Mahmoud Abdelnaby

A Rare Case of Fatal Left Ventricular Free Wall Rupture: Case Report and Short Review

Left ventricular free wall rupture (LVFWR) is a rare, yet lethal, complication of acute myocardial infarction (AMI), occurring in approximately 2% of cases. In the era of percutaneous coronary intervention, however, it is less frequently encountered. We were confronted with a case of AMI complicated with LVFWR after receiving thrombolytic therapy. The diagnosis was established using transthoracic echocardiography (TTE). Unfortunately, the patient passed away before surgical intervention. This case demonstrates the importance of prompt diagnosis and management of such a lethal complication.

Assessment of the progress of labor by the use of intrapartum ultrasound

Abstract Introduction Current obstetric practice strives to avoid difficult vaginal deliveries. The clinicians skill residing mainly in digital transvaginal examination is a subjective evaluation with several limitations. In recent years many reports have proposed a role for ultrasound in the evaluation of laboring patients. Aim of the work The aim of this work was to assess the ability of intrapartum ultrasound to accurately and objectively monitor the progress of normal labor as well as to predict successful vaginal birth. Material and methods The current work included 200 full term singleton pregnant women in the active phase of the first stage of labor. All cases were in cephalic presentation and in occipitoanterior position. Per vaginum examination (PV) was first performed followed by transabdominal then translabial ultrasound visualizing the infrapubic plane. Ultrasound parameters were tested for the ability to detect the engagement of fetal head and for the occurrence of vaginal delivery. Several parameters were measured at rest and during the peak of uterine contraction. Results 70.5% of patients considered PV worse than translabial ultrasound. For a cut-off of 22.3 mm, the dynamic progression distance correctly identified cases that will deliver vaginally with a sensitivity of 74.4% and a specificity of nearly 82.9%. The dynamic angle of progression showed a sensitivity of 85.4% and a specificity of 88.7% at a cut-off of 112° to detect fetal head engagement. A statistically significant correlation was found between cervical diameter assessed using PV examination and using TLUS (r = 0.75, p < 0.001), as well as for the presence of caput and molding of the fetal skull. Conclusion Intrapartum ultrasound enabled the objective measurement of birth progress, providing a more scientific basis for assessing labor. This study has demonstrated the feasibility of defining a group of women at high risk of operative delivery.

A Catastrophic Case of Thromboembolism: A Case Report

Pulmonary embolization (PE) carries a high mortality risk if not suspected and treated properly. Systemic embolization is quite common especially in cases of mobile left ventricular (LV) thrombi. We were encountered with a catastrophic case of thromboembolism with simultaneous massive PE and bilateral lower limb ischemia in a patient with biventricular systolic dysfunction and multiple LV thrombi. Tissue plasminogen activator (tPA) was given and the patient’s hemodynamics started to be stable. Unfortunately, he developed left lag, bilateral lower limb dry gangrene and subsequently he passed away despite all trials to resuscitate.

A Case of Pericardial Metastasis: Image Case Report

A 76-year-old male with a past history of resected cancer colon and a recurrence in the form of hepatic and lung metastases had a Chest X Ray (CXR) which revealed cardiomegaly and referred for echocardiography that revealed a large pericardial mass with pericardial effusion most likely metastatic in nature.

A right coronary artery aneurysm presenting as a mass in echocardiography

A 67-year-old male patient with hypertension presented for preoperative assessment. He complained of mild exertional dyspnea. Electrocardiogram and laboratory investigations were within normal limits. Echocardiogram revealed normal dimensions, preserved systolic function and evidence of diastolic dysfunction (E/A 0.6, E/e′ 7.2). However, a cystic echo-lucent mass measuring 23 × 24 mm was evident at the atrioventricular groove in close proximity to the right atrium in sub costal and modified apical four-chamber views (Fig. 1a, b). Pulsed wave Doppler on the mass reveled pulsatile flow (Fig 1c). Subsequently, cardiac computed tomography showed ectatic right coronary artery (RCA) with multiple partially thrombosed aneurysms with calcified walls, the largest was in the distal RCA which measures 39 mm in maximum dimension (Fig. 1d). Scan downward in the descending aorta revealed large infra-renal partially thrombosed abdominal aortic aneurysm measuring 54 mm. Myocardial perfusion imaging was negative. Patient was started on aspirin, statins and furosemide. In addition, biannual ultrasound was recommended to follow-up on the abdominal aortic aneurysm. Coronary artery aneurysm (CAA) is a localized dilatation of a coronary artery segment more than 1.5-fold the normal size of adjacent normal segments [1, 2]. CAAs are mainly caused by Kawasaki disease, coronary atherosclerosis or autoimmune diseases. Regarding our patient, he lacked any manifestations that would link him to a systemic or an autoimmune disorder and he had a negative inflammatory and autoimmune panel. Hence, we concluded that the cause was atherosclerosis. In addition, atherosclerosis is the most common cause in his age group and it is associated with hypertension and infrarenal aneurysms. Patients may be asymptomatic or can present with dyspnea, chest pain or palpitations. Rarely it can present clinically as a murmur. In our case, he presented with dyspnea which was attributed to the diastolic dysfunction. Several modalities can diagnose CAAs, such as coronary angiography, intra vascular ultra sound (IVUS), computed tomography, magnetic resonance imaging and echocardiography. Nowadays, IVUS is considered the gold standard, however, computed tomography is a very promising noninvasive modality [3]. There is no standard approach for all cases when it comes to treatment. Hence, therapy should be directed towards the cause and is tailored on every patient. Options include percutaneous coronary intervention, coronary artery bypass and medical treatment [4].

Acute Atrial Fibrillation Induced by Organophosphorus Poisoning: Case Report

Organophosphorus poisoning (OPP) remains a major clinical and public health problem in developing countries. OP compounds act as irreversible cholinesterase inhibitors. Toxicity of these compounds leads to cholinergic excess symptoms through the muscarinic, nicotinic, and central nervous system receptors . Cardiac complications include cardiac arrest, pulmonary oedema, and arrhythmia. Rarely, myocardial infarction has also been reported. Cardiac injury is a strong predictor of death in these patients . We are reporting a case of OP poisoning in a child recently admitted to our facility with acute onset of atrial fibrillation which reverted to sinus rhythm by direct current (DC) cardio version and detoxification of OP component.

A bilharzial pulmonary artery aneurysm with a large calcified mural thrombus

Although very rarely encountered nowadays, bilharziasis should still be considered as one of the main causes of pulmonary artery aneurysms (PAA) and core-pulmonale in endemic areas. The ideal treatment of PAA remains uncertain because there is no clear consensus about the best therapeutic approach, due to limited experience because of the rarity of the disease. Still the management of pulmonary artery thrombus is only through proper anticoagulation and follow-up with a very limited role for surgery.

A case of fibrosing mediastinitis complicated by pulmonary hypertension and right-sided heart failure

Nouran Eshak, Mahmoud Abdelnaby*, Hoda Shehata, and Karim Ziada Rheuamtology Unit, Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Chamblion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria 21517, Egypt; Cardiology and Angiology Unit, Department of Clinical and Experimental Internal Medicine, Medical Research Institute, University of Alexandria, 165 ElHoreya Rd, Al Ibrahimeyah Qebli WA Al Hadrah Bahri, Qesm Bab Sharqi, Alexandria 21561, Egypt; Department of Cardiology, Faculty of Medicine, University of Alexandria, Chamblion street, Al Mesallah Sharq, Qesm Al Attarin, Alexandria 21517, Egypt; and Department of Radiodiagnosis, Medical Research Institute, University of Alexandria, 165 El-Horeya Rd, Al Ibrahimeyah Qebli WA Al Hadrah Bahri, Qesm Bab Sharqi, Alexandria 21561, Egypt

A left ventricular true aneurysm

True ventricular aneurysm is a scarred wall that most commonly results after an unrevascularized ST elevation myocardial infarction. Patients usually present with heart failure, angina, ventricular arrhythmia, systemic embolization, or ventricular rupture. Diagnosis can be achieved via echocardiography, left ventricle angiogram, cardiac computed tomography, or cardiac magnetic resonance.

SonoCAD. A Software To Solve The Dilemma Of The Prenatal Diagnosis Of Fetal Syndromes

The aim of this work is to develop an efficient, user‐friendly, time‐saving computer software program specified with prenatal diagnosis, based solely on ultrasound findings provided by the sonographer.