Metachronous and Synchronous Triple Primary Lung Cancers in a Chronic Smoker.

Multiple primary lung cancers (MPLCs), characterized by the presence of more than one distinct primary lung tumors, may develop either synchronously (simultaneously) or metachronously (after initial cancer treatment). This case describes a rare occurrence of three primary lung cancers in a chronic smoker. After a lobectomy for right middle lobe adenocarcinoma (ADC), the patient was diagnosed with synchronous small cell carcinoma (SCLC) in the right upper lobe and squamous cell carcinoma (SCC) in the right lower lobe. Notably, the ADC and subsequent lung cancers were metachronous. Due to her unsuitability for surgery, the patient pursued a treatment regimen involving radiation therapy, chemotherapy, and immunotherapy. This case underscores the need for vigilant identification and comprehensive management of MPLCs, particularly in high-risk patients, to improve outcomes and reduce the burden of this rare condition.

Percutaneous Intervention of LVAD Outflow Graft Obstruction and Thrombosis.

Left ventricular assist devices serve as a salvage therapy for patients with advanced heart failure. Complications such as thrombosis and obstruction can lead to acute device malfunction, posing significant clinical risks. A multidisciplinary approach is crucial for management. Few cases in the literature have demonstrated the safety and efficacy of percutaneous intervention, which holds significant value due to its less invasive nature and minimal risk of morbidity, especially in high-risk surgical patients.

Aortic Ductus Diverticulum Mimicking Aortic Dissection: A Case of Diagnostic Ambiguity in Transthoracic Echocardiography.

Background: Aortic dissection is a critical condition often presenting with acute, severe chest pain and haemodynamic instability. Early diagnosis is essential to mitigate the high mortality risk. Imaging modalities play a pivotal role in diagnosing aortic conditions, but determining the appropriate method can be challenging. Case description: We report an asymptomatic 55-year-old female undergoing transthoracic echocardiography (TTE) for mitral and aortic valve regurgitation surveillance. Incidentally, a suspicious flow jet at the distal aortic arch was discovered, raising concerns of aortic dissection. A subsequent CT angiogram (CTA) identified this as an aortic ductus diverticulum at the aortic isthmus, not a dissection. Discussion: Aortic dissection has a high initial 48-hour mortality, with even surgically managed cases exhibiting a 26% risk. Imaging tools such as a transoesophageal echocardiogram (TEE), CT and MRI scans are instrumental for diagnosis, with their applicability depending on the patient's clinical situation. The aortic ductus diverticulum, a developmental outpouching, often mimics other aortic pathologies, emphasising the importance of accurate imaging interpretation. Conclusion: Aortic ductus diverticulum presents diagnostic challenges due to its resemblance to other aortic conditions. Advancements in imaging modalities improve diagnostic accuracy, but awareness and careful interpretation are paramount to ensure timely and appropriate patient care. LEARNING POINTS: Distinguishing aortic anomalies: recognise the differences between aortic dissection and aortic ductus diverticulum using imaging findings.Evaluating imaging modalities: understand the pros and cons of transthoracic echocardiography (TTE), transoesophageal echocardiogram (TEE), CT and MRI scans for diagnosing aortic conditions.Addressing diagnostic pitfalls: identify potential ambiguities in imaging results, especially concerning the aortic isthmus, and ensure accurate diagnosis before treatment.

Cardiac Arrest Following Retrieval of Inferior Vena Cava Filter: A Case Report and Literature Review of Pericardial Effusion and Cardiac Tamponade.

This report presents the clinical details and management of a 58-year-old Caucasian male with pericardial effusion and cardiac tamponade following outpatient inferior vena cava (IVC) filter removal. The patient was unresponsive and experienced cardiac arrest minutes after the procedure, requiring cardiopulmonary resuscitation. After return of spontaneous circulation he displayed somnolence, confusion and chest discomfort. Investigations revealed a large pericardial effusion, and an echocardiography confirmed cardiac tamponade. Prompt intervention involved pericardiocentesis, resulting in haemodynamic stabilisation and reduction in effusion size. The patient responded favourably with treatment. Differential diagnoses were considered and treatment options were discussed, highlighting the importance of timely recognition and appropriate intervention in managing pericardial effusion and cardiac tamponade. This report adds to the limited literature on pericardial effusion and cardiac tamponade following a scheduled outpatient IVC filter removal, emphasising the unique clinical presentation and successful management of this rare phenomenon. LEARNING POINTS: Understanding the link between pericardial effusion and cardiac tamponade following IVC filter removal.Recognising and differentiating cardiac tamponade from other emergencies using clinical and diagnostic tools.Learning the immediate management of cardiac tamponade, emphasising the role of pericardiocentesis.

Successful Management of Severe Bupropion Toxicity with Lipid Emulsion Therapy: A Complex Case Report and Literature Review.

This case report presents the management of a 53-year-old female with a complex psychiatric history who ingested multiple medications, resulting in severe cardiovascular compromise and subsequent respiratory failure. The patient's ingestion included clonidine, fluoxetine, gabapentin, quetiapine and bupropion. Initial treatment involved supportive measures, including fluid resuscitation, bicarbonate infusion and correction of electrolyte imbalances. Despite these interventions, the patient remained haemodynamically unstable, requiring multiple vasopressors. Lipid emulsion therapy was initiated and led to a remarkable improvement in the patient's cardiovascular status. However, she developed acute respiratory distress syndrome (ARDS) and required prolonged mechanical ventilation. Steroid therapy was initiated to manage the ARDS, and the patient was successfully extubated on day 6. The case highlights the potential effectiveness of lipid emulsion therapy in managing bupropion toxicity, but emphasises the need for further research to establish clear guidelines on dosing, timing and safety protocols. Adverse effects associated with lipid emulsion therapy must be carefully considered. Individualised decision-making and patient-centred care is crucial in optimising outcomes in cases of bupropion toxicity. LEARNING POINTS: Recognise the cardiotoxic effects of bupropion toxicity: be vigilant in identifying cardiotoxic effects such as prolonged QTc, hypotension and arrhythmias in cases of bupropion toxicity.Consideration of intravenous lipid emulsion therapy for toxic injections of lipophilic drugs such as bupropion: in severe lipophilic drug ingestions, such as bupropion, consider using intravenous lipid emulsion therapy as a potential treatment option.Individualised decision-making and monitoring is necessary when using lipid emulsion therapy: tailor treatment based on the patient's condition and closely monitor for responses and potential adverse effects when using lipid emulsion therapy.

Knowledge and Perceptions of Common Breast Cancer Risk Factors in Northern Saudi Arabia

Background: Breast cancer is the second leading cause of cancer death in women around the world. The degree of adoption of a preventive lifestyle offers valuable information for planning appropriate intervention programs for improving women's health. The objective of the present study was to assess the levels of breast cancer related knowledge among a Northern Saudi population. Methodology: In this cross sectional study, data were obtained from 566 Saudi volunteers living in the city of Hail, the Kingdom of Saudi Arabia (KSA). Results: With regard to breast cancer risk factors, 427/566 (75.4%) of participants answered in the affirmative to whether breast cancer could be inherited. For early puberty and late menopause, 209/566 (37%) were in agreement with increased risk, for low and delayed child birth, 261/566 (46%), and for overweight and obesity, 210/566(37%). For the question of whether natural breast feeding can reduce the risk of breast cancer, only 35/566 (6.2%) said yes. Conclusion: There is a general lack of knowledge regarding several BC risk factors among the northern Saudi community which necessitates urgent implementation of educational programs.