An Unusual Case of Dual Left Anterior Descending Artery with Coronary Computed Tomographic Angiographic Correlation

Dual left anterior descending artery (LAD) is a rare coronary anomaly that is important to recognize at coronary imaging as it may influence reperfusion strategies. Four types of dual LAD are described by the traditional literature. We present a novel case of dual LAD with coronary computed tomographic angiographic correlation that does not fit into this classification system. Rather, our case supports the recently proposed notion of adding a fifth variant to the traditional dual LAD classification system

Diagnosing burnt-out hypertrophic cardiomyopathy: daughter's phenotype solidifies father's diagnosis

AbstractPatients with hypertrophic cardiomyopathy classically have preserved systolic function in the setting of impaired diastolic function and decreased left ventricular end-diastolic volume. However, in a small sub-population, patients paradoxically develop systolic dysfunction, left ventricular dilatation, and ventricular wall thinning. This pattern is one that is likened to dilated cardiomyopathy and is known as end-stage hypertrophic cardiomyopathy or “burned-out cardiomyopathy.” The role of cardiac magnetic resonance imaging is well defined in narrowing the differential diagnosis of impaired left ventricular function, including that of hypertrophic cardiomyopathy. However, the importance of obtaining a family history and obtaining details of diagnosis for both preceding and future generations cannot be under-estimated. We report a case of end-stage hypertrophic cardiomyopathy that highlights how important family history can be in making a diagnosis.<Learning objective: While most cases of burned-out hypertrophic cardiomyopathy occur long after a patient has been initially seen and subsequently followed by cardiologists for hypertrophic cardiomyopathy, a small proportion of patients initially present with this entity. This is one such case, and it highlights the importance of thorough investigation into a patient's family history.

An Unusual Case of Dual Left Anterior Descending Artery with Coronary Computed Tomographic Angiographic Correlation

Dual left anterior descending artery (LAD) is a rare coronary anomaly that is important to recognize at coronary imaging as it may influence reperfusion strategies. Four types of dual LAD are described by the traditional literature. We present a novel case of dual LAD with coronary computed tomographic angiographic correlation that does not fit into this classification system. Rather, our case supports the recently proposed notion of adding a fifth variant to the traditional dual LAD classification system

Arteriovenous fistula as a complication of transradial coronary angiography: a case report

Abstract Introduction Iatrogenic arteriovenous fistula is a vascular condition that may result from coronary angiography. Many case reports have described arteriovenous fistula occurrence after coronary angiography using the transfemoral access route, but rarely as a complication of using the transradial approach. We report a rare case of a patient with arteriovenous fistula following transradial artery coronary angiography. Case presentation A 62-year-old Caucasian man underwent emergent coronary angiography using the right radial artery approach. One month after angiography, he discovered a turbulent sound near the access site. A right radial arteriovenous fistula was found upon duplex ultrasound investigation. The patient was treated conservatively. At 1-year follow-up, the arteriovenous fistula was unchanged and the patient remained hemodynamically stable and asymptomatic. Conclusion Iatrogenic arteriovenous fistula is a rare vascular complication of transradial artery coronary angiography. The natural history of arteriovenous fistula is benign and is thought to resolve spontaneously; therefore, a conservative approach, as opposed to surgical ligation, is recommended as the first-line treatment.</p

Primary Pulmonary Synovial Sarcoma: A Case with Unique and Impressive Computed Tomography Findings

Primary pulmonary synovial sarcoma (PPSS) is a rare malignancy. Its etiology, imaging features and optimal treatment are not well understood. Pulmonary pseudoaneurysms and lymphadenopathy are rare complications of synovial sarcomas. A 40-year-old woman with mild hemoptysis and thoracic back pain underwent a computed tomography scan that revealed multiple pulmonary lesions, paraesophageal lymphadenopathy and incidental bilateral pulmonary emboli. A diagnosis of PPSS was made through the identification of an SS18 translocation by fluorescence in situ hybridization. She was started on adriamycin, ifosfamide and mesna chemotherapy. Over the subsequent two months, she developed three pulmonary artery pseudoaneurysms, ultimately requiring endovascular coiling. Seven months after starting treatment, the patient was asymptomatic. The lesions and lymphadenopathy decreased in size. The present case highlights complications of a rare malignancy and demonstrates positive response to ifosfamide-based chemotherapy in the setting of PPSS