Goran Ilic

Primary pericardial mesothelioma presenting as constrictive pericarditis

Primary pericardial mesothelioma is an extremely rare and lethal cardiac tumor. We report an autopsy case of a primary pericardial mesothelioma in a 52-year-old man. He developed dyspnea, cough, low-grade fever and night sweats approximately 3 months before last admission. Initially, he was evaluated at a hospital in another city, without a firm diagnosis. Due to progressive symptoms and the development of lower-extremity edema, he presented at our hospital in September 2005. The physical examination at admission demonstrated signs of pericardial tamponade. Chest radiography revealed marked enlargement of the cardiac silhouette. Specimens of bloody pericardial fluid were positive for pericardial mesothelioma by cytologic examination. The general condition of the patient worsened very rapidly and he was transferred to the intensive care unit where he later died. Postmortem examination confirmed primary pericardial mesothelioma of the mixed/biphasic type with lymphatic metastasis in the right lung. By using immunohistochemical analysis for specific markers of mesothelioma and for differentiation of the mesothelioma from the lung adenocarcinoma, definitive diagnosis was established: primary pericardial mesothelioma.

Boerhaave syndrome - case report

CONTEXT: Boerhaave syndrome consists of spontaneous longitudinal transmural rupture of the esophagus, usually in its distal part. It generally develops during or after persistent vomiting as a consequence of a sudden increase in intraluminal pressure in the esophagus. It is extremely rare in clinical practice. In 50% of the cases, it is manifested by Macklers triad: vomiting, lower thoracic pain and subcutaneous emphysema. Hematemesis is an uncommon yet challenging presentation of Boerhaaves syndrome. Compared with ruptures of other parts of the digestive tract, spontaneous rupture is characterized by a higher mortality rate. CASE REPORT: This paper presents a 64-year-old female patient whose vomit was black four days before examination and became bloody on the day of the examination. Her symptoms included epigastric pain and suffocation. Physical examination showed hypotension, tachycardia, dyspnea and a swollen and painful abdomen. Auscultation showed lateral crackling sounds on inspiration. Ultrasound examination showed a distended stomach filled with fluid. Over 1000 ml of fresh blood was extracted by means of nasogastric suction. Esophagogastroduodenoscopy was discontinued immediately upon entering the proximal esophagus, where a large amount of fresh blood was observed. The patient was sent for emergency abdominal surgery, during which she died. An autopsy established a diagnosis of Boerhaave syndrome and ulceration in the duodenal bulb. CONCLUSION: Boerhaave syndrome should be considered in all cases with a combination of gastrointestinal symptoms (especially epigastric pain and vomiting) and pulmonary signs and symptoms (especially suffocation).

Boerhaave syndrome and black esophagus

They describe a rare case of spontaneous esophageal perforation in the setting of hematemesis in association with duodenal ulcer and black esophagus.Boerhaave syndrome is an unusual entity in clinical medicine that was historically described by classical physical examination findings of the Mackler triad (vomiting, chest pain and sub-cutaneous emphysema), Hamman’s mediastinal crepitus with heartbeat and pneumomediasti-num on X-ray imaging. Computed tomography scans showing Gastrografin extravasation are diagnostic on call to the operating room.

Spontaneous Coronary Dissection with Dissection of Ascending Aorta andCardiac Tamponade

Spontaneous Coronary Artery Dissection (SCAD) is a rare but potentially lethal event. A 46-year-old woman presented to her local hospital at 11:30 pm with an abrupt onset of severe chest pain, which occur one hour before. Diagnosis of acute myocardial infarction non-STEMI was set. The autopsy as a direct cause of death revealed cardiac tamponade from a ruptured dissection of ascending aorta that start with a rupture of right coronary artery. Microscopic examination of coronary artery revealed that a rupture occurred on junction between normal and abnormal intima and thin subintimal-media layer, because of loose of collagen fibers. Our case confirmed association of primary coronary artery dissections with female sex. As a direct cause of primary coronary artery dissection we identified loose of collagen fibers in intimal and subintimal-media layer .