A Large, Severely Obstructive, Calcified Mass in the Midsegment of Aortic Arch.

Severe obstructive lesions in the aortic arch are rare. Crossing such lesions poses additional challenges in patients who require cardiac catheterizations. Oftentimes, specialized catheters are required to negotiate the lesion. Herein, we are reporting a series of case images that illustrate a severe lesion in the aortic arch during coronary angiography

Atypical Reactivation of Varicella Zoster Virus Associated with Pancreatitis in a Heart Transplant Patient.

BACKGROUND Acute pancreatitis is rare following solid organ transplantation but is associated with high mortality. It has been most commonly reported following renal transplant but can occur with other solid organ transplantations. CASE REPORT A 46-year-old male who had an orthotopic heart transplant 6 months ago presented with a 3-week history of abdominal pain. The patient described it as intermittent, sharp, and stabbing, originating in the periumbilical area and radiating to the back. His lipase was elevated at 232 U/L. Given that the patient\u27s symptoms and lipase were elevated to greater than three times the upper limit of normal, he patient was diagnosed with acute pancreatitis. The patient also mentioned a diffuse itchy rash that started a few days prior to admission. Dermatology was consulted, and given the man\u27s clinical presentation, there was concern for atypical reactivation of varicella zoster virus (VZV). VZV polymerase chain reaction of the vesicles returned positive. The patient was started on acyclovir and his symptoms improved. CONCLUSIONS This is the first reported case of VZV-associated pancreatitis in a heart transplant patient. Our patient presented with acute pancreatitis and was treated supportively. However, he did not receive antiviral treatment until his rash was discovered. Timely treatment of VZV resulted in resolution of both the rash and pancreatitis. Timely diagnosis of pancreatitis and VZV is important to prevent development of multiorgan failure and death

A complete heart block in a young male: a case report and review of literature of cardiac sarcoidosis.

Cardiac sarcoidosis is one of the uncommon causes of heart failure. Generally, it presents in the form of varying clinical manifestations ranging from asymptomatic to fatal arrhythmias such as ventricular tachycardia and complete heart block. It is difficult to make a diagnosis strictly based on clinical grounds. However, in the setting of extracardiac sarcoidosis and patients presenting with advanced heart block or ventricular arrhythmia, direct cardiac involvement should be suspected. The definitive diagnosis of cardiac sarcoidosis can be made from endomyocardial biopsy, but it is falling out of favor due to patchy myocardial involvement, considerable procedure-related risks, and advancement in additional imaging modalities. Once cardiac sarcoidosis has been diagnosed, management of the disease remains challenging. Steroids are considered the mainstay of therapy, and implantable cardioverter defibrillator therapy can be considered in a selected group of patients at greater risk for malignant ventricular arrhythmias

Regional and seasonal variations in the US emergency department visits for acute pericarditis.

The pericardium is an avascular fibro-elastic enclosure surrounding the heart, composed of two layers divided by a potential cavity; the pericardial space. Inflammation of this space is termed acute pericarditis (AP), the etiology of which is believed to be multifactorial with the most common cause worldwide being idiopathic [1]. Seasonality of AP is often attributed to increased incidences of viral infection, but regional variations in AP have not been examined. We conducted this study to assess regional and seasonal trends of AP

Biliary Cast Syndrome Following Liver Transplantation: A Challenging Case.

Biliary cast syndrome (BCS) complicates up to one in six patients post-orthotopic liver transplant (OLT). Management of BCS is challenging with limited success using endoscopic retrograde cholangiopancreatography (ERCP) or open exploration to clear the casts with some patients requiring re-transplantation. We present a case of BCS in a patient who suffered from vascular complications at the time of OLT rendering him a non-candidate for repeat liver transplantation in addition to increasing risk for ischemic insult and biliary strictures, and the challenges faced in his care