Esophageal perforation, the most feared complication of TEE: early recognition by multimodality imaging.

Esophageal perforation is the most feared complication of transesophageal echocardiography (TEE), although the overall risk is extremely low. We report a case of esophageal perforation in a 77-year-old woman who had no apparent contraindications to TEE. Chronic steroid therapy for symptoms of asthma as well as osteophytic changes of the cervical vertebrae contributed to her increased risk of perforation. Unlike in prior reports, the perforation in this case was fortuitously recognized rapidly due to ingestion of a carbonated beverage for evaluation of a hiatal hernia suspected during a subsequent transthoracic echocardiogram performed because of inadequate TEE images after a difficult intubation. The incidence of esophageal perforation in our series (1 in 5,000 TEEs, 0.02%) is similar to that reported in the literature. Early recognition and prompt surgical repair of the esophageal perforation led to favorable outcome in our patient.

Enormous right atrial hemangioma in an asymptomatic patient: a case report and literature review.

We report the case of an enormous right atrial hemangioma in an asymptomatic 42-year-old woman. The diagnosis was made by echocardiogram after the patient was found to have an abnormal EKG during a routine medical exam. The hemangioma is the largest described in English literature. The tumor was surgically resected and the patient did well postoperatively. In this case report, we discuss the discovery of the tumor and treatment of our patient. A brief discussion of cardiac hemangiomas follows.

ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction (STAT-MI) trial.

OBJECTIVES: Our goal was to examine the effects of implementing a fully automated wireless network to reduce door-to-intervention times (D2I) in ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Wireless technologies used to transmit prehospital electrocardiograms (ECGs) have helped to decrease D2I times but have unrealized potential. METHODS: A fully automated wireless network that facilitates simultaneous 12-lead ECG transmission from emergency medical services (EMS) personnel in the field to the emergency department (ED) and offsite cardiologists via smartphones was developed. The system is composed of preconfigured Bluetooth devices, preprogrammed receiving/transmitting stations, dedicated e-mail servers, and smartphones. The network facilitates direct communication between offsite cardiologists and EMS personnel, allowing for patient triage directly to the cardiac catheterization laboratory from the field. Demographic, laboratory, and time interval data were prospectively collected and compared with calendar year 2005 data. RESULTS: From June to December 2006, 80 ECGs with suspected STEMI were transmitted via the network. Twenty patients with ECGs consistent with STEMI were triaged to the catheterization laboratory. Improvement was seen in mean door-to-cardiologist notification (-14.6 vs. 61.4 min, p < 0.001), door-to-arterial access (47.6 vs. 108.1 min, p < 0.001), time-to-first angiographic injection (52.8 vs. 119.2 min, p < 0.001), and D2I times (80.1 vs. 145.6 min, p < 0.001) compared with 2005 data. CONCLUSIONS: A fully automated wireless network that transmits ECGs simultaneously to the ED and offsite cardiologists for the early evaluation and triage of patients with suspected STEMI can decrease D2I times to <90 min and has the potential to be broadly applied in clinical practice.

Left ventricular non-Hodgkin lymphoma visualized on contrast echocardiography.

We present a case of AIDS-related Burkitt's type cardiac lymphoma in a middle-aged woman with Epstein-Barr virus infection and profound immunodeficiency. The original features of our case include left ventricular location, female sex, and the use of contrast echocardiography to help establish the diagnosis.

Metastatic signet ring adenocarcinoma: an unusual cause of cardiac constriction.

Pericardial constriction secondary to metastatic adenocarcinoma is exceedingly rare. We present the first recorded case of pericardial constriction secondary to metastatic signet-ring mucinous adenocarcinoma diagnosed by echocardiography. The cornerstones of echocardiographic diagnosis of constriction are the following: interventricular septal bounce phasic with respiration, M-mode recordings of the inferior vena cava, and the characteristic Doppler velocity patterns recorded from the mitral valve, hepatic veins, and mitral annulus.

Aortic rupture: comparison of three imaging modalities.

We report a case of a 56-year-old man with traumatic aortic rupture (TAR) sustained in a motor vehicle accident diagnosed by helical computed tomography, aortography, and transesophageal echocardiography. A large majority of patients with TAR never make it to the hospital, and for those who do, a timely diagnosis is critical for survival. We discuss the merits and pitfalls of the three imaging modalities.

CT appearance of isolated dextroversion.

We present the multidetector CT appearance of a case of isolated dextroversion. Dextroversion is a rare anomaly characterized by extreme right-sided rotation of the heart resulting in dextrocardia with the left ventricle anterior and to the left of the right ventricle. The diagnosis is easily made with ECG-gated multidetector CT.

Radiological reasoning: pulmonary embolism--thinking beyond the clots.

OBJECTIVE: We discuss the CT findings in a case of pulmonary embolism complicated by paradoxical embolism in a patient with a patent foramen ovale and atrial septal aneurysm. CONCLUSION: When confronted with a case of pulmonary embolism on CT, besides evaluating the extent of pulmonary artery occlusion, the radiologist should examine the cardiovascular system to identify any unsuspected underlying or associated conditions.

Echocardiographic assessment of left and right heart hemodynamics in a patient with Lutembacher's syndrome.

We present a case of a 53-year-old woman with intractable shortness of breath that was originally ascribed to bronchiolitis obliterans organizing pneumonia. Subsequently evaluation by echocardiography and cardiac catheterization revealed that she had Lutembacher's syndrome, an uncommon combination of congenital atrial septal defect (ASD) and acquired mitral stenosis that is difficult to diagnose clinically. Our case illustrates the pitfalls and advantages of echocardiographic assessment of the mitral valve area (MVA) and the left atrial pressure (LAP). The pressure half-time method used most commonly for estimating MVA echocardiographically is inaccurate and may lead to underestimation of the severity of mitral stenosis in patients with Lutembacher's syndrome. On the other hand, the presence of ASD provides an additional method of calculating LAP, the most important determinant of symptoms in patients with mitral stenosis.