Tension chylothorax: a rare life threatening entity after pneumonectomy.

Chylothorax is an accumulation of chyle in the pleural space due to disruption or blockage of the thoracic duct or its lymphatic tributaries. The thoracic duct carries chyle, which is defined as lymphatic fluid of intestinal origin, to the bloodstream. Chylothorax can occur due to traumatic or non-traumatic a etiologies. Chylothorax is a known complication of thoracic surgery and can occur after significant trauma. However, tension chylothorax is an extremely rare and life threatening complication after thoracic surgery. We describe a patient who developed tension chylothorax 2 weeks after a left pneumonectomy was performed. Early recognition and prompt treatment of this life threatening entity are essential.

Painless acute aortic dissection presenting as left lower extremity weakness and numbness.

Acute aortic dissection usually presents with a sudden, painful, tearing sensation in the chest or back. However, acute aortic dissection may also present atypically without pain and with solely neurological symptoms. We describe a case of painless acute aortic dissection which presented as acute left lower extremity weakness and numbness. These neurological symptoms are due to vascular occlusion causing peripheral ischaemic neuropathy. It is imperative to consider acute aortic dissection in the differential diagnosis of acute neurological syndromes.

Propionibacterium acnes: a rare cause of late prosthetic valve endocarditis and aortic root abscess.

Propionibacterium acnes is an anaerobic, non-spore forming, gram-positive bacillus, and is often part of the normal flora of human skin. It usually has relatively low virulence. However, it can rarely cause serious infections including infections of prosthetic valves, native valves, and annuloplasty rings. We describe a rare case of late prosthetic aortic valve endocarditis and aortic root abscess caused by P. acnes, an easily ignored pathogen.

Pulmonary artery sarcoma masquerading as saddle pulmonary embolism.

Pulmonary artery sarcoma is a highly malignant tumour. Therefore, making the diagnosis is very important. We describe a case which presented with dyspnea on exertion and was initially diagnosed as saddle pulmonary embolism per CT thorax with contrast. Despite adequate anticoagulation, symptoms still progressed. Follow-up CT thorax showed an extension of the presumed filling defect or clots into the left main pulmonary artery with new lung nodules. This prompted suspicion that this may not be a pulmonary embolism. Biopsy of the lung nodule revealed high grade soft tissue sarcoma with primary source from the pulmonary artery. Our case highlights that pulmonary artery sarcoma should always be included in the differential diagnosis of pulmonary embolism especially, if symptoms still progress while on adequate anticoagulation, or any pulmonary nodules develop on follow-up exam.

Citalopram induced torsade de pointes, a rare life threatening side effect.

Acquired Long QT syndrome is a disorder caused by medications, electrolyte imbalances, and drug interactions. This syndrome is associated with an increased risk of a characteristic life-threatening cardiac arrhythmia, known as torsade de pointes (TdP). In the setting of Long QT syndrome (LQTS), selective serotonin reuptake inhibitors (SSRIs) can precipitate TdP. We report the first case of LQTS and TdP induced by citalopram in the United States. After discontinuation of citalopram, the QT/QTc interval normalized after 3 days and resolved further episodes of TdP. Patients on citalopram should be monitored closely for QT/QTc interval to prevent torsade de pointes.