Rare Pathology Research Articles

Exploring the dynamics of ultrasound training in medical education: current trends, debates, and approaches to didactics and hands-on learning.

Medical education, especially in ultrasound training, is undergoing significant changes. This study examines practical issues in ultrasound medical education, emphasizing state-of-the-art teaching methods, their effectiveness, and implementation challenges. The study analyzed advancements in ultrasound education, including randomized controlled trials comparing peer-to-peer teaching with traditional faculty-led instruction. It evaluated the effectiveness of collaborative small-group training and group size impact in simulation-based training. The study also assessed practical training components outlined in the WFUMB Position Paper Part II. Findings indicate that peer-to-peer and collaborative small-group training are effective and cost-efficient. Group size did not significantly affect training outcomes. Key practical training elements, including early hands-on sessions and exposure to various equipment, substantially improved learning outcomes. Simulation tools like virtual reality (VR), augmented reality (AR), and phantoms were crucial for teaching standardized procedures and rare pathologies. Challenges identified include developing robust image acquisition skills, scarcity of qualified student tutors, and the need for reliable ultrasound skill assessment methods. Integrating peer-to-peer teaching and advanced simulation technologies significantly advances ultrasound medical education. These methods enhance cognitive and psychomotor skills but also present challenges such as ensuring quality education and developing effective assessment methods. Future research should compare different simulation tools and establish objective ultrasound proficiency assessment criteria. Continual method evaluation and improvement are essential for effective and standardized ultrasound training, ultimately enhancing patient care and clinical outcomes.

EGS SO28 - Management of oesophageal diverticulitis in a 71-year-old female: Case report and review of management approaches

Abstract Background Oesophageal diverticulitis is a rare condition with fewer than ten reports in the literature. We present a case of oesophageal diverticulitis in a 71-year-old female with a history of COPD, TIA, and known oesophageal diverticulum. She was managed conservatively with NBM, total parenteral nutrition and intravenous antibiotics requiring a 16-day inpatient stay. The rarity of this condition poses challenges in its diagnosis and management, necessitating a thorough understanding of both conservative and surgical interventions. This case highlights the complexity involved in treating oesophageal diverticulitis, especially in patients with significant comorbidities. Method Patient presented with a 6-day history of upper abdominal pain and sepsis (elevated inflammatory markers; CRP 320, WCC 11.1, temperature 38.0, pulse 104). Abdomen was soft with upper abdominal tenderness. Imaging was consistent with diverticulitis of a 5.9cm lower oesophageal diverticulum without perforation. Initial management included making the patient nil by mouth, total parenteral nutrition, and intravenous antibiotics (vancomycin and metronidazole). The patient’s condition was closely monitored with serial blood tests and clinical assessments. Opinion was sought from a tertiary upper GI centre. Discharge was planned once the patient safely transitioned to oral diet and was apyrexial for 48 hours. Results Inflammatory markers improved over five days (CRP from 320 to 51, WCC from 11.1 to 9). She remained intermittently pyrexial until day 8 of admission. Clinical improvement allowed transition from intravenous to oral therapy, and she was discharged on day 16 with double dose oral PPI therapy. Patient has been followed up by tertiary upper GI services with plans for consideration of surgical resection of the oesophageal diverticulum. The patient’s successful discharge without surgical intervention during the acute phase underscores the effectiveness of a conservative management approach initially, with a plan for definitive surgical treatment in a stable outpatient setting. Conclusion Oesophageal diverticulitis, though rare, requires a nuanced approach to management, especially in patients with significant comorbidities. This case demonstrates the importance of an awareness of thorough history taking and review of previous examinations to prevent delayed diagnosis of a rare pathology not demonstrated on a CT abdomen and pelvis. This approach highlights the importance of individualised treatment plans and the potential for conservative management to provide stabilisation, followed by elective surgical management. The paucity of cases of oesophageal diverticulitis has prevented development of evidence based guidelines, underscoring the importance of seeking advice from tertiary centers when managing rare presentations.

Diphallia with associated congenital malformations

BACKGROUND: Diphallia is an extremely rare congenital pathology in which children are born with a double penis. Diphallia is usually accompanied by systemic abnormalities, and their degree varies from no associated abnormalities to multiple abnormalities, including genitourinary, gastrointestinal, and musculoskeletal ones. Mortality among infants born with diphallia is higher due to infectious diseases accompanying developmental anomalies. CLINICAL CASE DESCRIPTION: The presented case is an example of diphallia with associated developmental malformations and the staged surgical treatment which resulted in good outcomes. DISCUSSION: Diphallia is treated surgically, but in each case, it is necessary to take into account the concomitant pathology. The main cause of death in children with diphallia are concomitant severe developmental defects, so the treatment is carried out in stages. In this case, because of the anorectal defect, intestinal obstruction was eliminated first by forming a sigmoid colostomy. Subsequently, after the child’s condition improved and he developed further, a staged surgical treatment was performed: removal of a lipoma in the cauda equina, simultaneous surgery (removal of the penis, elimination of the rectovesical fistula, lowering the rectum and forming the anus, elimination of vesicoureteral reflux, plastic surgery of the anterior abdominal wall), osteotomy with reduction of the right femur head and fixation with an L-shaped plate. The next stage of surgical treatment is the correction of the curvature of the spine and pelvic bones. CONCLUSION: In case of diphallia associated with other pathologies of organs and systems, especially of anorectal malformations, the initial formation of a double-barreled sigmostostomy helps to stabilize the child’s condition and to postpone radical surgery to the time more convenient for the patient and the doctor.

NCOG-10. LONGITUDINAL MULTIDISCIPLINARY MONITORING OF NEUROCOGNITIVE FUNCTION FOR COLLOID CYST RESECTION: THE IMPACT OF SURGERY

Abstract Endoscopic resection of colloid cysts, a rare pathology of the third ventricle, is now accepted clinical practice. Owing to their location proximal to numerous deep gray nuclei and to the forniceal columns, colloid cysts have always been feared to cause cognitive decline, whether operated on or not. Detailed cognitive testing before and after endoscopic resection, however, has rarely been described. Thus, out objective was to determine the neurocognitive effects of endoscopic colloid cyst resection. We analyzed formal pre- and postoperative neuropsychological testing performed in 20 patients undergoing endoscopic colloid cyst resection. Performance was compared either for each individual patient on a test-by-test basis or according to aggregated neuropsychological factor scores grouped via expert census. A clinical change was defined significant if (i) reaching statistical significance, and (ii) it was greater than 1.5 times the standard deviation of the preoperative performance distribution. Overall, 20 adult patients with colloid cysts (diameter 13.3 ± 1.3 mm) underwent matched pre- and postoperative testing generating 679 data points. No patient had a significant change in cognitive performance. When neurocognitive metrics assessing cognitive functions typically subsumed by the temporal (p = 0.35), extratemporal (p = 0.20), occipitoparietal (p = 0.31), or frontal lobes (p = 0.11), no statistically significant difference was observed between pre- and postoperative cognitive performance. No significant differences emerged when factor scores were generated according to composite score of different neurocognitive domains: attention (p = 0.32), executive function (p = 0.14), language (p = 0.98), and visuospatial function (p = 0.42). In conclusion, neuropsychological testing allows for the careful longitudinal monitoring of cognitive status and the identification of patients who may benefit from pre- and postoperative cognitive rehabilitation, and should be used as a valuable surgical psychometric marker and adjuvant. No significant cognitive decline was observed, again confirming the safety of endoscopic colloid cyst resection.

Adverse Reactions to the Orphan Drug Cerliponase Alfa in the Treatment of Neurolipofuscinosis Type 2 (CLN2)

Background/Objectives: Neuronal Ceroid Lipofuscinosis type 2 is a rare pathology affecting mainly the central nervous system (CNS) and retina, and is caused by variants in the gene encoding the lysosomal enzyme tripeptidyl peptidase 1. Therapy with enzyme replacement through the brain infusion of the orphan drug cerliponase alfa, a recombinant human tripeptidyl peptidase 1 enzyme replacement therapy delivered via intracerebroventricular infusion, has been approved for Neuronal Ceroid Lipofuscinosis type 2 disease. The safety profile of cerliponase alfa has been established based on pre-authorization studies; currently, no post-marketing investigation has been performed to confirm it. Here, a descriptive analysis of real-world spontaneous reporting data of suspected adverse reactions (SARs) to cerliponase alfa in the EudraVigilance database was performed to compile clear information on the safety profile. Methods: Suspected adverse reactions to cerliponase alfa reported in the data system EudraVigilance were analyzed for age, sex of the patient, adverse reactions, and the indication for use. Results: Cases with suspected adverse reactions to cerliponase alfa were found to be more frequent in female patients (58.1%) and in children aged 3–11 years. The most common adverse reactions were, in decreasing order, fever/pyrexia, device-related infection, vomiting, seizures/convulsions, pleocytosis, irritability, ventriculitis, and respiratory disorders. Conclusions: The results confirm the safety profile of cerliponase alfa established with pre-registration clinical studies but suggest the need for further studies to investigate the occurrence of adverse reactions, as possible predictive prognostic markers, in more depth.

An arrhythmic variant of the manifestation of paraneoplastic Loeffler endomyocarditis. Clinical case

A clinical case of chronic undulating course of parneoplastic Loeffler endomyocarditis, the leading manifestations of which were ventricular arrhythmias, is presented. The paper demonstrates the complexity of early diagnosis of a rare pathology in a polymorbid patient and attempts to identify the "keys" to the correct diagnostic and therapeutic tactics for managing such patients.

Developing a 10-Layer Retinal Segmentation for MacTel Using Semi-Supervised Learning.

Automated segmentation software in optical coherence tomography (OCT) devices is usually developed for and primarily tested on common diseases. Therefore segmentation accuracy of automated software can be limited in eyes with rare pathologies. We sought to develop a semisupervised deep learning segmentation model that segments 10 retinal layers and four retinal features in eyes with Macular Telangiectasia Type II (MacTel) using a small labeled dataset by leveraging unlabeled images. We compared our model against popular supervised and semisupervised models, as well as conducted ablation studies on the model itself. Our model significantly outperformed all other models in terms of intersection over union on the 10 retinal layers and two retinal features in the test dataset. For the remaining two features, the pre-retinal space above the internal limiting membrane and the background below the retinal pigment epithelium, all of the models performed similarly. Furthermore, we showed that using more unlabeled images improved the performance of our semisupervised model. Our model improves segmentation performance over supervised models by leveraging unlabeled data. This approach has the potential to improve segmentation performance for other diseases, where labeled data is limited but unlabeled data abundant. Improving automated segmentation of MacTel pathology on OCT imaging by leveraging unlabeled data may enable more accurate assessment of disease progression, and this approach may be useful for improving feature identification and location on OCT in other rare diseases as well.

The place and space of meals in the family of a premature infant with a rare ENT pathology

In the context of prematurity, invasive care can interrupt recognition of the oral sphere as a source of pleasure, substituting positive in utero experiences with others of pain and passivity. Aunique approach to care in the neonatal unit helps to support parents and baby during this period. However, if medical care can be reduced, what happens when the baby returns home, and when he or she discovers how to eat? How can the gastrostomic baby take part in the family meal? We'll take a look at Basile (born prematurely with a rare ENT pathology) and his family, to see how, at the age of2, he can carve out a place for himself within his family, particularly with his brothers, including his twin, who has a different background.

Clinical and epidemiological characteristics of patients with pheochromocytoma and retroperitoneal paraganglioma

Introduction. Pheochromocytoma/paraganglioma (PPGL) is a rare hormonally active tumor of chromaffin tissue. Delayed diagnosis of this disease can lead to severe, even fatal, complications. Surgical treatment of PPGL without the necessary preoperative preparation can cause intraoperative uncontrolled hemodynamic impairment. In addition, since 2017, PPGL has been recognized as a malignant tumor due to the presence of metastatic potential. All these factors determine the need for early diagnosis of PPGL, which is based, first of all, on knowledge of the clinical picture by specialists in various fields.Aim. To check and confirm the epidemiological characteristics of PPGL as well as the most common clinical symptoms in the whole group of PPGL and in subgroups of clinical forms; to form a risk group for screening for PPGL.Materials and methods. There were enrolled 353 patients in the study. These patients were operated on at the St. Petersburg State University Hospital in the period from 2010 to 2022 inclusive. All the patients were verified PPGL diagnosis histologically. Clinical symptoms were assessed: a) retrospectively, by analyzing complaints and anamnesis from the initial examination in medical histories upon admission to the hospital for surgical treatment b) both in the entire group as a whole and in subgroups of clinical forms (paroxysmal, constant, mixed, asymptomatic). Statistical analysis was performed using the Python 3.11 programming language (Python Software Foundation, USA). descriptive statistics of quantitative characteristics are presented in the form of medians, first and third quartiles in me format [q1; q3], categorical features – in the form of absolute and relative frequencies in the format n (%). the frequency histogram was constructed using the Matplotlib 3.8.2 library.Results. PPGL is most common in women over 40 years of age. The most common symptoms of PPGL are the following: a feeling of rapid heartbeat (55.95%), headache (41.07%), arterial hypertension (AH) in the form of hypertensive crises (55.65%), constant increase in blood pressure (38.39%), episodes of moderate increases in blood pressure (24.11%), sweating (30.65%), general weakness and fatigue (26.19%), hot flashes or chills (24.11%). These symptoms are formed into the criteria for screening for PPGL. In the asymptomatic clinical form – lower back pain is more common (14%); with paroxysmal – panic attacks (10%); with mixed – thirst and dry mouth (10%), and with constant form – the actual constant nature of hypertension (100%).Conclusion. In a large sample of patients with a rare pathology, the most characteristic symptom complex was identified, characteristic of both PPGL and individual clinical forms. A risk group has been formed for screening for PPGL.

Allergies aux fientes d’oiseaux

The problems of human–bird cohabitation are not a recent phenomenon even if today their importance has taken on an indisputable extent. Their droppings contain significant concentrations of microorganisms and can cause allergic diseases, such as hypersensitivity pneumonitis (HSP), formerly called extrinsic allergic alveolitis, but also rhinitis, asthma or conjunctivitis. We report a rare case of allergy to bird droppings in a patient who raises chickens and canaries, having consulted for rhinoconjunctivitis whose allergological assessment found sensitization of these droppings with positive skin and specific IgE tests. Its management consisted of avoiding the risk with medical treatment. It is a rare pathology that must be considered in the event of exposure to birds.

In toto resection of a rare intradural extramedullary cavernous malformation on the S1 nerve root: illustrative case.

Cavernous malformations (CMs) are vascular malformations that usually occur in the brain and occasionally in the spine. Most CMs are sporadic, but they can also be caused by heterozygous cerebral cavernous malformation (CCM) gene mutations. This case describes an intradural extramedullary CM in a unique location, within a fascicle of the S1 nerve root. This tumor was found to have a CCM2 mutation. An operative video demonstrates the surgical procedure used to remove this S1 intradural extramedullary CM. A 61-year-old male with an intradural extramedullary CM, located within a fascicle of the S1 nerve root, presented with pain and neurological symptoms. Additional imaging revealed two CCMs. The S1 CM was removed in toto. Subsequently, genetic screening revealed a CCM2 mutation. Given the rarity of a radicular CM, diagnosis can be challenging. CMs should be considered in patients with radicular pain and corresponding nerve root thickening. When a CM is suspected, imaging of the complete neuraxis should be performed. If multiple CMs are found, genetic screening is indicated. Complete resection of the CM yields good clinical results. The operative video in this case might help surgeons encountering this rare pathology to prepare for surgery. https://thejns.org/doi/10.3171/CASE24270.

Clinical features and survival rate of patients with ovarian granulosa cell tumor in Iran; a 10-year retrospective study

IntroductionOvarian granulosa cell tumor (OGCT) is a rare female pathology with few available demographic data. Besides, there are no comprehensive clinical characteristics regarding the OGCT in Iran. Thus, this study aimed to assess the clinical features and survival rate of OGCT patients in Iran to expand the scope of knowledge in this field.Materials and methodsIn this 10-year retrospective study (2013–2023), the cases were gathered from the oncologic clinic of women (Imam Khomeini Hospital, Tehran, Iran). The patients with definite OGCT diagnosis were selected based on the inclusion and exclusion criteria including medical history, interfering backgrounds, demographic data, histopathological assessment, clinical and para-clinical features, survival rates, and all previous medical reports for definite diagnosis of OGCT along with approved pathology samples.ResultsThe median age and BMI values of Iranian patients were 45 (19 ~ 83) years and 28.04 (19.4 ~ 48.0), respectively. The most common symptom was abdominal pain (56%) and 69.2% of cases were menopause. In 81.3% of cases, ovarian tumors were detected and metastasis was rare. Most patients (40.6%) underwent total abdominal hysterectomy and OGCT relapsing cases were seen in 13.2% of patients. The median of overall survival (OS) value using the Kaplan-Meier estimate was 52 months (95%CI:37.47–66.53), and the median of disease-free survival (DFS) was 45 months (95%CI: 28.88–61.12). There was a significant (p < 0.05) relation between chemotherapy and left oophorectomy with OS. A significant (p < 0.05) correlation was also detected among the OGCT stage and left oophorectomy with DFS.ConclusionOS and DFS values showed that the OGCT in Iranian patients can be treated in most cases using two main procedures of chemotherapy and oophorectomy. Parallel application of both procedures and associated outcomes are suggested for future studies.

Drug-resistant epilepsy cases in chromosomal pathology

Two cases of epilepsy in patients with a rare hereditary pathology associated with a chromosomal mutation caused deletion of chromosome 14 are presented. In the first case, this pathology was manifested in the child by generalized tonic-clonic seizures, delayed psycho-verbal development, and facial skull microanomaly. In the second case, it was expressed in tonic epileptic seizures, delayed psycho-verbal development, developmental microanomalies, pyramidal atactic syndrome and hand joint hypermobility. Such clinical observations are of professional and scientific interest, as they relate to a rare neurological pathology, with drug-resistant epilepsy as a leading sign.

Aneurism of the left portal vein branch in a teenager - a rare clinical case

The authors presented their own clinical observation of an aneurysm of the left portal vein branch in a teenager with a long-term asymptomatic course. Reduced serum concentrations of ceruloplasmin and α-1-antitrpsin made diagnostic search difficult, which could lead to incorrect therapeutic decisions. However, the results of imaging methods allowed us to establish the root cause of liver damage and its cirrhotic transformation. Vascular aneurysms of the portal vein system are a very rare pathology, and it should be taken into account in the differential diagnostic algorithm while excluding other, more obvious causes of liver pathology.

Management of a Rare Case of Superior Mesenteric Artery Aneurysm Associated with a Pancreatic Cyst Complicated by Acute Rupture: A Case Report and Review of Literature

Superior mesenteric artery aneurysms are a rare pathology, and rupture due to a pancreatic cyst in the context of alcohol-induced pancreatitis is an even rarer condition. The first line of treatment is usually an endovascular approach. We present the case of a 51-year-old male with alcohol-induced pancreatitis, diagnosed with a superior mesenteric artery aneurysm with active bleeding in close contact with a large pancreatic cyst. A covered stent was used to treat this condition. The patient developed hemorrhagic shock 12 h after the procedure and an urgent laparotomy was performed. A second rupture of the arterial wall at the distal end of the stent was observed and in order to obtain distal perfusion, first, an infrarenal aorta to superior mesenteric artery bypass distal to the rupture was performed in order to exclude the aneurysm. Secondly, a bypass originating from the distal end of the first bypass to the distal end of the superior mesenteric artery was performed. The patient had an uneventful recovery and was discharged after 10 days. We reviewed the literature regarding the incidence and the therapeutic management of superior mesenteric artery aneurysm complicated by pancreatic cyst. An advanced search on PubMed from 2004 to 2024 returned 194 results and after applying the inclusion–exclusion criteria, 11 publications were selected. Although the endovascular approach is usually the first line of treatment with obvious advantages for the patient, a patient-tailored approach should be made in such cases and surgery could be the first option, when considering that the mechanism of aneurysm rupture is due to erosion of the arterial wall by the pancreatic enzymes. Surgery has the advantage of cyst drainage and aneurysm exclusion and in our case proved lifesaving.

Postpartum Ultrasound: An Indispensable Tool in the Labor Ward.

Postpartum hemorrhage can occur because of different conditions. Apart from placental remnants and uterine atony, less common causes include uterine rupture, placental polyps, arteriovenous malformations, and pseudoaneurysms. Ultrasound plays a key role in the precise definition of the underlying pathology, which is necessary to initiate the appropriate therapy. It also helps to depict intraabdominal hematomas and uterine scar dehiscence, 2 conditions that do not necessarily lead to postpartum hemorrhage but are associated with increased maternal morbidity. This article presents 52 ultrasound images together with clinical and histopathologic images to give an overview of both frequent and rare pathologies in the postpartum period.

Orthodontic-Surgical Management of Triple Impacted Mesiodens and Maxillary Incisors - A Case Report

Abstract Rationale: Mesiodens are supernumerary teeth located in the pre-maxilla between the two central incisors with a prevalence rate of 0.15–1.9%. An impacted mesiodens may cause delayed eruption of permanent incisors, ectopic eruption, pathological disturbances and malalignment of teeth. Patient Concerns: The patient complained of missing upper front teeth associated with pain in the same region for two weeks. Diagnosis: Upon clinical and radiographic examination, it was diagnosed as triple impacted mesiodens with impacted permanent maxillary central incisors. Treatment: The clinicians in the study approached the issue by surgical removal of the impacted mesiodens and orthodontic treatment for extrusion of the impacted permanent maxillary central incisors. Outcomes: The patient was relieved of the pre-operative concerns and followed up regularly for the eruption of permanent maxillary central incisors. Take-away Lessons: The authors advocate the importance of timely diagnosis and proper management of such rare pathologies.

Botulinum Gastroparesis, A Case Report

Botulinum gastroparesis is a very rare pathology, complicating a botulinum toxi infection following ingestion of contaminated food, it is characterized by uncontrollable vomiting not responding to antiemetic treatment associated with a significant neurological syndrome, the diagnosis is made by abdominal CT scan without and after injection of PDC for possible elimination of a mechanical obstruction and following a history of ingestion of infected food, the evolution is marked following the taking of the botulinum antidote, by an improvement in digestive and neurological symptoms. Keywords: gastroparesis, botulinum, botulism, canned.

Comparison of Clinical Diagnosis and Autopsy Findings of Early Neonatal Deaths: Diagnostic Challenges and the Value of Autopsy in Identifying Rare Pathologies.

In a non-forensic hospital setting, neonatal death within the first week of life is often related to premature birth and/or lung diseases. Without post-mortem examination, the identification of the cause of death may be challenging. Autopsy can confirm the clinical diagnosis, uncover additional information or change the diagnosis. Our study aimed to assess the correlation between the clinical diagnosis and post-mortem findings in early neonatal deaths. The retrospective study included autopsy cases with neonatal deaths within the first 7 days of life (arbitrary time interval 2006-2021). Discrepancies between clinical and histopathological findings were classified into 3 groups: (i) full agreement, (ii) additional findings discovered by autopsy, or (iii) autopsy changed the diagnosis. A cohort of 27 cases could be identified and lung pathologies were the most common finding (56%). Additional findings could be discovered in 48% of cases. Major discrepancies which changed the clinical diagnosis could be found in 11% (n = 3/27) of cases. Frequently, post-mortem examinations validate the clinical diagnosis while revealing crucial information in a few cases. In these discrepant cases, autopsy findings can provide information for genetic counselling and quality control of clinical management.

Report of a giant invasive, wall-penetrating cardiac lipoma

BackgroundCardiac lipoma, a seldom-encountered benign tumor positioned beneath the endocardium, has the potential to impair electrophysiological functions. Diagnosis is principally based on imaging modalities. The uniqueness of this case lies in the tumor’s extension both internally and externally within the right atrium, rendering it of special interest. From a clinical standpoint, surgical removal is commonly advocated, wherein early intervention is pivotal in improving patients’ long-term prognoses.Case presentationA 35-year-old male was admitted to the hospital for treatment subsequent to the identification of a cardiac mass two days prior. Initial diagnostic assessments, encompassing CT scans and echocardiography, identified a space-occupying lesion within the heart. The patient underwent surgical excision of the cardiac tumor, utilizing mild hypothermic extracorporeal circulation via femoral vessel access. Intraoperative findings revealed adipose-like tissue of a “dumbbell-shaped” configuration situated both within and external to the right atrium, measuring approximately 8 cm*9 cm internally and 7 cm*6 cm externally, with the extracardiac mass being marginally larger. Postoperative pathological analysis confirmed a cardiac lipoma diagnosis. A follow-up echocardiogram conducted three months post-surgery exhibited no notable abnormalities. The patient is under continuous observation to monitor for any recurrence or potential long-term complications.ConclusionIn this case report, we detail with precision a rare cardiac pathology manifested by an expansive infiltrative lipoma that pervades the endocardial and epicardial layers of the right atrium. After thorough preoperative diagnostic workup and evaluation, we contend that surgical intervention represents the optimal therapeutic approach for managing such conditions, with the goal of preemptively reducing the likelihood of cardiac compression or intracardiac obstruction.