Cardiomegaly and abdominal mass in an acromegalic patient.

We herein report the case of a 53-year-old white acromegalic patient with an abdominal mass due to massive cardiomegaly. The patient suffered from long lasting acromegaly refractary to bromocriptine, transsphenoidal surgery and radiotherapy. He had been previously diagnosed as having systemic hypertension, ischemic chest pain and congestive heart failure with marked cardiomegaly. The present admission was due to asthenia, anorexia and weight loss that were finally attributed to adrenal insufficiency secondary to radiotherapy. Plain abdomen X-ray suggested the presence of supramesocolic mass. A large cold area in the left hepatic lobe was detected on the radionuclide liver scan. Radionuclide angiography surprisingly identified the cold area as a vascular structure corresponding to the heart. A body CT scan revealed the heart was expanding between stomach and liver. Two-dimensional echocardiography showed marked enlargement of left ventricle. Cardiomegaly was probably multifactorial (chronic hypertension, ischemic heart disease and acromegaly). To our knowledge, this is the first reported case of massive cardiomegaly behaving as an intraabdominal mass. This possibility must be considered when invasive intraabdominal diagnostic procedures are to be done, particularly in an acromegalic patient.

Venous digital angio-radiography: an accurate and useful technique for assessing coronary bypass graft patency.

Digital angiography has been reported to be a valid technique for anatomical studies of the peripheral cardiovascular system and for dynamic studies of ventricular function. The purpose of the present study was to assess the usefulness and accuracy of venous digital angiography (2 images per second) for imaging coronary bypass grafts after coronary artery bypass surgery, comparing its results with those of selective angiography. Fifty-two patients with 108 grafts (101 venous grafts and 7 internal mammary artery grafts) were studied by venous digital angiography and selective angiography. Venous digital angiography correctly diagnosed 95 out of 97 patent grafts and the 11 occluded grafts visualized by selective angiography. These results are better than those obtained in the very few studies so far reported in the literature. We were not able to adequately visualize distal anastomoses in most patients although we could identify the distal portion of 7 out of 8 patent sequential bypass grafts. Thus, these results suggest that venous digital angiography is a useful and accurate technique for assessing coronary bypass graft patency.

Probable early acute hepatitis with parenteral amiodarone.

A patient with acute changes suggesting acute hepatitis after parenteral amiodarone administration is described. A 77-year-old man with previous myocardial infarction was admitted with chronic left heart failure and atrial tachycardia. Initial hepatic function tests were strictly normal. After therapy with parenteral amiodarone (2300 mg in 3 days) and other measures, signs of congestive heart failure disappeared; subsequently the patient developed jaundice, marked increase in serum transaminase levels and fall in prothrombin time, and histologic changes of severe centrilobular necrosis were observed in hepatic biopsy. Clinical, laboratory (absence of others markers of hepatic disease), and histological findings seem to rule out common causes of hepatic disease. Therefore, parenteral amiodarone was implicated as the cause of acute hepatitis in this patient. In addition, there were findings suggesting a possibly immunologically mediated mechanism.

Direct non-invasive techniques for assessing coronary bypass graft patency.

Venous digital subtraction angiography (vDSA) and computed tomography (CT) are two non-invasive techniques that allow direct imaging of coronary grafts. Neither of them is 100% accurate when compared to selective angiography. We studied 52 patients with 107 coronary grafts (101 saphenous and 6 mammary artery grafts) by CT and vDSA. Fifty patients had control selective angiography and 2 had control digital arterial aortography. CT correctly diagnosed 88 of the 95 patent grafts and 8 out of the 12 occluded grafts (in 1 patient 3 patent grafts could not be well analyzed owing to artifacts from pacemaker wires). vDSA correctly identified 93 patent grafts and the 12 occluded grafts, allowing the correct diagnosis of the 11 non/or misdiagnosed CT grafts. CT allowed the correct identification of the 2 misdiagnosed vDSA grafts. These results show that when there was agreement between CT and vDSA there were no diagnostic errors and that the combination of these two non-invasive techniques may avoid selective angiography for studying coronary bypass graft patency.