Sandeep Singh Rana

Intrapericardial teratoma presenting as recurrent pericardial tamponade: Report of a case

Intrapericardial teratomas are rare after infancy. An accurate diagnosis can only be made with a high index of suspicion. Most of the time, a mediastinal teratoma ruptures/perforates the pericardial cavity, thus causing either pericardial effusion or life-threatening tamponade. These factors emphasize the importance of an early surgical excision even for extrapericardial locations. This report presents the case of a 16-year-old girl with intrapericardial teratoma who presented with cardiac tamponade which is a rare complication of this rare tumor with only eight cases reported so far beyond infancy. This patient presented with recurrent tamponade, and underwent multiple procedures of pericardiocentesis and developed pyopericardium and polyserositis. This intrapericardial teratoma was not detected by imaging modalities.

Post-myocardial infarction giant left ventricular pseudoaneurysm presenting with severe heart failure.

Left ventricle (LV) pseudoaneurysm is a late mechanical complication of myocardial infarction. A giant LV pseudoaneurysm is a rare presentation. We report a case of giant LV pseudoaneurysm in a post-MI patient who presented with gross congestive heart failure. The patient had a successful surgical repair of the aneurysm and had a favorable 3-mo outcome. The imaging modality and surgical treatment of the pseudoaneurysm are discussed.

A rare cause of hypertension in children: intrathoracic pheochromocytoma

Mediastinal pheochromocytomas account for only a small fraction of mediastinal tumors. Most commonly, these tumors are located in posterior mediastinum. Increasing number of cases of pheochromocytomas is being reported from middle mediastinum. Excision of mediastinal paraganglioma is often hazardous because of its rich blood supply and tendency to involve surrounding structures. It can be a big challenge to manage asymptomatic cases of pheochromocytoma intraoperatively. It is imperative that these patients receive adequate alpha adrenergic and if necessary beta adrenergic blockade. Adequate preoperative preparation with alpha and beta blockers may not prevent serious intraoperative hypertension. We report a case of posterior mediastinal pheochromocytoma which was biochemically active preoperatively. We review the presentation, diagnosis and management of intrathoracic pheochromocytomas including cardiac pheochromocytomas.

Multiple intrathoracic hydatids.

A 37-year-old woman with persistent dry cough and recurrent pleural effusion, developed empyema after 10 months of antitubercular treatment. Chest radiography revealed an opacity in the left lateral chest wall (Figure 1). Computed tomography showed multiple fluid collections with enhancing pleura and septa in the left pleural cavity, extending along the costal, mediastinal, and diaphragmatic pleura, with partial collapse of the left lung and central mediastinum, suggestive of left-sided multiloculated empyema and cystic pleural metastasis from adenocarcinoma/ mesothelioma (Figure 2). On attempting decortication and drainage of the empyema through a standard left posterolateral thoracotomy, it was difficult to Figure 1. Chest radiograph in posteroanterior view, showing a broad-based loculated homogenous opacity along the left lateral chest wall, extending from the apex to the costophrenic angle, with crowding of the ribs along the lower chest wall, and multiple nodular opacities in the upper, mid, and lower zones of the left lung.

Right Ventricle Segmental Strain Trends in Patients undergoing Tetralogy of Fallot Repair: An Observational Study

Introduction: Incidence of right ventricular (RV) dysfunction in early postoperative period after Tetralogy of Fallot (TOF) repair ranges from 28 to 63%. Echocardiography is the first-line tool for the assessment of RV function in early postoperative period. As speckle tracking echocardiography (STE) has emerged as a new promising tool for assessing myocardial performance and is independent of geometric assumptions and angle dependence, it is more sensitive for detecting changes in myocardial performance than conventional echocardiographic parameters of RV function. The current study demonstrates echocardiographic parameters assessed by conventional twodimensional (2D) echocardiography and STE in patients before and after TOF repair. Materials and methods: Fifty-nine consecutive patients planned for complete intracardiac repair for TOF were enrolled in this prospective cohort study. The 2D echocardiography and STE were performed a day prior to TOF repair, in the early postoperative period between days 3 and 7 and after discharge at 3 months. Results: The median age of patients was 6 years, with 57.6% males (34/59). Baseline hemoglobin and room air oxygen saturation were 17.7 ± 3.7 gm% and 79.4% ± 8% respectively. Two patients did not survive the procedure (3.4%). Right ventricular longitudinal peak systolic strain (RV LPSS) in early postoperative period was significantly decreased in all segments of both septal and lateral wall. However, RV LPSS assessed at midterm follow-up at 3 months postoperatively significantly improved in all segments of RV compared with assessment done in the early postoperative period, and was significantly better than preoperative values in all three segments of the septal wall. Conclusion: Our study shows that the use of 2D strain or speckle tracking is a feasible and easy-to-implement technique for the evaluation of RV function after TOF repair.

Critical pulmonary stenosis: challenges following surgical correction.

A 20-day-old girl was diagnosed with critical pulmonary valvular stenosis with patent ductus arteriosus (PDA). She underwent surgical pulmonary valvotomy and infundibular resection. A trial snaring of the PDA resulted in significant systemic desaturation, and the PDA was left undivided. A continuous infusion of prostaglandin was used to keep the PDA open for the next 8 days. The PDA acted as a “natural systemic-to-pulmonary shunt” to provide pulmonary blood flow until right ventricular compliance and function improved. The various causes of persistent desaturation following pulmonary valvotomy are discussed.