Isolated pericardial cystic Echinococcosis: A rare clinical presentation

Isolated pericardial Hydatid cyst without involvement of other viscera is a rare condition with reported incidence of 0.5-2% of all cases of cystic echinococcosis even in the countries endemic for the disease. Hydatid disease is a major public health concern in the animal raising regions worldwide. Pericardial hydatid disease can be asymptomatic or present with varying symptoms from atypical chest pain, arrhythmias, rupture and tamponade to anaphylaxis. Early diagnosis and surgical treatment is necessary to prevent fatal complications. Here we report a case of symptomatic isolated pericardial hydatid cyst who presented with epigastric pain. doi: https://doi.org/10.12669/pjms.38.3.4965 How to cite this:Thapaliya P, Ali TA, Bhutta MM. Isolated pericardial cystic Echinococcosis: A rare clinical presentation. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4965 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A Case of Malignant Right Coronary Artery: Frequent Angina in Young Person

Highlight:A young adult has activity-triggered atypical chest pain and diagnosed malignant RCA.Congenital anomalies needed to be aware by cardiologists to help clinical practice.Planning a treatment about management of the CAAs condition should be undertaken by the inter-specialist team. Abstract:We presented a case a young adult with activity-triggered atypical chest pain and diagnosed with anomalous origin of right coronary artery (RCA) from the left coronary sinus with an interarterial course between the aorta and the main pulmonary artery that was detected by CT coronary angiography. This anomaly has been called malignant RCA. Coronary artery anomaly is a congenital condition. Most of the cases remain asymptomatic. This condition is also one of the most causes of sudden cardiac death, because the coronary artery examination is not regularly done. Nevertheless, during high intensity activity, it could be symptomatic and might be lethal. Diagnosing coronary artery anomalies might be tricky and cardiologists must be aware of this. The CAAs condition is a rare situation. The CAAs condition is associated with sudden death, especially intense physical activity. There was no rigid guideline for the management of the CAAs condition, so that planning a treatment in the inter-specialist team should be done.

Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis

Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.

High take-off of coronary arteries contributing to lethal myocardial ischemia: report of two cases

Introduction/Objective High take-off coronary arteries (HTO) are defined by coronary ostia arising above the sinotubular junction (STJ). Although asymptomatic in most individuals, there is increasing evidence that HTO is a risk factor for sudden cardiac death. Here we present two patients where HTO contributed to death. Methods/Case Report Patient A was a 52 year old morbidly obese male with atypical chest pain, new inferior ST elevations and troponinemia. Multiple coronary angiographies did not reveal any stenosis, but 3 stents were placed in the RCA due to concern for vasospasm. 3 days later the patient died. Autopsy revealed cardiac tamponade and non- atherosclerotic ischemic heart disease with remote apical LV scar and diffuse patchy interstitial fibrosis in the myocardium, which could be attributed to HTO of the RCA 0.5 cm above the STJ and early intramuscular courses of both coronaries. Multiple angiographies likely caused iatrogenic coronary injury and subsequent tamponade. Patient B was a healthy 33 year old female at 34 weeks gestation, who developed anaphylaxis during IV iron infusion for severe iron deficiency anemia. She was transferred to the OR for emergent C-section. Minutes after delivery she died. Autopsy revealed HTO, with coronary ostia being 0.4 cm and 0.7 cm above the STJ, respectively and acute angle take-off of LCA. No atherosclerosis was noted. The inability to increase myocardial perfusion through the coronary arteries during a high stress situation due to pregnancy, iron deficiency anemia and anaphylaxis likely contributed to lethal myocardial ischemia. Results (if a Case Study enter NA) NA Conclusion HTO and other coronary artery anomalies (CAAs) should be considered in cases of cryptogenic acute and chronic myocardial ischemia. Hemodynamic characterization of HTO, including those < 1 cm above the STJ in presence and absence of other CAAs may help better understand their pathophysiologic significance. Antemortem diagnosis requires high clinical suspicion and appropriate surgical intervention could be life-saving.

A Case of Malignant Course of Right Coronary Artery: Frequent Angina in Young Person

Introduction:Congenital anomalous coronary artery is a rare condition, but it might be the biggest pitfall for cardiologist. It might be silent until the patient reach young adult and has high intensity activity. Symptomatic anomalous course of coronary artery has wide spectrum from asymptomatic until the lethal one.Case Ilustration: We present a case of young adult with activity-triggered atypical chest pain and diagnose with anomalous origin of right coronary artery (RCA) from the left coronary sinus with inter-arterial course between the aorta and the main pulmonary artery that was detected by CT coronary angiography. This anomaly has been called malignant course RCA.Discussion:Coronary artery anomaly is a congenital condition. Most of the cases are remain asymptomatic. This condition also one of the most cause for sudden cardiac death because the coronary artery examination is not regularly done. Nevertheless, during high intense activity, it will be symptomatic and might be lethal.Conclusion:Diagnose coronary artery anomalies might be tricky and cardiologist must be aware with this. More devastating, no firm guideline in treatment of right anomalous coronary artery from opposite sinus.

Incorporating Ensembled stacked approach into Automated Machine Learning in an attempt to predict acute ischemic heart disease in patients with atypical chest pain: Secondary analysis of a single-center retrospective cohort study

Automated Machine Learning is explored to predict AIHD in patients presenting with atypical chest pain with an ensembled stacked approach incorporated.

Breast Implants in A Woman Associated With Low-Voltage Electrocardiogram (ECG)

Breast Implants (BIs) in women are associated with several Electrocardiogram (ECG) modifications. However, the association between BIs and low-voltage ECG has not been reported yet. A 44-year-old woman with a history of breast implant surgery visited our outpatient cardiology clinic complaining of atypical chest pain. A standard ECG showed low voltage in all precordial and most of the limb leads. Physical examination and echocardiography showed no pathology. Nothing other than BIs was found as a cause of low-voltage ECG in the woman. Breast implant-induced ECG modification can mislead clinicians resulting in diagnostic challenges and unnecessary tests. Low-voltage ECG is one of the modifications associated with BIs, which has not been reported before. A large prospective study is required to investigate the impacts of BIs on ECG thoroughly.