Suk-Koo Choi

A Case of Leclercia adecarboxylata Endocarditis in a Woman With Endometrial Cancer

Leclercia adecarboxylata, a motile, gram-negative bacillus of the enterobacteriaceae family, is rarely recovered as a pathogen. We report an exceptionally rare case of L. adecarboxylata endocarditis complicated by embolization of the kidney and spleen in a 48-year-old woman with endometrial cancer. After 4 weeks of antimicrobial treatment, she recovered without sequelae.

A case of severe coronary spasm associated with 5-fluorouracil chemotherapy.

Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.

Serious cardioembolic stroke resulting from an overlooked left ventricular noncompaction.

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Inverted Tako-Tsubo Cardiomyopathy Associated with Bronchoalveolar Lavage

Tako-Tsubo cardiomyopathy (TTC), also known as transient left ventricular (LV) ballooning syndrome or stress-induced cardiomyopathy, is characterised by transient LV dysfunction in the absence of significant angiographic coronary stenoses, frequently provoked by an episode of emotional or physical stress. In TTC, typically transient akinesis or dyskinesis of the LV apical segments with normal or hypercontractile basal wall motions is observed. Recently, several cases of atypical or inverted transient TTC sparing the LV apex have been reported. We report a case of inverted TTC showing akinesis of the basal and mid-ventricular segments of the LV with apical hyperkinesia triggered by bronchoscopy with bronchoalveolar lavage.

Primary cardiac angiosarcoma treated by complete tumor resection with cardiac reconstruction.

Primary cardiac sarcoma is a rare malignant neoplasm, with an incidence of .0001% in collected autopsy series. Angiosarcoma is the most common cardiac sarcoma and is present in up to 33% of the cases that are associated with a poor prognosis. Because angiosarcoma is essentially not responsive to current regimens of chemotherapy and irradiation, early complete resection is recommended as the treatment choice. However, complete resection is difficult because of the limited amount of myocardium and expansion of the tumor at the time of diagnosis. We report a case of right atrial angiosarcoma treated by complete tumor resection with cardiac reconstruction with a bovine pericardium patch.

Right-sided myxomas with extramedullary hematopoiesis and ossification in Carney complex

The authors report the case of multiple right-sided myxomas in a 42-year-old man with Carney complex. He had previously been diagnosed as Cushings syndrome and undergone resection of pituitary adenoma at the age of 21. After 10 years, bilateral adrenalectomy had been performed with recurrence of Cushings syndrome. Recently, he complained of palpitation and intracardiac masses were detected. On physical examination, he had nevi on the lips and in the oral cavity. A tiny eyelid nodule was noted and histopathological analysis confirmed the diagnosis of skin myxoma. Thyroid ultrasonography revealed multiple hypoechoic nodules, which were confirmed pathologically as follicular adenomas. Scrotal ultrasonography also revealed small multiple testicular tumors. Echocardiography demonstrated intracardiac masses in right atrium and right ventricle. Right atriotomy revealed a right atrial mass attached to the annulus of the tricuspid valve and another mass arising from the interatrial septum. In right ventricle, a polypoid mass arose from the anterior leaflet of the tricuspid valve. Also, there were multiple tiny to small masses on the interatrial septum. The masses were completely excised and the tricuspid valve was repaired with annuloplasty. Histopathological analysis confirmed myxomas with foci of extramedullary hematopoiesis and ossification.

Atypical takostubo cardiomyopathy associated with nasal packing for paranasal sinus surgery

Takotsubo cardiomyopathy (TC) is characterized by reversible left ventricular (LV) apical ballooning and no significant coronary artery stenosis. New variants of TC with localized wall motion abnormality or inversed pattern with hyperdynamic apex have been reported. We present the case of a 24-year-old female with atypical presentation of TC occurring in the setting of paranasal sinus surgery under local anaesthesia with post-surgical nasal packing. She did not demonstrate ST-segment elevation on electrocardiogram, but transient moderate LV systolic dysfunction and localized wall motion abnormality affecting basal to mid-ventricular anterior and anteroseptal wall. She rapidly and completely recovered without sequelae.

A Case of Cardiac Amyloidosis Initially Misdiagnosed as Syndrome X

Cardiac infiltration of amyloid fibril results in progressive cardiomyopathy with a grave prognosis and results in cardiac diseases such as congestive heart disease, cardiomyopathy, valvular heart disease, and arrhythmias. We present a rare case of cardiac amyloidosis initially misdiagnosed as syndrome X in which recurrent chest pain and progressive heart failure could be managed finally by heart transplantation.