Brucellosis After Cardiac Transplantation.

Brucellosis is being increasingly recognized after solid organ transplantation but has not been reported after orthotopic heart transplantation. We present the case of a 51-year-old farmer who underwent orthotopic heart transplantation and was readmitted after 3 months in a severely immunosuppressed state with significant nonspecific complaints. He posed a diagnostic and management dilemma to all disciplines, but finally turned out to be harboring Brucella infection. He responded well to medical management and was discharged in a stable clinical status. Although rare, brucellosis should be included in the investigative workup for nonspecific symptoms after cardiac transplantation.

Inflammatory myofibroblastic lung tumor with dysphagia in a 4-year-old child.

Inflammatory myofibroblastic tumors of the lung are rare in adults but common among pediatric lung tumors. A 4-year-old girl was evaluated for respiratory symptoms, dysphagia, and weight loss. Radiology revealed a right hilar mass that persisted despite antibiotic treatment. On exploration, a hilar mass involving the pulmonary vasculature, diaphragm and gastroesophageal junction was found. Aggressive surgical excision including a right pneumonectomy was performed. Histopathology confirmed an inflammatory myofibroblastic tumor with no features of malignancy. At the 2-year follow-up, the child was clinically stable with no recurrence. Dysphagia is a very rare presentation of such tumors.

Late presentation of esophageal rupture following blunt thoracic trauma.

Esophageal rupture following blunt thoracic trauma is extremely rare. A 30-year-old man sustained a road traffic accident causing blunt thoracic trauma that resulted in lower esophageal rupture. He presented 24 h after the initial trauma and was managed with primary repair and aggressive lavage with a drainage procedure. Early identification and repair of esophageal rupture is vital for preventing mediastinitis, but an aggressive surgical and postoperative management strategy can prevent mortality even in late presentations.

Double aortic arch as a source of airway obstruction in a child.

Double aortic arch (DAA) is a congenital vascular anomaly. The diagnosis was difficult till the child was symptomatic, and other causes were ruled out. We present the interesting images of a child of respiratory distress because of tracheal compression from DAA.

The trunk with a twist: right sinus origin of pulmonary arteries in a child with common arterial trunk.

Sinusal origin of pulmonary arteries in a patient with common arterial trunk is rare. We report echocardiographic diagnosis of this uncommon variant of common arterial trunk in an infant wherein pulmonary artery segment arose from anterior aspect of right truncal sinus very close to the right coronary artery.

A comparison of external and internal jugular venous pressures to monitor pulmonary artery pressure after superior cavopulmonary anastomosis.

The internal jugular vein continues to be the preferred site for cannulation to monitor central venous pressure despite the reported evidence of the accuracy of external jugular venous pressure (EJVP) to reliably predict internal jugular venous pressure (IJVP). Internal jugular venous cannulation carries a risk of thrombosis that can be life-threatening in children undergoing superior cavopulmonary anastomosis and a subsequent Fontan procedure. The present study compared IJVP and EJVP in children undergoing superior cavopulmonary anastomosis and found no statistical and clinical difference between IJVP and EJVP. Thus, external jugular vein cannulation reliably predicts IJVP and pulmonary artery pressures in children undergoing superior cavopulmonary anastomosis, and may obviate the risk of life-threatening cavopulmonary thrombosis.