Posterolateral Wall Research Articles

Computed Tomography Scan Images of Sphenoidal Sinus Septa and Their Relations to the Internal Carotid Artery

The trigeminal nerve and optic nerve, cavernous sinus optic chiasm, pituitary gland, and internal carotid artery are all encircled by the sphenoid sinus, which is located in the sphenoid. More than one asymmetrical vertical septa separate the sphenoidal sinus. Because of its position and linkages with important neurovascular and glandular systems, the sphenoid sinus poses a substantial diagnostic and therapeutic challenge. Objective: To look at the relationship between sphenoid sinus septation and the number and position of the internal carotid artery in people from Peshawar, Pakistan. Methods: The prospective study was conducted from November 2019 to April 2020 at the Radiology Department of a Khyber Teaching Hospital, Peshawar, the CT image was performed on 150 patients (100 males, 50 females) of the paranasal sinuses. From the originating axial slices, secondary coronal scans were obtained. Only individuals with no sphenoid sinus problems were included in the research to examine anatomical changes in the septation of the sphenoid sinus. Results: According to CT scans of the participants, 34% of males and 23% of females had more than one sphenoid septum, with 24 men accounting for 20.8 % and 16 female cases (16.8%) having the septum attached to the posterolateral wall of the sinus of the carotid canal. Conclusions: Prior to surgery, a CT scan of the paranasal sinuses is essential to rule out any potential complications caused by anatomical differences.

Gender Related Differences in the Clinical Presentation of Hypertrophic Cardiomyopathy-An Analysis from the SILICOFCM Database.

Background and Objectives: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease that affects approximately 1 in 500 people. Due to an incomplete disease penetrance associated with numerous factors, HCM is not manifested in all carriers of genetic mutation. Although about two-thirds of patients are male, it seems that female gender is associated with more severe disease phenotype and worse prognosis. The objective of this study was to evaluate the gender related differences in HCM presentation. Materials and Methods: This study was conducted as a part of the international multidisciplinary SILICOFCM project. Clinical information, laboratory analyses, electrocardiography, echocardiography, and genetic testing data were collected for 362 HCM patients from four clinical centers (Florence, Newcastle, Novi Sad, and Regensburg). There were 33% female patients, and 67% male patients. Results: Female patients were older than males (64.5 vs. 53.5 years, p < 0.0005). The male predominance was present across all age groups until the age of 70, when gender distribution became comparable. Females had higher number of symptomatic individuals then males (69% vs. 52%, p = 0.003), most frequently complaining of dyspnea (50% vs. 30%), followed by chest pain (30% vs. 17%), fatigue (26% vs. 13%), palpitations (22% vs. 13%), and syncope (13% vs. 8%). The most common rhythm disorder was atrial fibrillation which was present in a similar number of females and males (19% vs. 13%, p = 0.218). Levels of N-terminal pro-brain natriuretic peptide were comparable between the genders (571 vs. 794 ng/L, p = 0.244). Echocardiography showed similar thickness of interventricular septum (18 vs. 16 mm, p = 0.121) and posterolateral wall (13 vs. 12 mm, p = 0.656), however, females had a lower number of systolic anterior motion (8% vs. 16%, p = 0.020) and other mitral valve abnormalities. Conclusions: Female patients are underrepresented but seem to have a more pronounced clinical presentation of HCM. Therefore, establishing gender specific diagnostic criteria for HCM should be considered.

Placenta accreta and posterolateral uterine wall rupture in first trimester in multiparous woman with scarred uterus with history of intake of misoprostol and mifepristone: a case report

Placenta accreta and posterolateral uterine wall rupture in first trimester in multiparous woman with scarred uterus with history of intake of misoprostol and mifepristone: a case report

Degeneration of a Huge Pleomorphic Adenoma in the Nasal Cavity Extended to the Hard Palate: A Case Report and Review of the Literature.

The pleomorphic adenoma is a benign tumor. The patient was 55years old, with no particular pathological history. For 18months, she had a progressive and permanent right nasal obstruction associated with intermittent epistaxis, rhinorrhea and chronic unilateral tearing. The nasofibroscopy showed a smooth reddish bleeding tumor of the right nasal cavity, reaching the lower part of the middle cornet. Oropharynx examination revealed on the right side a sessile and bulging tumor of the palate with respect of the mucosa, the tumor goes through the choanae into the oropharynx. The CT scan showed a large aggressive lesion process centered on the right nasal cavity with bone lysis of the posterolateral wall of the maxillary sinus and invasion of the infratemporal fossa. MRI showed a maxillary right naso-sinusal tumor process infiltrating the ethmoidal cells, the right infratemporal fossa with endobuccal extension and filling the nasopharyngeal lumen. The patient was operated through the right external para-latero-nasal, associated to an endonasal abord. Anatomo-pathological with immune-histochemical study was performed to ensure complete removal of the tumor and it showed a high grade cystic adenoid carcinoma.

THE EFFECTIVENESS OF RADIOFREQUENCY ABLATION FOR THE SURGICAL MANAGEMENT OF JUVENILE NASOPHARYNGEAL ANGIOFIBROMA: REPORT OF A CASE SERIES.

Juvenile angiofibroma is a fibrovascular tumour originating from the vascular structures of the posterolateral nasal wall, the endoscopic technique has become the approach of choice. Radiofrequency ablation is a minimally invasive procedure that generates thermal ablation through coagulation, allowing dissecting, cauterizing, and aspirating the tissue with the same device. We describe our experience with a series of 3 cases of patients operated on for juvenile angiofibroma resection using radiofrequency ablation and evaluate the efficacy and usefulness of the treatment performed.

Epstein Barr Virus Infection Induced Suspected Acute Myocarditis in COVID-19 Pandemic

Background: Epstein Barr Virus infection (EBV) could be associated with cardiovascular disease, including myocarditis. We informed a case of EBV infection presenting initially as myocarditis, followed 5 days later by the typical symptoms of infectious mononucleosis. Case Presentation: A 19-year-old man with persistent retrosternal chest pain was admitted to the emergency department. On physical examination, the patient had sub-febrile fever (37.2°C) and palpable cervical lymphadenopathy, with no hepatosplenomegaly. Initial ECG has repolarization abnormalities in leads II, aVF and III. Laboratory testing revealed elevated cardiac enzymes and liver enzymes (high sensitive troponin I levels 3000 ng/mL, aspartate transaminase 158 U/L, alanine transaminase 100 U/L). Blood white cells were 10,500 μL, platelet level were low 98,000 (thrombocytopenia), and lenfo-monocytosis in complete blood count. We hospitalized the patients the intensive coronary unit (ICU) because of high troponin levels. We recognized hypokinesia of the posterolateral wall of the left ventricle with mild impaired systolic function and increased perimyocardial brightness by echocardiography. Antibody serology tests showed that the anti-EBV capsid antigen IgM (EBV-VCA) was positive, EBV-VCA) IgG was negative. Other etiologies were excluded. Therefore, the patient was referred to cardiac positron emission tomography due to technic problems of magnetic resonance imaging device. We documented in positron emission tomography imaging that increased 18F-FDG uptake on posterior and posterolateral walls of left ventricle (indicating a large jeopardized area). We diagnosed suspected diagnosis of myocarditis without associated pericarditis. We monitored the patient and gave beta blocker, and aldosterone antagonists. Complications in the intensive care unit not occurred. We discharged patients after one week. After three weeks, we re-evaluated the patient. We not observed wall segment motion abnormality on echocardiography and liver tests were near normal. Conclusion: In suspected EBV myocarditis, 18F-FDG PET-CT cardiac positron emission tomography imaging represents an interesting noninvasive imaging technique to identify inflammatory processes in acute myocarditis and can be considered in patients with contraindications/unavailable to cardiac magnetic resonance.

Electrocardiographic features of patients with hypertrophic cardiomyopathy

Introduction. Hypertrophic cardiomyopathy is a disorder of the myocardium characterized by asymmetric or symmetric left ventricular hypertrophy. It is often an inherited disorder with an autosomal dominant pattern. The aim of this study was to evaluate the electrocardiographic characteristics of patients with hypertrophic cardiomyopathy, as well as to assess the accuracy of current electrocardiographic criteria for left ventricular hypertrophy used as indicators of hypertrophic cardiomyopathy. Material and Methods. This retrospective study was conducted using hospital medical records of 42 patients with the diagnosis of hypertrophic cardiomyopathy. Detailed electrocardiography analysis, apart from all the usual parameters, included the calculation of indices used to diagnose left ventricular hypertrophy including Sokolow augmented vector left, Cornell voltage, Cornell product, and Sokolow-Lyon index. Results. Sinus rhythm was present in 95.2% of patients, while atrial fibrillation was found in 4.8%. The majority of patients presented with left axis deviation. A slight positive correlation was found between the Sokolow augmented vector left index and posterolateral wall thickness (r = 0.475; p &lt; 0.05), and also between the Cornell voltage index and posterolateral wall thickness (r = 0.368; p &lt; 0.05). A borderline positive correlation was found between the Cornell product index and posterolateral wall thickness (r = 0.290; p = 0.063). Interventricular septum thickness showed no significant correlation with any of the electrocardiographic indices of left ventricular hypertrophy. Conclusion. In patients with hypertrophic cardiomyopathy, the Sokolow augmented vector left and Cornell voltage indices were the best indicators of posterolateral wall hypertrophy, whereas none of the examined indices correlated well with the interventricular septum thickness.

Urethral diverticulum: an unknown pathology.

A 25-year-old female patient, pregnant at 30 weeks gestation, with no particular medical history, presented to the clinic with urethral pain. The interrogation reveals dysuria evolving for more than 7 months, with urethral pain progressively increasing in intensity and dyspareunia preventing any sexual act for the couple. The clinical examination in the gynecological position found a rounded swelling developed in the anterior wall of the vagina. The vaginal touch: allowed the appreciation of the volume, of the consistency. Also, a small pressure on the mass caused cloudy urine to come out, confirming the communication between the pouch and the urethra. Urethrocystoscopy was impossible for our patient. The magnetic resonance imaging (MRI) objectified a urethral diverticulum of the left postero-lateral wall measuring 22*15Â mm. Urethral Diverticulum occurs in approximately 0.6-6% of women. Clinically, the most common presenting symptoms are urgency, pollakiuria, burning on urination, and dysuria. The most suggestive symptoms are posted voiding urine loss and dyspareunia. The diagnosis of the urethral diverticulum with less aggressiveness and 100% reliability thanks to endo-vaginal ultrasound and MRI. The treatment is based on the complete surgical removal of the urethral diverticula for a definitive cure. The therapeutic attitude for our patient is abstention until delivery, then the patient will be proposed to a surgical cure.

105 An intriguing case of pericardial effusion after acute coronary syndrome

Abstract Aims Left ventricular free wall rupture is one of the mechanical complications of myocardial infarction with an incidence of 2–4%. Sometimes the myocardial rupture hasn’t an immediate fatal evolution, nor is easy to be diagnosed because it is contained by the pericardium and thrombus formation, leading to pseudoaneurysm of the left ventricle. Pseudoaneurysms need a prompt surgical correction for their high risk of rupture both in the acute phase and later. Methods and results A 57 years old, smoker, woman with no previous cardiological history was admitted to our cardiological department for acute coronary syndrome with persistent ST segment elevation involving the postero-lateral wall (door to balloon time about 10 h, Killip class I and peak hs-TnI value was 27.67 ng/ml n.v. ˂0.02 ng/ml). The echocardiography showed mild left ventricular disfunction (LV EF 45%), postero lateral akinesia and moderate mitral regurgitation; ubiquitous pericardial effusion (1 cm) was present, particularly along the anterior left ventricular wall, with irregular echo-dense aspect. She underwent urgent coronarography that showed a critical stenosis of the distal third of the left circumflex and a thrombotic occlusion of the first marginal branch. The distal circumflex was treated with angioplasty and stent implantation but we couldn’t obtain the reperfusion of the marginal branch. Post procedural echocardiogram was unchanged and no free wall rupture was detected. 7 days after the admission, the patient showed persistent elevation of white blood count and CRP and developed fever, promptly empirically treated with a cephalosporin (blood cultures collected before were negative). After two new episode of fever with persisting biochemical flogistic parameters, a rheumatologic cause of the pericardial effusion was considered in the presence of positive antinuclear antibodies suggesting the diagnosis of Systemic Lupus Erythematosus. Steroidal therapy was prescribed which caused clinical improvement without complete resolution of the pericardial effusion. On day 20 of hospital stay a new echocardiographic evaluation showed a discontinuation of the postero lateral myocardial wall (Figure 1), about 1 cm in width, widely communicating with the left ventricular cavity and suggestive for a left postero-lateral ventricular pseudoaneurysm. The patient underwent surgical intervention and it was possible to expose a big clot occluding the pseudoaneurysmatic cavity communicating with the left ventricular chamber through an inlet about 1 cm in diameter, that was repaired with a bovine pericardial patch (Bard Sauvage technique). After surgery the patient was supported with an IABP and inotropes and was discharged to a rehabilitation structure on day 29 of hospital stay. Four months after the hospital discharge the patient died for a recently diagnosed pancreatic cancer. Conclusions Pseudoaneurisms are life-threatening complications of myocardial infarction that sometimes are hardly diagnosed. When correctly recognized surgical correction can lead to a good prognosis.

61-Year-Old Man With Nausea and Vomiting

61-Year-Old Man With Nausea and Vomiting

Abstract 11163: Biomechanics of Left Ventricular Remodeling in a Chronic Swine Model of Myocardial Infarction

Introduction: Adverse left ventricular (LV) remodeling after a myocardial infarction (MI) is an insidious process whose severity predicts future decompensated heart failure, morbidity and mortality. Our understanding of LV remodeling has been extensive at the molecular level, but little is known of the biomechanical changes that occur as the LV remodels, dilates, thins, and potentially has rearranged myofibers. In this study, we developed a chronic swine model of post-MI remodeling and used cardiac MRI to assess biomechanics of the remodeling LV after 10 weeks of infarction. Methods: Fourteen Yorkshire swine (n=14) were induced percutaneously with an MI by acute thrombosis of the left circumflex artery with ethanol infusion ( Fig.A1-A2 ), and the animals were survived. Echocardiography and MRI was performed at baseline and at 10 weeks to assess LV function and biomechanics, respectively. MRI was performed on a 3T Siemens scanner, with short axis CINE and tagged imaging ( Fig.A3-A4 ). LV strain, twist and torsion from short-axis tagged images and compared between baseline and 10 week values. Results: Survival rate after the infarction was 85.71%. Ejection fraction reduced from 54.79±5.52% at baseline to 47.29±8.36% 10 weeks post-MI (p=0.023) ( Fig.A5 ). LV end diastolic volume, end systolic volume and sphericity index were significantly elevated ( Fig.A6-A8 ). Radial strain values showed an increasing trend at 10 weeks after an MI, compared to baseline values ( Fig.B3 ). Circumferential strain values showed a decreasing trend by 10 weeks after MI compared to baseline values ( Fig.B4 ). Both ventricular twist and torsion were reduced compared to baseline, but the trend was more evident with LV torsion ( Fig.B5-B6 ) . Conclusions: After an MI of the postero-lateral wall, reduced ejection fraction and dilatation were observed as expected. LV radial strain was increased but circumferential strain, twist, and torsion of the left ventricle were significantly diminished.

Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia).

BackgroundOcclusion myocardial infarctions (OMIs) of the posterolateral walls are commonly missed by ST‐segment–elevation myocardial infarction (STEMI) criteria, with >50% of patients with circumflex occlusion not receiving emergent reperfusion and experiencing increased mortality. ST‐segment depression maximal in leads V1–V4 (STDmaxV1–4) has been suggested as an indicator of posterior OMI.Methods and ResultsWe retrospectively reviewed a high‐risk population with acute coronary syndrome. OMI was defined from prior studies as a culprit lesion with TIMI (Thrombolysis in Myocardial Infarction) 0 to 2 flow or TIMI 3 flow plus peak troponin T >1.0 ng/mL or troponin I >10 ng/mL. STEMI was defined by the Fourth Universal Definition of Myocardial Infarction. ECGs were interpreted blinded to outcomes. Among 808 patients, there were 265 OMIs, 108 (41%) meeting STEMI criteria. A total of 118 (15%) patients had “suspected ischemic” STDmaxV1–4, of whom 106 (90%) had an acute culprit lesion, 99 (84%) had OMI, and 95 (81%) underwent percutaneous coronary intervention. Suspected ischemic STDmaxV1–4 had 97% specificity and 37% sensitivity for OMI. Of the 99 OMIs detected by STDmaxV1–4, 34% had <1 mm ST‐segment depression, and only 47 (47%) had accompanying STEMI criteria, of which 17 (36%) were identified a median 1.00 hour earlier by STDmaxV1–4 than STEMI criteria. Despite similar infarct size, TIMI flow, and coronary interventions, patients with STEMI(−) OMI and STDmaxV1–4 were less likely than STEMI(+) patients to undergo catheterization within 90 minutes (46% versus 68%; P=0.028).ConclusionsAmong patients with high‐risk acute coronary syndrome, the specificity of ischemic STDmaxV1–4 was 97% for OMI and 96% for OMI requiring emergent percutaneous coronary intervention. STEMI criteria missed half of OMIs detected by STDmaxV1–4. Ischemic STDmaxV1–V4 in acute coronary syndrome should be considered OMI until proven otherwise.

Radiological features and clinical implications of persistent congenital mesocolon: Pictorial essay.

In human foetus, the mesenteries that carry vascular and neural supply to the alimentary tube play an important role in its development and anatomical location within the abdominal cavity. The mesenteric attachments of the small bowel, transverse colon and sigmoid allow them to be intraperitoneally mobile structures. In contrast, the ascending and descending colon lose their mesenteries by fusion with the parietal peritoneum and become fixed in retroperitoneal position along the posterolateral walls of the abdomen. In about 2%-4% of individuals, this process is disrupted, causing a complete or partial retention of their congenital mesocolon. The ascending or descending colon will then remain intraperitoneally mobile, affecting the normal visceral anatomy and causing potential complications. This article reviews the spectrum of radiological manifestations and clinical consequences of these anomalies.

Iatrogenic esophageal perforation with mediastinitis, multidisciplinary management: a case report

Acute mediastinitis is a low incidence pathology, but it is associated with a high mortality rate. Iatrogenic lesions are the most common cause of mediastinitis secondary to esophageal perforation. Early diagnosis and surgical treatment are the most important factors in the treatment of patients with this condition. 83-year-old female patient, with a history of left saphenectomy due to venous insufficiency with difficult intubation two days prior to the emergency consultation. She was admitted to the emergency room due to dyspnea, hemoptysis, chest pain, and right hemifacial edema. A chest tomography was performed with findings suggestive of esophageal perforation or airway injury. Later, in an upper digestive tract study, extravasation of the contrast medium was documented in the right posterolateral wall of the cervical esophagus with a collection in the middle mediastinum. The patient was taken for drainage of mediastinitis by right thoracoscopy and the presence of a perforation in the cervical esophagus was confirmed with an intraoperative endoscopy. Esophageal repair was performed, with drainage of the prevertebral space and the superior mediastinum by a left longitudinal cervicotomy. Postoperatively, she received antibiotic and enteral nutritional support by a nasojejunal tube. Low output fistula of the cervical esophagus, organized by a drain, was documented, which closed after 4 weeks of conservative management. Iatrogenic esophageal perforation with mediastinitis is a very rare entity with a high mortality. Early surgical treatment is the most important prognostic factor in patients with mediastinitis due to esophageal perforation.

A Dentigerous Cyst Arising from an Ectopic Supernumerary Tooth Lodged in the Posterolateral Wall of the Maxillary Sinus: A Rare Case Report and Treatment Modality.

The occurrence of a dentigerous cyst in relation to a supernumerary tooth in the maxilla is extremely rare. We in this case discussion present an even rarer case of a dentigerous cyst in relation to an ectopic supernumerary tooth in the posterolateral wall of the maxillary sinus. An endoscopically assisted multi speciality surgical approach was adopted to minimize morbidity in this complex bony lesion, with the residual bony defect reconstructed with the help of buccal fat pad.

Myeloid Sarcoma of the Bladder in a Patient with Chronic myelomonocytic Leukaemia

Background Myeloid sarcoma is a rare extramedullary tumour of immature granulocytes, most commonly involving the skin, bone, lymph nodes, and soft tissue. It is usually associated with a diagnosis of relapsed or de novo acute myeloid leukaemia, acute lymphoblastic transformation of a myelodysplastic/myeloproliferative neoplasm, or can occur as isolated myeloid sarcoma. Case report A 66-year-old female with a 7-year history of stable chronic myelomonocytic leukaemia presents with urgency, frequency, dysuria symptoms, and without new constitutional symptoms. She is found to have atypical, multifocal lesions on the right posterolateral wall of the bladder with associated hydronephrosis. Pathology reveals the diagnosis as myeloid sarcoma; surprisingly, bone marrow evaluation does not show evidence of acute leukaemic transformation. Conclusions Myeloid sarcoma occurring in patients with chronic myelomonocytic leukaemia is extremely rare, and there are no cases reported in the English literature of these patients developing lesions in the bladder. The urological manifestations of an underlying haematological malignancy are best managed with a combination of systemic chemotherapy and allogeneic stem cell transplant, and in this case, the only surgical intervention required was ureteric stenting and tissue biopsy. Although rare, it is essential to consider alternative diagnoses when confronted with an atypical bladder tumour; failure to do so may result in patient harm by exposure to unnecessary intervention and delay to potentially curative treatment.

New sperm whale remains from the late Miocene of the North Sea and a revised family attribution for the small crown physeteroid Thalassocetus Abel, 1905

In spite of a continuously expanding physeteroid fossil record, our understanding of the origin and early radiation of the two modern sperm whale families Kogiidae Gill, 1871 (including the pygmy and dwarf sperm whales, Kogia spp.) and Physeteridae Gray, 1821 (including the great sperm whale, Physeter Linnaeus, 1758) remains limited, especially due to the poorly resolved phylogenetic relationships of a number of extinct species. Among those, based on fragmentary cranial material from the late early to middle Miocene of Antwerp (Belgium, North Sea basin), the small-sized Thalassocetus antwerpiensis Abel, 1905 has been recognized for some time as the earliest branching kogiid. The discovery of a new diminutive physeteroid cranium from the late Miocene (Tortonian) of Antwerp leads to the description and comparison of a close relative of T. antwerpiensis. Thanks to the relatively young ontogenetic stage of this new specimen, the highly modified plate-like bones making the floor of its supracranial basin could be individually removed, a fact that greatly helped deciphering their identity and geometry. Close morphological similarities with T. antwerpiensis allow for the reassessment of several facial structures in the latter; the most important reinterpretation is the one of a crest-like structure, previously identified as a sagittal facial crest, typical for kogiids, and here revised as the left posterolateral wall of the supracranial basin, comprised of the left nasal (lost in kogiids for which the postnarial region is known) and the left maxilla. Implemented in a phylogenetic analysis, the new anatomical interpretations result in the new Belgian specimen and T. antwerpiensis being recovered as sister-groups in the family Physeteridae. Consequently, the geologically oldest kogiids are now dated from the Tortonian, further extending the ghost lineage separating these early late Miocene kogiid records from the estimated latest Oligocene to earliest Miocene divergence of kogiids and physeterids.

What is the precaecocolic fascia?

The precaecocolic fascia, previously known as Jackson's membrane, is a variable vascular peritoneal fold between the ascending colon and the right posterolateral abdominal wall. First described in 1913, it was originally thought to be of developmental or inflammatory origin and associated with abdominal pain. This investigation aimed to review its frequency, form and structure and look for evidence of association with malformation of the bowel, or previous inflammation. 26 dissecting room cadavers were studied to identify the precaecocolic fascia, any malrotation of the colon or signs of previous inflammation: adhesions, surgical scars, or absence of the appendix. Its structure was examined histologically and latex injections were used to trace the arteries. Membranes comparable with previous descriptions of the precaecocolic fascia occurred in 12 of 26 abdomens. They varied in form and size from long and translucent to short, thick, and opaque. In structure, the fascia resembled a fold of peritoneum containing a thickened fibrous lamina. Large thin-walled arteries in the fascia crossed the arteries in the wall of the colon at the point of attachment. No significant association with colonic malrotation or markers of previous inflammation were found. Attention should be paid to the definition of the precaecocolic fascia and "membrane" seems a more appropriate term than "fascia". It is one of a recognized group of peritoneal folds/bands, doubtful in origin but unlikely to be post-inflammatory. It may modify colonic mobility or complicate colonic operations.

Cardiac magnetic resonance features of left dominant arrhythmogenic cardiomyopathy: differential diagnosis with myocarditis

Cardiac magnetic resonance (CMR) findings suggesting a suspected left-dominant arrhythmogenic cardiomyopathy (LDAC) may be difficult to distinguish from those related to previous myocarditis; however, especially in patients with ventricular arrhythmias (VA) with ECG morphology consistent with a left ventricle (LV) origin differential diagnosis is fundamental. Aim of the study was to identify potential imaging features at CMR specific for LDAC diagnosis. Between January 2011 and December 2019, we enrolled 15 consecutive stable patients with a recent diagnosis of significant VA and ECG morphology consistent with a LV origin, detection of potential LV arrhythmic substrate at CMR and undergoing a clinically-indicated LV endomyocardial biopsy showing tissue abnormalities consistent with the diagnosis of LDAC. From the same CMR-endomyocardial biopsy registry, a second group of 30 consecutive patients who underwent CMR and biopsy with a histological diagnosis of previous myocarditis were identified. (1) Subepicardial LGE at the level of the posterolateral wall of the LV was detected in 13 cases of LDAC vs. 21 cases of myocarditis; (2) fat infiltration, and particularly subepicardial posterolateral fat infiltration, was found in almost all LDAC patients vs. one myocarditis only (p < 0.01). (3) No differences in other CMR findings or in any clinical or echocardiographic parameters were found between patients with a biopsy consistent with LDAC vs. myocarditis. In patients with significant VA and ECG morphology consistent with a LV origin, the presence of morpho-functional involvement of the subepicardial layer of LV posterolateral wall at CMR (LGE, fat infiltration, wall dyskinesis) supports LDAC diagnosis.

Primary Follicular Dendritic Cell Sarcoma of Urinary Bladder.

Follicular dendritic cell sarcoma is a rare malignant mesenchymal neoplasm composed of follicular dendritic cells. A subset of cases can be found at extranodal sites. Only 2 follicular dendritic cell sarcomas were previously reported in the urinary bladder. We report a follicular dendritic cell sarcoma that involved the urinary bladder of an 81-year-old woman, who presented with painless gross hematuria. The neoplasm was composed of large epithelioid cells with atypical nuclei, admixed with inflammatory cells. On immunohistochemistry, the neoplastic cells were reactive only for CD21, CD35, and vimentin. The tumor was considered unresectable due to its large size and proximity to the iliac vessels and the patient was treated with bortezomib, cyclophosphamide, and dexamethasone. Although a full course of chemotherapy was not completed due to adverse side effects, the tumor was reduced in size. A subsequent involved-field radiotherapy was performed. Three years postdiagnosis and 2 years after the radiotherapy treatment, a recurrent tumor was identified on imaging in the left posterolateral bladder wall. However, at that time the patient was found to have a newly developed advanced colonic adenocarcinoma. Three and a half months later she developed a bowel perforation and died.