Wakana Sato

Contralateral Pulmonary Embolism Caused by Pulmonary Artery Stump Thrombosis After Pneumonectomy

A 73-year-old man with atrial fibrillation and previous left pneumonectomy was admitted with pleural effusion. Anticoagulant therapy was discontinued because of chest tube drainage. Six days later, the patient experienced chest discomfort. Echocardiography showed a pedunculated thrombus with swaying motion in the left pulmonary artery (PA) stump. Contrast-enhanced computed tomography of the chest revealed filling defects in not only the left PA stump but also the right PA, implying contralateral pulmonary embolism. Anticoagulants were resumed, and thrombolysis was successful 3 days later. Patients undergoing pneumonectomy in whom anticoagulant therapy is discontinued should be recognized as being at high risk for PA stump thrombosis and subsequent contralateral pulmonary embolism.

Morphological Determinants of Obstructive Hypertrophic Cardiomyopathy Obtained Using Echocardiography

The morphological determinants of left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM) are not completely understood. We aimed to identify the anatomical risks of the obstruction using echocardiography.Fifty patients with untreated HCM were classified into two groups: those with LVOT pressure gradient (LVOTPG) ≥ 30 mmHg (obstructive HCM [HOCM] group) and those with LVOTPG < 30 mmHg (HNCM group). The echocardiographic morphological variables were analyzed to determine whether they were predictive of LVOT obstruction. Systolic anterior motions of the mitral valve were observed in 100% of patients in the HOCM group but only in 58% in the HNCM group. There were no significant differences in wall thickness, end-systolic LV dimension (LVDs), or LVOT diameter between the two groups. However, HOCM subjects had a shorter distance from papillary muscles to the inter-ventricular septum (5.97 ± 2.3 versus 9.20 ± 1.9 mm, respectively, P < 0.0001) and a longer anterior mitral leaflet (AML) length (24.7 ± 5.8 versus 20.1 ± 5.4 mm, respectively, P < 0.01) compared to the HNCM group. The AML length/LVDs ratio was significantly higher in the HOCM group compared to the HNCM group (1.02 ± 0.34 versus 0.78 ± 0.26, P < 0.01), and an LVOT obstruction was predicted with an area under the curve of 0.71 (P < 0.05). Multiple linear regression revealed that only the AML length/LVDs ratio was independently associated with LVOTPG (P < 0.01).The AML length/LVDs ratio has a significant predictive value for LVOT obstruction and a strong relationship with LVOTPGs. The AML length/LVDs ratio determines the anatomical risk of LVOT obstruction in HCM.

Inflammatory aneurysm of ileocolic artery discovered on fluorine 18-fluorodeoxyglucose-positron emission tomography/computed tomography

A 68-year-old man with periodontal disease presented with a 2-month history of recurrent fevers. Although much effort had been expended to identify the cause of fever, the origin remained unclear. The patient was referred to our hospital for further diagnostic workup. Blood tests showed an elevated white blood cell count (16.7 10 cells/L) and C-reactive protein level of 4.48 mg/dL, but were otherwise normal. A blood culture resulted in growth of Streptococcus sanguinis. Echocardiography showed no pathognomonic findings of infectious endocarditis. However, fluorine 18-fluorodeoxyglucose-positron emission tomography/computed tomography (CT) revealed enhanced isotope uptake in the ileocecal region, with an maximum standardized uptake value of 4.4 (A/Cover). Notably, a re-examination of enhanced CT with thin slice images detected aneurysmal dilatation of the ileocolic artery with surrounding “dirty fat” sign in the area corresponding to the uptake noted on positron emission tomography/CT (B). On this basis, the patient was diagnosed as having an inflammatory ileocolic arterial aneurysm. Antibiotic treatment resulted in amelioration of the inflammation, and the aneurysmal site was surgically excised. Histologic examination confirmed the diagnosis of an inflammatory arterial aneurysm containing mural thrombi (C). His postoperative course was uneventful.