Luiz Guilherme Carneiro Velloso

Angiossarcoma de átrio direito

A 19 years-old-female with primary right atrial angiosarcoma partially obstructing the tricuspid valve, developed severe hypoxemia due-to-right to left shunting through a patent foramen ovale. This is the first report of such a clinical situation with this type of tumor. A complete resection of the tumor was attempted, and the right atrium had to be rebuilt with a bovine pericardial patch. Postoperative cranial, thoracic and abdominal CT scans and bone scintigraphy did not show metastatic spread. Chest radiation therapy was started on the third postoperative week. Chemotherapy was not used. The patient died a few months after surgery due to disseminated metastatic disease but no evidence of the tumor was found in the necroscopic study of the heart.

Assistência circulatória em choque cardiogênico pós-infarto agudo do miocárdio

Em pacientes com insuficiencia coronariana aguda e choque cardiogenico, a mortalidade e alta. O dispositivo mais utilizado para suporte hemodinâmico e o balao intra-aortico que, no entanto, pode ser insuficiente em pacientes com choque cardiogenico refratario. Relato de caso com dois dias de dor precordial opressiva e intensa, irradiada para membro superior esquerdo. ECG com supradesnivelamento anterior. Realizado angioplastia e implante de stent na arteria descendente anterior. Evolucao com choque cardiogenico refratario ao uso de drogas vasoativas e balao intra-aortico. Foram realizadas medidas hemodinâmicas e decidiu-se pela colocacao do Impella® 2,5 por via percutânea para assistencia circulatoria.

Endocardite infecciosa com apresentação inicial de abdome agudo

A 35-year-old patient was seen in an Emergency Department. with six hours of pain in the right iliac fossa and fever. The hypothesis diagnosis was acute appendicitis and an exploring laparotomy for appendectomy was carried out. The patient returned to the hospital three days after having been discharged. debilitated. feverish. having alterations in speech. reduction in the level of consciousness and complete hemiparesis to the left. The computed tomography scan of the skull and the liquor puncture were normal. Cerebral magnetic resonance image showed aspects compatible with vertebrobasilar ischemic stroke. Transesphofagic echocardiogram showed vegetation of the aortic valve and moderate aortic insufficiency. Blood cultures were positive for Enterococcus bovis.Paciente de 35 anos de idade foi atendido em Servico de Emergencia com seis horas de dor em fossa iliaca direita e febre. Feita hipotese diagnostica de apendicite aguda e realizada laparotomia exploradora. com apendicectomia. O paciente retornou ao hospital tres dias apos alta hospitalar. prostrado. febril. com alteracao de fala. diminuicao de nivel de consciencia e com hemiparesia completa a esquerda. CT scan de crânio e puncao de liquor normal. RMN de encefalo revelou aspectos compativeis com AVC isquemico vertebro-basilar. Ecocardiograma transesofagico demonstrou vegetacao em valva aortica e insuficiencia aortica moderada e hemoculturas foram positivas para Enterococcus bovis.

Endocarditis infecciosa con presentación inicial de abdomen agudo

A 35-year-old patient was seen in an Emergency Department. with six hours of pain in the right iliac fossa and fever. The hypothesis diagnosis was acute appendicitis and an exploring laparotomy for appendectomy was carried out. The patient returned to the hospital three days after having been discharged. debilitated. feverish. having alterations in speech. reduction in the level of consciousness and complete hemiparesis to the left. The computed tomography scan of the skull and the liquor puncture were normal. Cerebral magnetic resonance image showed aspects compatible with vertebrobasilar ischemic stroke. Transesphofagic echocardiogram showed vegetation of the aortic valve and moderate aortic insufficiency. Blood cultures were positive for Enterococcus bovis.Paciente de 35 anos de idade foi atendido em Servico de Emergencia com seis horas de dor em fossa iliaca direita e febre. Feita hipotese diagnostica de apendicite aguda e realizada laparotomia exploradora. com apendicectomia. O paciente retornou ao hospital tres dias apos alta hospitalar. prostrado. febril. com alteracao de fala. diminuicao de nivel de consciencia e com hemiparesia completa a esquerda. CT scan de crânio e puncao de liquor normal. RMN de encefalo revelou aspectos compativeis com AVC isquemico vertebro-basilar. Ecocardiograma transesofagico demonstrou vegetacao em valva aortica e insuficiencia aortica moderada e hemoculturas foram positivas para Enterococcus bovis.

Infective endocarditis with initial presentation of acute abdomen

A 35-year-old patient was seen in an Emergency Department. with six hours of pain in the right iliac fossa and fever. The hypothesis diagnosis was acute appendicitis and an exploring laparotomy for appendectomy was carried out. The patient returned to the hospital three days after having been discharged. debilitated. feverish. having alterations in speech. reduction in the level of consciousness and complete hemiparesis to the left. The computed tomography scan of the skull and the liquor puncture were normal. Cerebral magnetic resonance image showed aspects compatible with vertebrobasilar ischemic stroke. Transesphofagic echocardiogram showed vegetation of the aortic valve and moderate aortic insufficiency. Blood cultures were positive for Enterococcus bovis.Paciente de 35 anos de idade foi atendido em Servico de Emergencia com seis horas de dor em fossa iliaca direita e febre. Feita hipotese diagnostica de apendicite aguda e realizada laparotomia exploradora. com apendicectomia. O paciente retornou ao hospital tres dias apos alta hospitalar. prostrado. febril. com alteracao de fala. diminuicao de nivel de consciencia e com hemiparesia completa a esquerda. CT scan de crânio e puncao de liquor normal. RMN de encefalo revelou aspectos compativeis com AVC isquemico vertebro-basilar. Ecocardiograma transesofagico demonstrou vegetacao em valva aortica e insuficiencia aortica moderada e hemoculturas foram positivas para Enterococcus bovis.