Ruptured penetrating ulcer of the ascending aorta with pulmonary artery compression.

Pulmonary artery involvement has been reported in various degrees of complicated dissection of the ascending aorta. The prognosis remains poor without high-risk surgical intervention, but conservative management can be considered in high-risk cases. We report a case of nonoperative management of an octogenarian who presented with a contained rupture of his proximal ascending aorta, likely from a penetrating atherosclerotic ulcer.

Prevalence of structural central nervous system abnormalities in early-onset type 1 diabetes mellitus.

Objective: To characterize the effects of severe hypoglycemia on the developing brain in children with early-onset type 1 diabetes mellitus (T1DM).

Study Design: Children diagnosed with T1DM before age 6 years were studied. Those with prospectively monitored severe hypoglycemia (coma/seizure; n = 32) were compared with age-matched peers (n = 30) with no history of such events using magnetic resonance imaging.

Complex coronary sinus fistula in a 58-year-old female.

Coronary artery aneurysms and arterio-venous fistulae are uncommon malformations. We report the case of a 58-year-old woman with a large aneurysmal fistula arising from the left coronary tree and involving the entire coronary sinus venous system, resulting in significant left-to-right shunt. We discuss the management of aneurysmal fistulae of the coronary arteries, and the merits of prophylaxis for thrombotic complications of large aneurysms.

Bevacizumab reverses need for liver transplantation in hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease characterized by mucocutaneous and visceral telangiectasia. Hepatic involvement with vascular malformations may lead to portal hypertension, biliary ischemia, and high-output cardiac failure. Liver transplantation is indicated for life-threatening disease but carries significant risk from surgery and chronic immunosuppression.

Value of multislice CT scan in redo cardiac surgery with previous Lita graft.

Redo cardiac surgery is commonly performed in the current era. We describe a clinical scenario in a patient with a patent left internal thoracic artery to left anterior descending artery graft, requiring replacement of ascending aortic aneurysm with previous coronary artery bypass operation complicated by mediastinitis. A pre-operative 64 slice computed tomographic scan helped us plan and perform replacement of ascending aorta safely.

Large bronchogenic cyst: diagnosis and surgical management.

Herein we describe a patient with an unusually large bronchogenic cyst. The removal of the cyst was performed through a mini-thoracotomy and facilitated by video-assisted thoracic surgery (VATS).

MR findings in cardiac amyloidosis.

Objective: The objective of our study was to describe a combination of features on MRI specific to cardiac amyloidosis.

Conclusion: Cardiac amyloidosis is a common cause of infiltrative heart disease. The combination of subtle widespread heterogeneous myocardial enhancement on delayed postcontrast inversion recovery T1-weighted images, which may initially be dismissed as a technical error, with ancillary features of restrictive cardiac disease is highly suggestive of cardiac amyloidosis.