Left Cardiac Border Research Articles

Aneurisma de apêndice atrial esquerdo: um achado radiográfico acidental - relato de caso

Left atrial appendage aneurysm is an extremely rare condition. It usually oc-curs together with changes in the mitral valve and manifests itself with cardiac arrhythmias or thromboembolisms, most commonly between the second and fourth decade of life. It can be asymptomatic, and the diagnosis is made by ob-serving radiographic changes, such as the prominence of the left cardiac bor-der. Due to the complications that can occur, surgery for resection is recommended. The present study reports a case of an infant who was seen in con-sultation for a cough complaint two months ago. An investigation was initiated which diagnosed an aneurysm of the left atrial appendage. Therefore, it is shown that although it is more common between the second and fourth decades of life, the left atrial appendage aneurysm may also be present in children.

Left Atrial Appendix Aneurysm: An Accidental Radiographic Finding - Case Report

Left atrial appendage aneurysm is an extremely rare condition. It usually occurs together with changes in the mitral valve and manifests itself with cardiac arrhythmias or thromboembolisms, most commonly between the second and fourth decade of life. It can be asymptomatic, and the diagnosis is made by observing radiographic changes, such as the prominence of the left cardiac border. Due to the complications that can occur, surgery for resection is recommended. The present study reports a case of an infant who was seen in consultation for a cough complaint two months ago. An investigation was initiated which diagnosed an aneurysm of the left atrial appendage. Therefore, it is shown that although it is more common between the second and fourth decades of life, the left atrial appendage aneurysm may also be present in children.

Multiple Giant Coronary Artery Aneurysms in Kawasaki Disease

A 35-year-old man with a history of Kawasaki disease and coronary artery aneurysms (CAAs) at the age of 1 year, for which a coronary artery bypass graft surgical procedure (saphenous vein graft to the left anterior descending [LAD] artery because of the occluded left internal thoracic artery) was performed, presented with dyspnea on exertion. On arrival at our institution, his vital signs were stable, but electrocardiography revealed T-wave inversions in leads V1 through V3. Chest radiography revealed an abnormality of the contour of the left cardiac border (Supplemental Figure 1, available online at http://www.mayoclinicproceedings.org), and chest computed tomography revealed bulky calcified masses on the left ventricle (Supplemental Figure 2, available online at http://www.mayoclinicproceedings.org).

A novel technique of repair of congenital left atrial appendage aneurysm using bovine pericardial patch: A video presentation

Because of its rarity and association with life threatening complications like supraventricular arrhythmias, systemic embolization, congestive cardiac failure, prompt recognition of congenital left atrial appendage aneurysm is important in patients with an enlarged cardiac silhouette and a prominent convex bulge of the left upper cardiac border without carinal widening. We report here-in a new technique of resection of the congenital left atrial appendage aneurysm and anatomical reconstruction using a bovine pericardial patch under cardiopulmonary bypass, permitting us to avoid undersizing and deformation of the left atrium.

Tuberculous Pleuro-Pericardial Effusion with Adenitis

Background: Hydra-headed clinical presentations of tuberculosis could be confusing even in immunocompetent, for example pleuro-pericardial effusion with adenitis. From our literature search, this is rare. Case presentation: A 61-year-old clergyman presented with a 3-week history of cough, fever and a 5-day history of progressive dyspnoea. There was associated anaemia, weight loss but no history of drenching night sweat, hemoptysis, exposure to tuberculosis, diabetes or other suggestion of immunosuppression. Examination revealed multiple matted left axillary lymph nodes. Erythrocyte sedimentation rate (ESR) was 70 mm/hr; and negative for Hepatitis B, C and HIV. Chest X-ray showed left lower lung zone homogenous opacity with obliteration of the left cardiac border. Lymph node aspirate and pleural fluid analyses confirmed a tuberculous aetiology. Conclusion: Tuberculous pleuro-pericardial effusion with adenitis occurs in immunocompetent. High index of suspicion in endemic areas as well as early anti-tubercular treatment could be life-saving.

Sclerosing Hemangioma of the Lung and Concurrent Sarcoidosis of the Hilar Lymph Nodes

Objective: To present chest radiographs, CT and pathological fndings of pulmonary sclerosing hemangioma with concurrent sarcoidosis. To review the literatures regarding lung cancer and associated sarcoidosis and/or sclerosing hemangioma.Materials and Methods: A 50 year-old female patient was screened for health at human dock at Preventive Medicine Research Center of our institution, and a rounded nodule, measuring about 15 mm in diameter, was found in the left lower lung feld medially. Non-enhanced CT showed a round nodule at the left cardiac border. The patient was sent to a clinic of our institution.Results: The patient was further studied by contrast enhanced CT (CECT), which showed marked increase of CT value to 91.8 HU from 50.1 HU on non-enhanced CT. It was difcult to di?erentiate a benign lesion from malignant lesion. CECT also showed enlarged hilar and mediastinal lymph nodes. Cytology at the time of bronchoscopy revealed Class 3 at the left B5b bronchus. Partial resection of the lingual was carried out by video-assisted thoracoscopic surgery. Biopsy of the left hilar nodes (#10, #11) at the same time revealed sarcoidosis.Conclusion: A rare case of pulmonary screlosing hemangioma and concurrent sarcoidosis was reported with imaging results and pathological proof.

Left Atrial Appendage Aneurysm

A 57-year-old woman presented to our emergency department with intermittent episodes of palpitations, which began abruptly without significant precipitants and resolved spontaneously. Physical examinations showed a rapid heart rate of 130 beats per minute approximately, with irregular pattern; the remainder was unremarkable. She was otherwise healthy, without history of panic disorders or cardiovascular diseases. No remarkable family history was reported. She did not take medicine and did not use illicit drugs, alcohol or tobacco. No emotional stress was noted recently. An electrocardiogram showed atrial fibrillation with rapid ventricular responses. The patient received transthoracic echocardiography initially in our emergency department, and the preliminary findings showed no significant structural abnormalities. Surprisingly, the chest x-ray revealed a bulky mass, obliterating the left cardiac border (Figure 1A, arrow). Under the impression of possible structural heart disease, advanced computed tomography of the chest confirmed a large aneurysm (Figure 1B, arrow), arising from the left aspect of atrium (Figure 1B, asterisk). Blood testing showed normal serum thyroid-stimulating hormone and electrolyte levels. The patient underwent an aneurysmectomy. After surgery, the patient recovered and was discharged uneventfully, with a regular sinus rhythm and resolution of symptoms.

Incidentally detected congenital left atrial appendage aneurysm

A 22-year-old male patient was referred to us for cardiac computed tomography (CT) angiography since chest radiograph showed prominent left cardiac border. Patient was asymptomatic and chest radiograph was done as a routine health checkup. Laboratory findings were within the normal range. Electrocardiograph (ECG) showed normal sinus rhythm. Cardiac CT angiography revealed a 9×8×6 cm sized left atrial appendage aneurysm communicating with left atrium (Figs. 1a and 2). There was associated partial thrombus within the aneurysm (Fig. 1b). Echocardiography showed left atrial aneurysm with partial thrombus and normal cardiac valves. Due to the potential risk of embolism, the patient was referred for surgical resection of the aneurysm. Fig. 1 a Coronal multiplanar reformatted and b axial cardiac CT angiography images showing the presence of left atrial appendage aneurysm (black arrows) communicating with left atrium. Hypodense filling defect noted within the aneurysm suggestive of partial thrombus (white arrow)

Congenital complete and partial absence of the left pericardium

Congenital absence of pericardium is a rare malformation. We report 2 young patients with a diagnosis of congenital absence of the pericardium. The posteroanterior view of the chest X-ray showed displacement of the left cardiac border into the left hemithorax. Unusual acoustical windows and abnormal cardiac and septal motion during echocardiography suggested the diagnosis of congenital absence of pericardium. Magnetic resonance imaging definitive confirmed diagnosis of congenital absence of pericardium.

Saccular Coronary Artery Aneurysm and Fistula with Organized Thrombi

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography, multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombectomy of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.

Successful surgical repair of a giant coronary-pulmonary artery fistula: role of magnetic resonance imaging

A 69-year-old woman was referred for the evaluation of an abnormal shadow at the left cardiac border on her chest X-ray films ( Panel A ). A Levine II/VI continuous murmur was heard at the upper left parasternal area on physical examination, while coronary angiogram (CAG) subsequently revealed the presence of a coronary-pulmonary artery fistula (CPAF) …

Surgical Resection of a Rapidly Growing Giant Pericardial Cyst: A Case Report

We report here a case of a patient who underwent surgical resection of a giant pericardial cyst that was growing rapidly, causing anterior chest pain. An asymptomatic 56-year-old woman underwent a complete medical checkup in a health-care center. Her chest X-ray showed an unusually large bulge on the left cardiac border, and she was referred to our hospital. The chest X-ray taken 2 years ago in another hospital showed similar bulge on the same left cardiac border, but it was noticeably smaller. Chest CT revealed a 9.5 × 4.5 cm pericardial cyst within the anterolateral aspect of the left cardiac border. The CT number of the mass was approximately 15 - 20 HU. The mass also showed slight hyperintensity on T1-weighted MR images and hyperintensity on T2-weighted MR images. Four weeks later, she experienced anterior chest pain for the first time, and the chest X-ray and CT showed an increase in the size of the pericardial cyst. The CT number of the mass increased to approximately 30 - 40 HU. The cyst was successfully removed by video-assisted thoracic surgery. The pericardial cyst was diagnosed as benign according to the results of histopathology. We conclude that the rapid growth of the pericardial cyst was caused by intracystic hemorrhage that originated from vascularized connective tissue in the cyst wall.

Multimodality cardiac imaging of a giant left ventricular pseudoaneurysm

A 56-year-old male with a history of myocardial infarction (9 years before) was admitted to our hospital because of dyspnoea, cough, and fever. A chest X-ray revealed a rounded opacity silhouetting the left cardiac border ( Panel A ). Transthoracic echocardiography showed a saccular structure with a 4.0 cm neck in the lateral wall of the left ventricle, with an …

Congenital Giant Aneurysm of the Left Coronary Artery

We report an unusual case of congenital giant coronary aneurysm. A 23 year-old male with a history of acute myocardial infarction presented an abnormal shadow in the left cardiac border on routine X-ray. Electrocardiogram and physical examination were normal without any clinical signs of inflammation, but computed tomography (CT) scan and cardiac magnetic resonance imaging (MRI) revealed a giant (>50mm) coronary aneurysm. Coronary artery bypass grafting (CABG) with coronary artery aneurysm (CAA) resection resolved the CAA. Coronary artery aneurysms are entities of localised dilation and can be common events in chronic infectious disease as a result of the systemic inflammatory state; however, giant coronary aneurysms (measuring more than 50mm) are rare. This is especially true where the pathological aetiology was not clearly defined or was believed to be of congenital origin. To date only a few published case reports exist for this type of pathological entity.

Atrioventricular Valve Dyssynchrony Resulting From Severe Mitral Regurgitation

A nearly 4-year-old Ethiopian girl with a 1-year history of weight loss and rapid breathing who had just immigrated to the United States presented to the emergency department with respiratory distress and increasing lethargy. Over the preceding year, she had been found to have increasing tachypnea, anorexia, a 5-kilogram weight loss, fatigue, intermittent emesis, and decreased urine output. There were multiple notable findings on the physical examination. Abnormalities of the vital signs included a respiratory rate of 52 breaths per minute, blood pressure of 70/53, and an oxygen saturation of 85% on room air. In general, she was cachectic and lethargic. There was jugular venous distension with accentuated a waves. There were diffuse fine inspiratory crackles across the lung fields. There was asymmetrical protrusion of the left anterior chest with a visible, dynamic cardiac impulse. On auscultation, there was a regular rhythm with an S3 present. There was a III/VI, holosystolic, midfrequency, blowing murmur in the 5th intercostal space at the midclavicular line with radiation to the apex and the left axilla. A diastolic rumble was not appreciated. The liver edge was 4 centimeters below the right costal margin. Pulses were normal at the brachia and femoral arteries, bilaterally. There was no peripheral edema or clubbing. Blood work revealed a negative troponin and a B natriuretic peptide of 2761 picograms per milliliter. A chest radiograph was performed, which showed cardiomegaly with enlargement of the left superior cardiac border, bilateral pulmonary edema, and superior deviation of the left mainstem bronchus suggestive of left atrial dilatation (Figure 1). A 15-lead electrocardiogram demonstrated sinus rhythm with left atrial enlargement and ST segment elevation in the anterior precordial leads (Figure 2). Figure 1. A chest radiograph taken in an anteroposterior projection demonstrates: pronounced cardiomegaly with a cardiothoracic ratio of 71%; a double contour of …

Pneumomediastino espontâneo multiloculado em recém-nascido: Caso clínico

Spontaneous pneumomediastinum in a term baby without assisted ventilation or known underlying pulmonary disease is uncommon. The authors present a case report of a term baby delivered by caesarean that developed mild respiratory distress after birth. The pulmonary X-ray on day 2 showed an abnormal gas lucency adjacent to the left cardiac border elevating thymic border indicative of pneumomediastinum. Our case demonstrates two unique features of neonatal pneumomediastinum – the presence of multiple internal septae and its tendency to loculate locally.The authors present this case for its rarity and the specific imagiological aspects.Rev Port Pneumol 2010; XVI (1): 163-169

A case of giant coronary artery aneurysm and literature review

A 40-year-old man was referred to our hospital because of an abnormal shadow on the left cardiac border on the chest roentgenogram at the regular medical health examination without any symptoms. A giant coronary artery aneurysm of left anterior descending artery with a maximum diameter of approximately 50 mm was detected with computed tomography and coronary angiography. The patient was treated and followed up medically. Four years later, the size of the coronary artery aneurysm became larger. Then resection of the coronary artery aneurysm and coronary artery bypass grafting were successfully performed. Coronary artery aneurysms are rare in adults and are usually found in association with Kawasaki disease, coronary atherosclerosis, and so on. We also review the literature of giant coronary artery aneurysms exceeding 50 mm in diameter.

Giant left atrial appendage aneurysm

A 67-year-old lady was referred to our hospital because of abnormal findings on a simple chest radiograph. The chest radiograph showed a markedly prominent left cardiac border (Panel A). Because a radiolucent cleft (Panel A, arrow heads) was observed in the lower medial side of the bulge, the bulging shadow rather looked like a longish mass (Panel A, asterisk). She had a complaint of atypical chest discomfort and a history of embolic stroke. Physical …

Effects of High-Resolution CT of the Lung Using Partial Versus Full Reconstruction on Motion Artifacts and Image Noise

The purpose of our study was to evaluate the effects of 0.3-second high-resolution CT (HRCT) of the lung using partial reconstruction on cardiac motion artifacts and image noise. Thirty-seven pairs of 0.3-second (partial reconstruction) and 0.75-second (full reconstruction) HRCT images were obtained for the lower lung zone during full-inspiration breath-holding. Imaging parameters other than temporal resolution were identical for each patient. Two radiologists visually graded motion artifacts of the cardiac border, bronchi, pulmonary vessels, and fissure in the left lung on a 4-point scale (with 4 indicating no artifacts). The maximum width of motion along the left cardiac border and the area percentage of motion artifacts in the left lung were calculated. Image noise in the air and lung was also determined. Cardiac motion artifacts and image noises were compared between the two sets of CT images. Visual grades for the cardiac border (4 +/- 0), bronchi (3.8 +/- 0.7), pulmonary vessels (3.6 +/- 0.8), and fissure (3.9 +/- 0.5) were higher for 0.3-second images than for 0.75-second images (1.7 +/- 0.7, 2.0 +/- 1.0, 1.6 +/- 0.7, and 2.4 +/- 0.9, respectively) (p < 0.001). The maximum width of motion along the left cardiac border (0.1 +/- 0.5 mm) and the area percentage of motion artifacts in the left lung (6.7% +/- 18.4%) were smaller for 0.3-second images than for 0.75-second images (4.5 +/- 1.7 mm and 36.2% +/- 20.9%, respectively) (p < 0.001). Image noises in the air (38.0 +/- 9.2) and the lung (86.0 +/- 23.1) were greater for 0.3-second images than for 0.75-second images (35.6 +/- 9.6 and 76.0 +/- 20.3, respectively) (p < 0.01). Compared with 0.75-second HRCT using full reconstruction, 0.3-second HRCT using partial reconstruction substantially reduces cardiac motion artifacts in the lung at the expense of increasing image noise.

Near Sudden Death From Cardiac Lipoma in an Adolescent

A previously healthy 13-year-old boy collapsed at home. The emergency medical service diagnosed ventricular tachycardia and cardioverted to sinus rhythm. The left cardiac contour was abnormal on radiography (Figure 1). Echocardiography showed a large mass at the lateral mitral annulus (Figure 2), without impediment to valvar function or blood flow. Magnetic resonance imaging (MRI) confirmed an encapsulated, homogenous, 5×4×5-cm mass, embedded in the myocardium, adjacent to but not involving the circumflex coronary artery. This mass had hyperintense MRI T1-weighted …