Case 270: Spontaneous Coronary Artery Dissection Associated with Fibromuscular Dysplasia.

HistoryA 54-year-old woman presented with typical chest pain during physical training at the gym. She had a history of hypertension controlled with hydrochlorothiazide, without any other cardiovascular risk factor and with neither personal nor family history of ischemic heart disease. She was postmenopausal and had a long-standing history of migraine headaches without hormonal or drug therapy. The patient had no history of clinically important thoracic trauma or invasive chest interventions. Initial electrocardiography (ECG) showed signs of ongoing anterior ST segment elevation myocardial infarction, and emergent coronary angiography with angioplasty and intravascular US were performed. Maximal level of high-sensitive T troponins was 820 ng/L (normal, <13 ng/L), while echocardiography showed a normal left ventricular ejection fraction, with no apparent regional wall motion abnormalities. General physical examination findings were unremarkable, excluding ligamentous hyperlaxity and joint instability. C-reactive protein, rheumatoid factor, antinuclear antibody, cytoplasmic antineutrophil cytoplasmic antibody, and angiotensin-converting enzyme blood test results were negative. For further evaluation, arterial phase ECG-synchronized CT angiography from the skull base to the pubis symphysis was performed.

Case 214: Adrenal pheochromocytoma with perirenal brown fat stimulation.

History A 61-year-old woman with well-controlled diabetes presented with a 10-year history of hypertension, stifling sensation, and flushing. Her body mass index was 19.1 kg/m(2) (normal range, 18.5-25.0 kg/m(2)). She was being followed up for mild hypercalcemia (calcium level, 10.8 mg/dL [2.7 mmol/L]) (normal range, 8.5-10.5 mg/dL [2.12-2.62 mmol/L]) by the endocrinologist (S.J.M.), who decided to perform a technetium 99m sestamibi ((99m)Tc MIBI) parathyroid scan. The test showed an abnormal tracer deposit in the region of the clavicle and sternum; thus, unenhanced thoracic computed tomography (CT) was performed. No mass was seen in the region of abnormality. In light of these findings, the patient underwent contrast material-enhanced (120 mL of iopromide, Ultravist 300; Schering, Berlin, Germany) thoracic abdominopelvic CT. There was no history of underlying malignancy, and the complete blood counts were normal. The axial and appendicular skeleton showed no sign of lesions.

Fibrosis miocárdica grave tras inflamación sarcoidea / Severe myocardial fibrosis after sarcoid inflammation

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