Contrast enhanced computed tomography and 18-fluorine-labelled 2-deoxy-2-fluoro-d-glucose positron emission tomography/computed tomography correlation in the management of a patient with primary mediastinal seminoma and candidate to liver transplant”, Gazzetta Medica Italiana Archivio per le Scienze Mediche

We report a case of a 34 years old man with primary mediastinal seminoma, discovered after investigations for worsening dyspnea. A peculiarity of this patient is the coexistence of other diseases that mutually influence each other as congenital liver shunts, thrombosis of the vena cava, right chronic heart failure and thyroid goiter. Immediately after the diagnosis of the seminoma he underwent 4 cycles of chemotherapy (CHT) with Cisplatin, Etoposide and Bleomycin (BEP), according to the standard scheme. In this case (18FDG-PET/CT), assessing the biological behaviour of the disease, has proved an essential adjunct in the clinical management of this patient. 18FDG-PET/CT has avoided that the patient performed others contrast enhancement computed tomography (CE-CT) that could further damage the kidneys and interfere with the thyroid function and the thrombogenesis. Furthermore 18FDG-PET/CT, excluding the seminoma recurrence or spread disease, allowed to choose the right therapeutic treatment and to place the patient on the transplant waiting list because of the presence of liver shunts. An assessment as accurate as possible, of remission after treatment has an important role for decision making to stop treatment or to initiate further one. 18FDG-PET/CT is actually the best predictor of active seminoma in postchemotherapy residual lesions

Inadvertent Lead Malposition in the Left Heart during Implantation of Cardiac Electric Devices: A Systematic Review

Background. The inadvertent lead malposition in the left heart (ILMLH) is an under-recognized event, which may complicate the implantation of cardiac electronic devices (CIEDs). Methods. We investigated the clinical conditions associated with ILMLH and the treatment strategies in these patients. We made a systematic review of the literature and identified 132 studies which reported 157 patients with ILMLH. Results. The mean age of patients was 68 years, and 83 were women. ILMLH was diagnosed, on average, 365 days after CIEDs implantation. Coexisting conditions were patent foramen ovale in 29% of patients, arterial puncture in 24%, perforation of the interatrial septum in 20%, atrial septal defect in 16% and perforation of the interventricular septum in 4%. At the time of diagnosis of ILMLH, 46% of patients were asymptomatic, 31% had acute TIA or stroke and 15% had overt heart failure. Overall, 14% of patients were receiving anticoagulants at the time of diagnosis of ILMLH. After diagnosis of ILMLH, percutaneous or surgical lead extraction was carried out in 93 patients (59%), whereas 43 (27%) received anticoagulation. During a mean 9-month follow-up after diagnosis of ILMLH, four patients experienced TIA or stroke (three on oral anticoagulant therapy and one after percutaneous lead extraction). Conclusion. ILMLH is a rare complication, which is usually diagnosed about one year after implantation of CIEDs. An early diagnosis of ILMLH is important. Lead extraction is a safe and effective alternative to anticoagulants