Fatou Aw

A case of pericardial tuberculoma presenting as a left anterior chest wall mass

Introduction Tuberculosis (TB) can present both in its pulmonary or extra-pulmonary forms. Cardiac tuberculoma previously described only after autopsy is continuously seen with the advent of more advanced imaging modalities. Case report A 23-year-old male with a four month history of a progressively increasing left anterior thoracic wall mass of 5 cm in diameter was referred from oncology for clinical re-evaluation and for echocardiography. Systemic examination was essentially normal. Transthoracic and trans-oesophageal echocardiography showed the presence of a pericardial mass around the right atrioventricular junction. Thoracic CT scan showed an anterior mass in left chest wall extending to the pericardium and also the presence of mediastinal lymphadenopathy. Mantoux test was positive and histological examination of tissue biopsy confirmed the presence of TB. However, blood tests and culture of aspirated purulent fluid were unyielding. A diagnosis of pericardial tuberculoma with mediastinal and parietal extension was made and patient was successfully treated with standard anti-TB chemotherapy. Discussion The possible differential diagnoses for chest wall tumors are varied and a high degree of suspicion is needed to diagnose cardiac tuberculoma especially in endemic regions. Imaging though helpful in morphological description cannot make precise diagnosis. The diagnosis depends on histological and culture studies. There is usually a good evolution with anti-TB treatment. Conclusion In an era of an increasing number of acquired immune-compromised patients, and with increasing number of diagnoses of tuberculosis, a diagnosis of cardiac tuberculoma should be considered in patients presenting with a thoracic wall mass.

Cardiac MRI: Luxury or Necessity, beyond the Electrocardiogram and Biology in the Management of Acute Coronary Syndrome in Young Patients? About 2 Cases Reports in Sub-Saharan Environment

Introduction: Precordial pain is a common reason for admission in cardiology, and has many causes. Acute myocarditis in its pseudo-infarctoid form is sometimes difficult to differentiate from myocardial infarction. Cardiac magnetic resonance imaging (MRI) helps to differentiate these two disease entities. We report the respective cases of two young patients, one presenting with myocarditis whilst the other with myocardial infarction. Case Report: We present the cases of two patients. The first who had a recent history of febrile syndrome is a 23-year-old who stopped smoking 3 months prior to presentation whilst the second is a 22-year-old professional footballer with a history of stress with no other cardiovascular risk factors. They were respectively admitted in our emergency department for a constrictive, intense chest pain. Physical examination was normal. The chest pain in both patients was associated with elevated cardiac markers, primary repolarisation abnormalities on ECG, wall motion abnormalities as well as left ventricular systolic dysfunction on transthoracic echocardiography. Coronary angiograms were normal in both patients. In the first patient, MRI concluded with an acute myocarditis with apical akinesia extending to the anterior wall, a T2 hypersignal indicative of myocardial edema, and uptake of a nodular heterogeneous contrast without affecting the sub-endocardial layers on the late enhancement sequences. In the second patient, MRI showed an appearance consistent with acute extensive infarction in the antero-apical region with severe hypokinesia and late quasi-transmural enhancement, impairment of the anterior papillary muscle of the mitral valve and a reduced left ventricular ejection fraction at 33%. In addition to analgesics, the first patient was treated with perindopril and bisoprolol, and the second patient received antithrombotic and anticoagulant treatment. There was clinical improvement in both patients. Conclusion: Cardiac MRI is a useful diagnostic tool for the precise diagnosis of precordial pain with elevated cardiac enzymes, especially in young patients.

Syndrome cardio-rénal: Aspects épidémiologiques, à propos de 36 cas dans un service de cardiologie de Dakar

Introduction Le syndrome cardio-rénal (SCR) est un trouble physiopathologique du cœur et des reins dans lequel une dysfonction chronique ou aiguë de l’un peut induire une dysfonction chronique ou aiguë de l’autre. En Afrique et au Sénégal en particulier l’incidence du syndrome cardio-rénal est mal connue. L’objectif de cette étude était d’apprécier la prévalence du SCR en milieu cardiologique. Méthodes Nous avons mené une étude rétrospective incluant tous les insuffisants cardiaques ayant une altération de leur fonction rénale et hospitalisés entre avril 2010 et avril 2011 au service de cardiologie. Les données étaient analysées avec le logiciel statistique Epi-info 3.5.3. Résultats Nous avons inclus 36 patients. La prévalence était de 3,7% avec une prédominance masculine (sex-ratio à 1,77) et un âge moyen à 56,9 ans [30-92]. Les antécédents étaient dominés par l’hypertension artérielle (52,77%) et le diabète (19,4%). Les principales étiologies étaient la cardiomyopathie hypertensive (39%) et l’insuffisance coronarienne (19,44%). La symptomatologie était dominée par la dyspnée (69,4%) et les œdèmes (50%). On notait une anémie (17 patients). La clairance moyenne (MDRD) à 46 ml/min. L’échocardiographie Doppler retrouvait majoritairement des troubles de la cinétique (89,3%), une dysfonction systolique VG (71%). Les 3 échographies rénales étaient normales. Six décès (16,7 %) étaient notés. Conclusion Le syndrome cardio-rénal est une réalité et marque un tournant dans l’évolution de toute cardiopathie et néphropathie. Sa prévalence en milieu cardiologique sénégalais est faible. Des études prospectives et multicentriques sont nécessaires pour une meilleure évaluation au Sénégal.

Prevalence and characteristics of dysfunction of right ventricle in peripartum cardiomyopathy

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Left Valsalva Sinus Aneurysm on Infection Tuberculous

Sinus of Valsalva Aneurysm (SVA) is a localized dilatation of the aortic wall, forming a sacral ectasia, located just above the aortic cusps between the valve and the sino-tubular junction [1-3]. It is a rare condition that is congenital or acquired and whose frequency is less than 1% according to the literature [1]. The aneurysm most often involves the right coronary sinus (65-85% of cases), more rarely the posterior sinus (10-30%) and exceptionally the left coronary sinus (<5%) [4]. we report a case of an unruptured left SVA in an 18-year-old patient in a context of disseminated tuberculosis associated with rheumatic valvulopathy.

A Rare Case of Junctional Tachycardia Revealing a Paraganglioma

Authors report the case of eleven years old boy named CAN who complained moderate atypical abdominal pain without irradiation, without increasing or decreasing factors, accompanied by palpitations lasting during two days with abrupt beginning following a dispute. He had also hypersudation and dyspnea at rest. The past medical history revealed that he was correctly vaccinated, with a good psychomotor development. No parental consanguinity was found or similar symptoms in the pedigree. Two years ago, he were admitted in hospital for systemic inflammatory response syndrome and reversible left ventricular dysfunction, which would have been attributed to a myocarditis; for which he had benefited from treatment with angiotensin converting enzyme inhibitor and diuretic.

The Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) in Senegal

The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare malformation that represents less than 0.5% of the congenital heart diseases. The common clinical feature is congestive heart failure. The treatment is strictly a surgical repair. The authors report the first 3 cases of ALCAPA diagnosed in Senegal in infants under the age of 1 year old. Two were successfully treated by surgical repair; the 3rd child is still waiting for surgical repair to be performed abroad.

Right Ventricular Infarction: Prevalence, Diagnostic and TherapeuticCharacteristics, and Prognosis about 10 Cases

Objectives: The objectives of this study were to evaluate the prevalence of the right ventricular infarction and its diagnostic, therapeutic and prognostic characteristics. Patients and methods: A single center retrospective study was carried out between January 2011 and December 2014. Patients who were diagnosed with right ventricular infarction at electrocardiogram and echocardiography were recruited. Outcomes: Among the 159 patients hospitalized for myocardial infarction, 10 had myocardial infarction extended to the right ventricle (6.3%). It occurred on an inferior infarction in 7 cases out of 35 and anterior infarction in 3 cases out of 124. The mean age was 53 years and sex ratio M/F of 2.33. All patients had at least 3 cardiovascular risk factors. Right-sided heart failure was found in 4 patients. Right ventricular infaction was associated with inferior STEMI in 7 patients, and anterior STEMI in 3 patients. Echocardiography showed right ventricular dilatation and impaired right ventricular systolic function in respectively 6 cases. Thrombolysis was performed in 7 patients and rescue angioplasty in 1 case. A regressive cardiogenic collapse was noted in 6 cases and one death in 1 case. Conclusion: Right ventricular infarction is relatively rare and usually related to an extension of an inferior myocardial infarction. Hemodynamic instability is of worse prognosis.

Obstructive Primary Cardiac T-Cell Lymphoma: A Case Report from Senegal

Patient: Female, 32 Final Diagnosis: Obstructive primary cardiac T-cell lymphoma Symptoms: Right heart failure Medication: — Clinical Procedure: None Specialty: Cardiology Objective: Rare disease Background: Cardiac lymphoma is a rare entity, defined by the non-extra cardiac location at diagnosis. Case Report: Our patient was a 32-year-old female with no particular medical history, who presented with right heart failure with recurrent ascites and pleural effusion. There was a progressive worsening exertional dyspnea. On admission, examination revealed an irregular tachycardia at 170 beats per minute (bpm) and congestive heart failure. The electrocardiogram scored full tachyarrhythmia by atrial fibrillation with an average ventricular rate of 179 cycles per minute. Doppler echocardiography showed dilatation and systolic dysfunction of the left ventricle. There were dilated atria. We noted a large mass in the right atrium, which was less mobile, heterogeneous, integral with the wall, and filling three quarters of the cavity. It clogged the tricuspid valve in diastole. CT scan showed a tissue process enhanced after contrast injection, occupying the predominant cavities in the right atrium and filling it. Its borders were irregular. The lesion was extended to the posterior mediastinum, in front of the vertebral axis. In addition, there was a thrombosis of the jugular vein and the inferior vena cava. There was no other tumor site noted. The patient died after presenting with cardiovascular shock associated with refractory right heart failure. Pathology examination confirmed T-cell lymphoma. Conclusions: The primitive cardiac lymphoma is an entity of intra-cardiac masses. It is therefore to be considered even if the diagnosis is challenging.

[Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases].

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.