol 57 (3) ◽  
pp. 542-546
Author(s):  
Shinsuke MII ◽  
Akira MORI ◽  
Hisanobu SAKATA ◽  
Masakazu ASO ◽  
Shigeru IMAMURA ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Lower Limb ◽  
Acute Ischemia

scholarly journals Rare condition: Upper & lower limb lymphoedema

2020 ◽  
Vol 152 (7) ◽  
pp. 158
Author(s):  
Manish Taywade ◽  
Divya Sethi
Keyword(s):  
Lower Limb ◽  
Rare Condition

scholarly journals Nonbacterial Thrombotic Endocarditis and Widespread Skin Necrosis in Newly Diagnosed Lung Adenocarcinoma

2020 ◽  
Vol 13 (1) ◽  
pp. 239-244 ◽  
Author(s):  
Katerina Zakka ◽  
Patrick Zakka ◽  
Amir Davarpanah ◽  
Nikoloz Koshkelashvili ◽  
Mehmet A. Bilen ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Lung Adenocarcinoma ◽  
Ct Scan ◽  
Metastatic Disease ◽  
Skin Lesions ◽  
Primary Adenocarcinoma ◽  
Neoplastic Disease ◽  
Lung Field ◽  
Nonbacterial Thrombotic Endocarditis ◽  
Hands And Feet

Nonbacterial thrombotic endocarditis (NBTE) is a rare entity most commonly diagnosed postmortem with rates in autopsy series ranging from 0.9 to 1.6%. A 63-year-old female with past medical history of hypertension and mitral valve prolapse presented to the hospital with shortness of breath, headache, and necrotic skin lesions on her hands and feet. Computed tomography (CT) scan of her chest demonstrated a pulmonary embolus in the right lower lung segmental artery and right upper lobe lobar to segmental pulmonary artery, a mass-like consolidation in the left upper lung field impeding the hilum. CT scan of the abdomen demonstrated metastatic disease in liver and bone and bilateral femoral deep vein thrombosis. Transesophageal echocardiography revealed severe mitral regurgitation with two small mobile plaques on the mitral valve and two immobile plaques on the descending aorta. Magnetic resonance imaging of the brain was consistent with subacute infarcts and metastatic disease. Bronchoscopy was performed and pathology revealed primary adenocarcinoma of the lung. She was treated with anticoagulation and systemic chemotherapy. The patient and family elected to proceed with hospice due to her clinical decline, poor performance status, and poor prognosis after a prolonged hospital stay. Underlying malignancy is detected in approximately 40–85% of patients with NBTE. Lung cancer is the most frequently associated malignancy followed by pancreatic, stomach, breast, and ovarian cancer. Widespread necrotic skin lesions as presenting symptoms of primary lung adenocarcinoma are rare. In the present case, the diagnosis of necrotic skin lesions and NBTE preceded that of the neoplastic disease. Necrotic skin lesions and NBTE can be the first manifestations of an occult malignancy causing extensive multi-organ infarcts. NBTE can present with such extensive skin lesions as a first presenting sign of malignancy. To the best of our knowledge, this is the first case to present with such extensive skin lesions as the first presenting symptom of lung adenocarcinoma.

scholarly journals Atypical Presentation of Takayasu's Arteritis—A Case Report

2019 ◽  
Vol 04 (01) ◽  
pp. 026-028
Author(s):  
V. Satish Kumar Rao ◽  
Ponugoti Godhasiri
Keyword(s):  
Common Iliac Artery ◽  
Takayasu’S Arteritis ◽  
Rare Condition ◽  
The Body ◽  
Asian Women ◽  
Atypical Presentation ◽  
Age Group ◽  
Takayasu's Arteritis ◽  
Pulseless Disease ◽  
Initial Manifestation

AbstractTakayasu's arteritis, known as “pulseless disease,” is a chronic idiopathic inflammatory disease, which has a greater predilection for large vasculature in the body. Initially described in the1800s, this rare condition is more commonly seen in Asian women in 40 years age group. Herein, the authors report the case of a 36-year-old woman whose exertional claudication was the initial manifestation of active Takayasu's arteritis along with involvement of multiple peripheral arteries not involving ostial area of the vessels, instead affecting the proximal area and also presenting with thrombosis of right CIA (common iliac artery), which is an unusual presentation in case of Takayasu's arteritis without aneurysmal involvement.

P6489Preoperative determination of artificial chordae length by transesophageal echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pitsis ◽  
N Tsotsolis ◽  
E Theofilogiannakos ◽  
H Boudoulas ◽  
K Boudoulas
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Pearson Correlation ◽  
Transoesophageal Echocardiography ◽  
Valve Repair ◽  
Bottom Part ◽  
Artificial Chordae ◽  
The Mean

Abstract The use of artificial chordae is one of the main techniques used in mitral valve repair to treat prolapsing leaflets, especially in anterior and bileaflet prolapse. With the use of PTFE sutures to replace elongated or ruptured chords mitral valve repair rates have significantly improved. The main difficulty with this technique is to determine the optimal length of the artificial chordae. Intraoperative transoesophageal echocardiography (TOE) is mandatory in mitral valve repair in order to determine the type of lesion of the mitral valve but also to evaluate the quality of the repair. We examined the accuracy of preoperative prediction of artificial chordae length by the preoperativeTOE. Patients and methods Twenty-one consecutive patients (7 females) underwent mitral valve repair with artificial chordae for significant mitral valve prolapse in our department during the last year. The median age of the patients was 62 y. (range 25 - 87) and the mean EuroSCORE II 3,36% (SD 4,61%). During the prep TOE we determined the predicted length of the required replacement chordae for the repair using mainly the 4 chamber view to calculate the distance between the tip of the papillary muscle and the coaptation point of the two leaflets and we subtracted 5mm which is the minimum of the desired coaptation length (top right part of the Figure). All the patients underwent totally endoscopic mitral repair through a 3 cm right periareolar incision. 14,3% of the patients had anterior leaflet (AML) prolapse, 23,8% bileaflet and 61,9% posterior (PML). The appropriate length of the required chordae was measured intraoperatively. Results We used on average 3 loops of artificial chordae size 23,3 mm (SD 1,15mm) to treat the AML prolapse, 5 loops size 23,2 mm (SD 2,28mm) to treat the bileaflet prolapse and 2,23 loops size 18mm (SD 2mm) to treat the PML prolapse (bottom part of the figure). The predicted size of the artificial chordae had a positive correlation to the length used (Pearson correlation, p<0,001) as demonstrated in the top left part of the Figure. An annuloplasty band was implanted to all the patients. All the patients had no mitral regurgitation in the postoperative TOE. The mean valve area was 3,54cm2 (SD 0,57) and the mean peak gradient 5,6 mmHg (SD 1,82). There was no mortality. Chordae length predicted by echo Conclusion The length of artificial chordae can be predetermined with great accuracy with the use of TOE, making TOE an important tool not only for the determination of the mitral lesion and quality of the repair but also for the planning of the operation.

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