scholarly journals Anterior Mediastinal Mass Causing Intermittent Atrial Fibrillation

2021 ◽  
Author(s):  
Adam M Spanier ◽  
Garrett R Evans ◽  
Hugh M Hiller
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Mediastinal Mass ◽  
Mass Effect ◽  
Metabolic Effects ◽  
Anterior Mediastinal Mass ◽  
Chest Discomfort ◽  
Rare Finding ◽  
Ventricular Response ◽  
History Of

ABSTRACT Mediastinal masses are a rare finding in the emergency department and typically present with vague chest complaints such as chest discomfort, chest pain, or dyspnea. Rarely do these tumors present with dysrhythmias, and when dysrhythmias are present, they typically arise secondary to endocrine or metabolic effects exerted by the tumor. Here we report a case of a patient who presented to the emergency department with atrial fibrillation with rapid ventricular response, concomitant with a history of recurrent palpitations that were previously aborted with self-induced vagal maneuvers. Upon further investigation, the patient had an anterior mediastinal mass, diagnosed as a thymoma, suspected to be contributing to his presenting dysrhythmia through mass effect.

scholarly journals A141 SPONTANEOUS ESOPHAGEAL PERFORATION: AN UNREPORTED COMPLICATION OF LYMPHOCYTIC ESOPHAGITIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 128-129
Author(s):  
A LAGROTTERIA ◽  
A W Collins ◽  
A Someili ◽  
N Narula
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Case Report ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Esophageal Perforation ◽  
Distal Esophagus ◽  
Chest Discomfort ◽  
History Of ◽  
Lymphocytic Esophagitis

Abstract Background Lymphocytic esophagitis is a new and rare clinicopathological entity. It is a histological pattern characterized by lymphocytic infiltrate without granulocytes. Its etiology and clinical significance remains unclear. The clinical manifestations are typically mild, with reflux and dysphagia the most commonly reported symptoms. Aims We describe a case report of spontaneous esophageal perforation associated with lymphocytic esophagitis. Methods Case report Results A previously well 31-year-old male presented to the emergency department with acute food impaction. His antecedent symptoms were acute chest discomfort and continuous odynophagia following his most recent meal, with persistent globus sensation. The patient had no reported history of allergies, atopy, rhinitis, or asthma. A previous history of non-progressive dysphagia was noted after resuscitation. Emergent endoscopy revealed no food bolus, but a deep 6 cm mucosal tear in the upper-mid esophagus extending 24 to 30 cm from the incisors. Chest computed tomography observed small volume pneumoperitoneum consistent with esophageal perforation. The patient’s recovery was uneventful; he was managed conservatively with broad-spectrum antibiotics, proton pump inhibitor therapy, and a soft-textured diet. Endoscopy was repeated 48 hours later and revealed considerable healing with only a residual 3-4cm linear laceration. Histology of biopsies taken from the mid and distal esophagus demonstrated marked infiltration of intraepithelial lymphocytes. There were no eosinophils or neutrophils identified, consistent with a diagnosis of lymphocytic esophagitis. Autoimmune indices including anti-nuclear antibodies and immunoglobulins were normal, ruling out a contributory autoimmune or connective tissue process. The patient was maintained on a proton pump inhibitor (pantoprazole 40 mg once daily) following discharge. Nearly six months following his presentation, the patient had a recurrence of symptoms prompting representation to the emergency department. He described acute onset chest discomfort while eating turkey. Computed tomography of the chest redemonstrated circumferential intramural gas in the distal esophagus and proximal stomach. Conclusions Esophageal perforation is a potentially life-threatening manifestation of what had been considered and described as a relatively benign condition. From isolated dysphagia to transmural perforation, this case significantly expands our current understanding of the clinical spectrum of lymphocytic esophagitis. Funding Agencies None

scholarly journals Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
E Marcusohn ◽  
O Kobo ◽  
M Postnikov ◽  
D Epstein ◽  
Y Agmon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Prosthetic Valves ◽  
Ventricular Response ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background  The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR). Aim  The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL). Methods  This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF >50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded. Results From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction. Conclusion In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

Qualität des Antikoagulationsmanagements bei ambulanten Patienten mit Vorhofflimmern

Praxis ◽  
2003 ◽  
Vol 92 (21) ◽  
pp. 991-995 ◽  
Author(s):  
Gubler ◽  
Martina ◽  
Arpagaus ◽  
Dieterle
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Oral Anticoagulation ◽  
Medical Emergency ◽  
Psychiatric Disease ◽  
Recurrent Falls ◽  
History Of ◽  
Acute Condition

Many patients with atrial fibrillation do not receive anticoagulation due to accepted contraindications but also due to considerable underuse. We screened 2215 consecutive patients when they entered the Medical Emergency Department for any acute condition. The decision on correct use or underuse of oral anticoagulation was made from the charts by consensus of two experienced physicians. The prevalence of atrial fibrillation was 3.7%. 43 of 83 patients with atrial fibrillation had oral anticoagulation (52%, mean age 76 years). 32 patients were treated with Aspirin only (38%, mean age 79 years). 29 patients (35%) did not receive anticoagulation because of accepted contraindications, i.e., dementia and risk for recurrent falls (n = 16), history of bleeding (n = 6), drug malcompliance due to forgetfulness (n = 4) and psychiatric disease (n = 1). Underuse of anticoagulation occurred only in three patients (4%, unclear reasons in two patients, patient's unwillingness in one patient). Conclusion: We did not observe substantial underuse of anticoagulation in patients with atrial fibrillation.

scholarly journals ACTH-Producing Thymic Carcinoid: A Rare Cause of Cushing’s Syndrome

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A990-A990
Author(s):  
Lisette Patricia Rodriguez ◽  
Wende Michele Kozlow
Keyword(s):  
Cushing’S Syndrome ◽  
Mediastinal Mass ◽  
Cushing's Syndrome ◽  
Anterior Mediastinal Mass ◽  
Thymic Carcinoid ◽  
Acth Secretion ◽  
Ectopic Acth ◽  
Ectopic Acth Secretion ◽  
History Of

Abstract Background: Thymic carcinoids are rare neoplasms that account for less than 5% of all thymic tumors. Approximately 25% of these tumors will result in Cushing’s syndrome due to ectopic ACTH secretion. These tumors can also be associated with MEN1 syndrome. This is a case report of a patient with history of macroprolactinoma now presenting with Cushing’s syndrome due to ectopic ACTH production from a thymic carcinoid tumor. Clinical Case: This is a 57 year old male with history of pituitary macroprolactinoma diagnosed in 2011, now status post transsphenoidal resection and external beam radiation therapy, with persistent hyperprolactinemia on cabergoline, who presented to our clinic for a routine follow up visit. Patient had already developed secondary hypogonadism and secondary hypothyroidism as a consequence of treatment for the macroprolactinoma. He complained of worsening fatigue and weight gain ongoing for several months. Laboratory studies revealed an hemoglobin A1c of 8.3% (nl < 5.7%), TSH 0.24 MIU/L (0.4-4.5 MIU/L), free T4 1.2 ng/dL (0.8-1.8 ng/dL), 8 AM cortisol 31.4 mcg/dL (4-22 mcg/dL), ACTH 185 pg/mL (6-50 pg/dL), prolactin 29.6 ng/mL (2-18 ng/mL), IGF-1 88 ng/mL (50-317 ng/mL). Follow up labs confirmed cushings syndrome: cortisol AM-DST 36.4 mcg/dL (< 2 mcg/dL), free urinary cortisol 291.9 mcg/24h (2-50 mcg/24h). Pituitary MRI showed empty sella turcica. Cortisol after an 8 mg DST 32.5 mcg/dL (< 5 mcg/dL). CT chest, abdomen and pelvis revealed an heterogeneously enhancing solid anterior mediastinal mass measuring 4.9 x 3.1 x 4.3 cm. Whole body OctreoScan showed a markedly hyperintense large mass adjacent to the right heart border measuring 47 x 32 mm. He was referred to cardiothoracic surgery and underwent a right video-assisted thoracic surgery with resection of the anterior mediastinal mass. Pathology revealed a thymic well-differentiated neuroendocrine tumor with strong cytoplasmic staining for ACTH. It was also positive for OSCAR, Cam5.2, synaptophysin, CD56, and S100. Ki67 stain was positive in fewer than 1% of tumor cells. Final diagnosis was carcinoid tumor. Conclusion: Cushing’s syndrome secondary to ectopic ACTH secretion from a thymic carcinoid is rare. The presence of two MEN1-associated tumors in this patient, macroprolactinoma and thymic carcinoid, is highly suggestive of a clinical diagnosis of MEN 1.

scholarly journals A CASE OF PRIMITIVE NEUROECTODERMAL TUMOR (PNET) PRESENTING AS ANTERIOR MEDIASTINAL MASS

2021 ◽  
pp. 4-5
Author(s):  
Shweta S Hattarkar
Keyword(s):  
Soft Tissue ◽  
Primitive Neuroectodermal Tumor ◽  
Mediastinal Mass ◽  
Clinical Symptoms ◽  
Malignant Tumors ◽  
Mass Effect ◽  
Soft Tissue Tumors ◽  
Neuroectodermal Tumor ◽  
Anterior Mediastinal Mass ◽  
Male Preponderance

Peripheral primitive neuroectodermal tumors (pPNET) are a group of highly malignant tumors composed of small round cells of neuroetodermal origin that affect soft tissue and bone ,most commonly present in the thoracopulmonary region (Askin tumor), abdomen , pelvis and rarely in the head and neck. They usually present in the second decade of life, with slight male preponderance and account for 4-17% of all soft tissue tumors. Clinical symptoms depend on the site of presentation but invariably include pain and swelling of surrounding structure due to mass effect. Current recommendations advocate complete surgical resection whenever possible, adjuvant or neoadjuvant chemotherapy and radiotherapy. Here we present a 20 year old male patient who presented with chest pain and breathlessness and on investigation found to have an anterior mediastinal mass which further evaluation found to be a primitive neuroectodermal tumor

scholarly journals Massive Thymic Hyperplasia Mimicking Anterior Mediastinal Neoplasia in Occult Graves' Disease

2019 ◽  
Vol 08 (01) ◽  
pp. e24-e26 ◽  
Author(s):  
Christopher James Kennedy ◽  
David James William Paton
Keyword(s):  
Mediastinal Mass ◽  
Systemic Disease ◽  
Thymic Hyperplasia ◽  
Anterior Mediastinal Mass ◽  
Graves Disease ◽  
Case Description ◽  
Unique Case ◽  
History Of ◽  
Comprehensive Search ◽  
Work Up

Background Thymic hyperplasia is a recognized complication of Graves' disease that can present radiologically as an anterior mediastinal mass. Case Description We present a unique case of massive thymic hyperplasia occurring in a 24-year-old female without a known history of thyroid or other systemic disease in whom Graves' disease first manifested intraoperatively during thymectomy for presumed neoplasia. Conclusion We suggest that the work-up of all anterior mediastinal masses should include a comprehensive search for medical causes of reversible thymic enlargement.

A Case Report of Atrial Fibrillation Potentially Induced by Hydroxycut

2010 ◽  
Vol 23 (3) ◽  
pp. 245-249 ◽  
Author(s):  
Abigail Karth ◽  
Noa Holoshitz ◽  
Clifford J. Kavinsky ◽  
Richard Trohman ◽  
Brian F. McBride
Keyword(s):  
Atrial Fibrillation ◽  
Weight Loss ◽  
De Novo ◽  
Normal Sinus Rhythm ◽  
Regulatory Oversight ◽  
Normal Sinus ◽  
Patients At Risk ◽  
Ventricular Response ◽  
History Of ◽  
Dietary Weight Loss

Multicomponent dietary weight loss supplements comprise the single largest segment of herbal preparations available to the public. As a result of limited de novo regulatory oversight, supplement-related adverse events are underreported secondary to the lack of adequate pharmacodynamic, pharmacokinetic, and clinical data. Here we report the case of an obese 63-year-old caucasian female with a 2-day history of symptomatic paroxysmal atrial fibrillation (AF) with rapid ventricular response following a 2-week course of therapy with hydroxycut, a multicomponent dietary weight loss supplement devoid of sympathomimetic amines. Upon presentation, the patient received 2 doses of intravenous diltiazem, was loaded with intravenous digoxin, and spontaneously converted to normal sinus rhythm 36 hours following her last dose of the product. Epigallocatechin (EGCG), a principal ingredient in the hydroxycut preparation is the suspected causative component. EGCG blocks the atrial-specific KCNA5 potassium channel. Loss of KCNA5 function has been reported in patients with familial lone AF. Thus, causal relationship between hydroxycut and AF in this patient is probable. Given the serious risks associated with AF, patients at risk of developing AF should avoid dietary supplements containing EGCG until more information on the adverse effects of EGCG is known.

scholarly journals Case Report of An Unusual Mediastinal Mass - Thymolipoma

2020 ◽  
Vol 7 (11) ◽  
pp. C169-171
Author(s):  
Sreeja Raju ◽  
Divya S ◽  
M C Savithri ◽  
Ajaykumar KK ◽  
Gayathri G Nair
Keyword(s):  
Case Report ◽  
World Literature ◽  
Mediastinal Mass ◽  
Anterior Mediastinal Mass ◽  
Chest Discomfort ◽  
Mediastinal Neoplasms ◽  
Slow Growing

Thymolipomas are rare, slow-growing, benign anterior mediastinal neoplasms which are very often detected incidentally. Here we present a case of a 47 year old female who presented with chest discomfort and radiology revealed an anterior mediastinal mass. Total thymectomy was done and histopathology showed features consistent with thymolipoma. Very few cases of thymolipomas have been reported in Indian and world literature.

scholarly journals Anesthetic Management in Anterior Mediastinal Pheochromocytoma Case

2020 ◽  
Author(s):  
Yücel Özgür
Keyword(s):  
Rare Case ◽  
Mediastinal Mass ◽  
Anesthetic Management ◽  
Tumor Resection ◽  
The Body ◽  
Anterior Mediastinal Mass ◽  
Open Thoracotomy ◽  
Anesthesia Management ◽  
History Of ◽  
Different Parts

Paraganglioma can be found in different parts of the body. In this case report, a rare case of anterior mediastinal paraganlioma was examined. Pheochromocytoma can pose problems in intraoperative anesthesia management. A 17-year-old male patient with an anterior mediastinal mass was first scheduled for thoracoscopic tumor resection, and then proceeded with open thoracotomy. The patient, who was diagnosed with preoperative pheochromocytoma, had a history of dual antihypertensive drug use. The patient, who showed an intraoperative labile course, had episodes of hypertension (270/140 mmHg) and tachycardia (200 bpm). Esmolol and nitroglycerin infusion was applied and intervened. Diagnosis of paraganglioma-related pheochromocytoma can be challenging. Risks can be minimized by making appropriate decisions and interventions before and during the operation.

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