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1.
J Cardiothorac Surg ; 13(1): 107, 2018 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-30326931

RESUMO

BACKGROUND: Fungal endocarditis is a rare and lethal cardiac infection which most commonly presents in immunocompromised patients or patients with other predisposing conditions. In a small subset of these patients, lesions present as mural masses and do not have any involvement with native valves or implanted devices. Here we present one such case which was diagnosed in the antemortem period in time to be managed with surgical resection. CASE PRESENTATION: A 70 year-old female patient who presented with multiple cerebral abscesses and was found on echocardiography to have a mass along the inferior wall of the left ventricle. She underwent surgical resection which revealed an Aspergillus vegetation along the left ventricle wall without any involvement of the cardiac valves. An intraoperative photograph was obtained and is presented in this case. The patient was started on antifungal therapy and expired on day 30 of treatment. CONCLUSIONS: Fungal endocarditis is a rare yet lethal disease. It can be difficult to detect and workup should be initiated immediately if there is any clinical suspicion. This is especially true in any patient with predisposing conditions or any patient who presents with undiagnosed, culture-negative fevers or evidence of embolic foci. Once diagnosis is made, early initiation of antifungal therapy coupled with aggressive surgical debridement is required for any significant chance of survival.


Assuntos
Aspergilose/diagnóstico , Aspergillus fumigatus/isolamento & purificação , Abscesso Encefálico/microbiologia , Endocardite/diagnóstico , Idoso , Antifúngicos/uso terapêutico , Aspergilose/complicações , Aspergilose/terapia , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/terapia , Terapia Combinada , Desbridamento , Ecocardiografia , Embolia/microbiologia , Endocardite/complicações , Endocardite/terapia , Evolução Fatal , Feminino , Humanos , Neuroaspergilose/diagnóstico , Neuroaspergilose/terapia
2.
Semin Ultrasound CT MR ; 39(5): 412-424, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30244757

RESUMO

Rapid multimodal imaging is essential in the workup and management of acute ischemic stroke. Early parenchymal findings on noncontrast computed tomography or standard magnetic resonance imaging are used to triage patients for intravenous thrombolysis and to provide insight on prognosis. In the wake of recent endovascular stroke trials, advanced techniques including perfusion imaging and noninvasive vascular imaging are becoming important tools to guide potential endovascular treatment or expand therapy windows. Advanced imaging is also important in pediatric ischemic stroke which requires a slightly different workflow and treatment approach. Here, we will discuss key imaging findings in acute ischemic stroke, as well as the present and future of neuroimaging in light of recent and ongoing clinical trials.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/complicações , Humanos , Acidente Vascular Cerebral/complicações
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