Communicating bilateral coronary artery to pulmonary artery fistula with aneurysm in asymptomatic patient: successful conservative management with selective coil embolization of the aneurysm.

Congenital coronary artery fistula (CAF) is a rare disease. We report a case of a 58-year-old man having a complex coronary to pulmonary artery fistula associated with a large saccular aneurysm originated from the terminal portion of the right coronary artery. An endovascular approach was adopted in order to prevent aneurysmal rupture without need of complete closure of the fistula. We suggest transcatheter embolization as an alternative technique for aneurysmal formation closure in asymptomatic patients with complex CAF complicated with aneurysmal formation if it is not necessary to obtain a complete CAF closure.

Quantification of aortic valve area with ECG-gated multi-detector spiral computed tomography in patients with aortic stenosis and comparison of two image analysis methods.

Thirty-three consecutive patients with aortic stenosis underwent a 16-row spiral CT scan. Aortic valve planimetry was performed using two methods: double-oblique reformation (DO) and 2D-curved multiplanar reconstruction using advanced vessel analysis software (VA). The mean aortic valve area determined by transthoracic echocardiography was 0.88+/-0.34 [0.53-1.88] and did not differ significantly from that determined by CT (DO): 0.87+/-0.38 [0.42-1.93] (p=0.75) or CT (VA): 0.87+/-0.38 [0.44-2.00] (p=0.69). This study demonstrates that 16-row spiral CT scan is a feasible, accurate and reproducible method for aortic valve planimetry in patients with aortic stenosis. Both methods show similar accuracy but the VA method takes slightly longer.

Phalangeal microgeodic syndrome and pine processionary caterpillar.

We describe an 11-month-old-girl with a 1-month history of edematous fingers. She had been hospitalized 3 months before for a mucocutaneous reaction to a processionary caterpillar. Manifestations of arthritis or systemic illness were absent. Radiographs of fingers showed small round lytic lesions within the middle and distal phalanges. A diagnosis of 'Phalangeal Microgeodic Syndrome' (PMS) was established. Bone biopsy of an osteolytic lesion showed fibrosis and foreign bodies with hair aspect surrounded by an epithelioid granuloma. PMS signs include sub-acute swelling and redness of fingers associated with microgeodic osteolytic lesions of phalanges. Sickle-cell anemia, syphilis, osteomyelitis, tuberculosis and sarcoidosis are the main differential diagnoses to exclude. The etiology is still unknown. Circulatory disturbances in the phalanges exposed to low temperatures have been mentioned by several authors. We describe the first case of PMS in a child with a clear history of play with a caterpillar and the presence of a caterpillar hair with epithelioid granuloma in an osteolytic lesion.