Pneumopericardium: An uncommon complication of atrial lead perforation following pacemaker implantation

Cardiac perforation is an infrequent but potentially life-threatening complication of pacemaker implantation. We report a case of right atrial lead perforation complicated by pneumopericardium shortly after pacemaker lead insertion. Transthoracic echocardiography revealed no evidence of pericardial effusion and pacemaker lead displacement, but a thoracic computed tomography scan illustrated the lead course and confirmed the diagnosis. This case suggests that computed tomography is a sensitive modality to confirm the diagnosis at the early stage of this complication

Cardiac CT findings in patients with family history of premature CAD: an observational study.

A family history of premature CAD may promote enhanced development of coronary atherosclerosis in a sibling population. Baseline CV algorithms may underestimate the risk of coronary incidents in individuals at familial risk. Cardiac CT provides high diagnostic performance for the detection of coronary plaques. There is little data on the use of this technology in the initial diagnostic approach of these patients. The prognostic value of early detection of coronary plaques by cardiac CT remains unknown in this population. The study aimed to estimate the global CV risk and the pre-test probability of CAD in patients with a family history of premature CAD. We investigated the potential role of cardiac CT imaging in the assessment of coronary risk in patients from high-risk families. We sought to remind the 2019 ESC guidelines for screening for CAD in asymptomatic subjects. Fifty siblings of patients with premature CAD were investigated. The pre-test probability of CAD was determined with the Clinical Model of the CAD consortium. The risk of CV disease was calculated and compared with three different risk algorithms (SCORE, FRS, PROCAM). All patients underwent cardiac CT with both non-contrast and contrast imaging. Coronary artery calcium (CAC) scoring was calculated and CT angiograms were analyzed. Patients with suspected CT obstructive CAD underwent coronary angiography. Clinical outcomes in terms of treatment were analyzed. The pre-test probability of CAD was low: CAD consortium <10% in 60%, SCORE <5% in 100%, FRS <10% in 88%, CAC scoring <100% in 68%. However, PROCAM was <10% in 16 cases (32%). Only 12 patients (24%) presented normal CCTA findings. In patients with abnormal CCTA findings ( = 38), PROCAM was higher than FRS in 20 patients (53%). Coronary angiography was performed in 31 cases (62%) for suspected CT obstructive CAD. Most patients presented no significant lesions (55%). Revascularization was performed in 8 patients (16%), 6 of them (75%) presented CAC scoring <100, 4 of them (50%) presented CAC scoring <400. After investigation, lipid-lowering therapy was enhanced by 66%. Coronary atherosclerotic-phenotyping using cardiac CT may provide discriminatory information allowing earlier identification of patients at familial risk of premature CAD. This diagnostic workup strategy may help to guide and improve the management of these patients. However, there is a paucity of data concerning the prognostic significance of this technology in relatives at familial risk of premature CAD. Therefore, further randomized controlled trials are needed to assess the incremental risk-predictive value of this approach in this population

An imaging artifact unmasked by contrast‐enhanced transesophageal echocardiography

Key Clinical Message Performing transesophageal imaging of the left atrial appendage is key before cardioversion for atrial fibrillation. Ultrasound artifacts may induce misinterpretation and decrease in confidence for thrombus exclusion

Bluish vomiting: A rare clinical presentation of poisoning

Bluish vomiting is a symptom of poisoning that is rarely seen in Western emergency departments. Consequently, physicians are not aware of the diagnosis, complications, and treatment of this unusual form of intoxication. In this article, we report a case of bluish vomiting that occurred after an accidental ingestion of copper sulphate. In the discussion, we review three life-threatening causes of bluish vomiting (copper sulphate, boric acid, and paraquat ingestion), and we discuss their respective clinical manifestations, specificities, complications, and management therapies. © Acta Clinica Belgica 2014

Cardiac computed tomography in asymptomatic siblings of patients with premature coronary disease: illustrations and current knowledge.

A strong family history of early-onset coronary artery disease (CAD) may represent a substantial predictor of enhanced development of subclinical atherosclerosis in a sibling population. In this population, standard cardiovascular (CV) risk assessment could be underrated with the predictive capacity of the Framingham Risk Score. At present, cardiac computed tomography (CT) provides a high diagnostic performance for the detection of coronary atherosclerosis. Nevertheless, there is a paucity of data concerning the prognostic value of this technology in apparently healthy relatives of patients with premature coronary events. In addition, little is known about the prevalence of CAD in the siblings of patients with premature cardiac events. However, we are convinced that the reclassification of cardiac risk in middle-aged adults at familial risk is a fundamental issue in preventive cardiology. In this manuscript, we report cardiac CT findings in three subjects apparently free of CV disease from families with early-onset CAD. Afterwards, we provide a summary of the current knowledge and discuss the potential usefulness of this non-invasive imaging technique in susceptible individuals. Finally, we hope that this article will help to increase awareness for the management of middle-aged adults from high-risk families

Leptospirosis-induced purpura: An atypical manifestation of Weil's disease.

Purpura is a rare but documented presenting feature of severe leptospirosis. We describe a case of Weil's disease characterized by predominating coagulopathy and hepato-nephritis. We illustrate dynamic changes in cutaneous lesions

COVID-19 pandemic: overview of protective-ventilation strategy in ARDS patients.

: In the context of COVID-19 pandemic, the aim of this manuscript is to provide a standard of care of patients with ARDS for non-emergency medicine trained physicians who are not customary with mechanical ventilation.: We conducted a systematic review of the literature to investigate the best practice recommendations regarding the mechanical ventilation of patients with ARDS.: We summarized the principal strategies for lung-protective ventilation of patients with ARDS. This focus is particularly addressed to physicians who are not experienced in the invasive respiratory management of ARDS patients. Nevertheless, it remains fundamental to acknowledge that new insights concerning this quickly spreading illness become available on a regular base

Three-dimensional critical care transesophageal echocardiography: A bedside tool in the diagnosis and management of shock.

Critical care echocardiography has become fundamental in diagnosis, management, and monitoring of patients in shock. Transesophageal echocardiography has gained importance, particularly in critically ill patients under mechanical ventilation. We describe echocardiographic findings concerning a patient admitted with confusion, pulmonary edema, hypotension, and systolic murmur at apex