Enigma of Huge mass filling the apical wall of the left ventricle. Is it thrombus, tumor or endomyocardial fibrosis?

Background: Cardiac masses have a wide range of etiologies with the most common being thrombi and less commonly tumors. Certain areas of the heart have specific tumor predilections. We present an interesting case in which the diagnosis of the ventricular mass was difficult given the initial symptomatology and the patient's phobia. Case summary: A 45-year-old male patient with medical history of smoking, was admitted to the emergency room complaining of severe breathlessness, However, the patient declined any chest discomfort or pain. On physical examination he was dyspneic, with vital signs revealed heart rate of 110 beats/min, blood pressure of 125/90 mmHg. Cardiovascular examination showed regular heart rhythm and normal heart sounds. Electrocardiogram revealed sinus tachycardia, chest X-ray was suggestive of cardiomegaly. Transthoracic Echocardiography demonstrated a dilated left ventricle with severely reduced ejection fraction and diffuses kinetic disturbances. The presence of a huge mass filling the apical wall of the left ventricle, hyperechogenic in appearance and very adherent to the ventricle. In front of this doubtful appearance at the echocardiography the patient was programmed for a cardiac magnetic resonance imaging which could not be carried out because of the claustrophobic state of the patient. In the meantime, the patient had a cardiac arrest due to refractory ventricular fibrillation successfully resuscitated. In front of this complication, he benefited from an automatic implantable defibrillator as a secondary prevention. Subsequently, a coronary angiography was performed in the context of the patient's smoking habits and kinetic disorders, to our surprise showed a complete occlusion of the left anterior descending artery knowing that the patient is not diabetic and he never complained of any painful symptomatology, primary coronary intervention was successfully performed to the left anterior descending artery. The patient was started on therapeutic anticoagulation and heart failure therapy. Follow-up imaging after 6months showed a significant improvement of the left ventricular systolic function and thrombus regression to apical segment without embolic events. Conclusion: The diagnosis of a ventricular mass remains difficult, the orientation can be done initially by the ground of the patient while being helped by the transtoracic echography and the multimodality imagery at the end to specify the nature of the intra-cardiac mass for an adequate and fast management. Keywords: Thrombus, ventricular mass, coronary angiography, heart failure, oral anticoagulation. DOI: 10.7176/JHMN/98-05 Publication date:March 31st 202

Etude du comportement stochastique de systèmes diphasiques par analyse couplée du bruit électrochimique et d'images vidéo.

This work is aiming at coupling acquisitions of electrochemical noise and video images to study electrochemical systems with a strongly stochastic behaviour such as gas-evolving electrodes and hydrodynamic flows of oil-brine mixtures of various composition. The mean radius and the mean detachment rate of hydrogen bubbles evolving at a current density between 5 and 500 mA/cm2 on an horizontal platinum electrode have been estimated from the electrolyte-resistance fluctuations generated. The analysis of the video images allowed the results to be validated at current densities lower than 100 mA/cm2. The electrolyte-resistance fluctuations close to or between two iron electrode(s) at the corrosion potential in an oil-brine mixture with a volume oil content between 0 and 80 % are extremely sensitive to the oil content of the mixture and allow changes in hydrodynamic flows to be monitored in real time. The mean electrolyte resistance measured between two electrodes in a pipe for a mixture circulating at a flow rate of 2 m/s and the theoretical resistance of the Maxwell model are in good agreement.Le but de ce travail est de coupler des acquisitions de bruit électrochimique et d'images vidéo pour étudier des systèmes à caractère fortement aléatoire, le dégagement de bulles gazeuses sur électrode en milieu liquide et l'écoulement de mélanges huile-saumure de composition variée. Le rayon moyen et la fréquence moyenne de détachement de bulles d’hydrogène se dégageant à une densité de courant entre 5 et 500 mA/cm2 sur une électrode horizontale de platine ont été déterminés à partir des fluctuations de résistance d’électrolyte générées. L'analyse des images vidéo a permis de valider les résultats pour les densités de courant inférieures à 100 mA/cm2. Les fluctuations de résistance d’électrolyte près d'une ou entre deux électrode(s) de fer au potentiel de corrosion dans un mélange huile-saumure avec un pourcentage en volume d’huile entre 0 et 80 % sont extrêmement sensibles à la composition du mélange et permettent de suivre en temps réel les changements d'écoulement hydrodynamique. La résistance d’électrolyte moyenne entre deux électrodes mesurée pour un mélange circulant dans un canal à la vitesse de 2 m/s et la résistance théorique du modèle de Maxwell sont en bon accord

Measurement of Electrolyte Resistance Fluctuations Generated by Oil-Brine Mixtures in a Flow-Loop Cell

International audienceMeasurements of current and electrolyte-resistance fl uctuations between two working electrodes in a fl ow-loop cell have been carried out with the objective to assess and/or monitor corrosion and characterize hydrodynamic fl ows in pipelines. Linear fl ow velocities of 1 m/s and 2 m/s were used to ensure different hydrodynamic conditions for oil-brine mixtures with a large range of volumetric oil content (VOC) from 0% to 80% (water-cut from 100% to 20%). Previous results obtained in conventional cylindrical cells, in which the oil-brine mixture was homogenized with a rotating magnet, have been confi rmed. The current fl uctuations present a very complex and nonmonotonic behavior with the VOC, which yields corrosion monitoring virtually impossible in these conditions. Conversely, the electrolyte-resistance fl uctuations appeared to be a reliable and very sensitive tool for the real-time analysis of hydrodynamic conditions and fl ow composition that can be used for the indirect assessment of oil-brine corrosivity. The analysis of the mean electrolyte-resistance values has shown an excellent agreement with the theoretical predictions of Maxwell's model of the electrical conductivity in two-phase media over the whole VOC range investigated, provided that hydrodynamic conditions ensure the homogeneity of the mixture. Electrochemical measurements have been complemented with the analysis of video images that allowed identifi cation of the oil/brine mixture structure close to the pipe wall and the distribution function of the oil-droplet diameter, which were shown to be spherical for VOCs up to 60% (water-cut down to 40%)

Electrochemical noise study of the effect of electrode surface wetting on the evolution of electrolytic hydrogen bubbles

International audienceNi and Ni–polytetrafluoroethylene (Ni–PTFE) composite electrodes were used as model systems for the study of the effect of electrode surface wetting on the evolution of electrolytic bubbles. This study was carried out by recording electrochemical noise and video images of the electrode surface. Ni–PTFE electrodes were prepared by a sediment co-deposition method, i.e., by electrodepositing Ni while PTFE particles, initially suspended in the Ni2+ electrolyte, formed a sediment on the electrode and became incorporated in the deposit. SEM images showed that co-deposition of PTFE induced an increase in the deposit roughness. PTFE particles were rather uniformly dispersed in the Ni layer. Their concentration (mass ratio) in the deposits, estimated by EDX, varied almost linearly between 1.7% and 7.1% when the PTFE concentration in the suspension was changed between 1.6% and 8.2%.The analysis of the power spectral density of the fluctuations of the electrolyte resistance, induced by hydrogen-bubble evolution in a 1 M NaOH solution at a constant current density, showed that the average radius of the H2 bubbles detaching from the Ni–PTFE cathodes increased with the PTFE concentration and therefore with the hydrophobicity of the electrodes. As a limiting behaviour observed with PTFE-rich electrodes (with a PTFE concentration as large as 38.5%) the bubble size became comparable with that of the electrode. The video images confirmed that the average size of the detaching gas bubbles determined from the electrochemical noise measurements was correct and showed that coalescence phenomena were quite common and significantly contributed to the overall noise