Agenesia de vena cava superior derecha y persistencia de vena cava superior izquierda

The presence of persistent left superior vena cava (PLSVC) has an incidence of 0.3 to 0.5% in the general population. In most cases, the right superior vena cava (RSVC) is present, however, on rare occasions the RSVC may be absent. Our case shows the importance of the initial echocardiographic evaluation in the differential diagnosis of the dilated coronary sinus and the suspicion of associated congenital malformations.La presencia de la vena cava superior izquierda persistente (VCSIP) tiene una incidencia del 0.3 al 0.5% en la población general. En la mayoría de los casos, la vena cava superior derecha (VCSD) está presente, sin embargo, en raras ocasiones ésta puede estar ausente. Nuestro caso pretende mostrar la importancia de la evaluación ecocardiográfica inicial en el diagnóstico diferencial del seno coronario dilatado y la sospecha de malformaciones congénitas asociadas

A definitive prognostication system for patients with thoracic malignancies diagnosed with COVID-19: an update from the TERAVOLT registry

Background: Patients with thoracic malignancies are at increased risk for mortality from Coronavirus disease 2019 (COVID-19) and large number of intertwined prognostic variables have been identified so far. Methods: Capitalizing data from the TERAVOLT registry, a global study created with the aim of describing the impact of COVID-19 in patients with thoracic malignancies, we used a clustering approach, a fast-backward step-down selection procedure and a tree-based model to screen and optimize a broad panel of demographics, clinical COVID-19 and cancer characteristics. Results: As of April 15, 2021, 1491 consecutive evaluable patients from 18 countries were included in the analysis. With a mean observation period of 42 days, 361 events were reported with an all-cause case fatality rate of 24.2%. The clustering procedure screened approximately 73 covariates in 13 clusters. A further multivariable logistic regression for the association between clusters and death was performed, resulting in five clusters significantly associated with the outcome. The fast-backward step-down selection then identified seven major determinants of death ECOG-PS (OR 2.47 1.87-3.26), neutrophil count (OR 2.46 1.76-3.44), serum procalcitonin (OR 2.37 1.64-3.43), development of pneumonia (OR 1.95 1.48-2.58), c-reactive protein (CRP) (OR 1.90 1.43-2.51), tumor stage at COVID-19 diagnosis (OR 1.97 1.46-2.66) and age (OR 1.71 1.29-2.26). The ROC analysis for death of the selected model confirmed its diagnostic ability (AUC 0.78; 95%CI: 0.75 - 0.81). The nomogram was able to classify the COVID-19 mortality in an interval ranging from 8% to 90% and the tree-based model recognized ECOG-PS, neutrophil count and CRP as the major determinants of prognosis. Conclusion: From 73 variables analyzed, seven major determinants of death have been identified. Poor ECOG-PS demonstrated the strongest association with poor outcome from COVID-19. With our analysis we provide clinicians with a definitive prognostication system to help determine the risk of mortality for patients with thoracic malignancies and COVID-19