Amiodarone Related Skin Toxicity -The Blue Man Syndrome; a Case Report and Review of Literature.

Amiodarone induced blue-gray syndrome is a rare condition. It develops over years of use of amiodarone and can lead to discontinuation of the drug. It tends to develop over the sun exposed areas of the body typically involving the face and neck. Published medical literature is scarce with regard to the pathogenesis, clinical implications and management of this potential association. We chronicle here the case of a patient with amiodarone induced blue-grey discoloration of skin from our clinical experience. Furthermore, a systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 9 cases fulfilled the inclusion criteria. The data on patients' characteristics, epidemiology, clinical features, comorbid conditions, diagnosis, clinical course and outcome were analyzed. The present review outlines our current understanding of the epidemiology and risk factors for amiodarone induced-blue man syndrome, the pathophysiology of this condition and currently available management options.

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Morbidly Obese Patient Presenting with Chest Pain.

BACKGROUND Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital anomaly with an incidence of 0.002%. CASE REPORT A 58-year-old African American female with a history of diabetes mellitus, hyperlipidemia, and hypertension was evaluated for shortness of breath and chest heaviness. On physical examination, she was found to be morbidly obese. Her blood pressure was 160/90 mmHg. There were no carotid bruits or jugular venous distension. Cardiac auscultation showed distant heart sounds with no audible murmurs. Lower extremity examination showed +1 edema with weak pedal pulses. ECG showed non-specific ST segment and T-wave changes. Echocardiogram demonstrated dysfunction grade I with preserved ejection fraction. An adenosine nuclear study showed an area of reversible ischemia of the inferior wall. Selective left coronary angiography showed the left coronary artery (LCA) originating from the left sinus of Valsalva. From the LCA, the left anterior descending and the left circumflex coronary arteries arose in a typical course. The right coronary artery (RCA) was visualized in a retrograde fashion via collaterals originating from the left coronary system and it drained into the pulmonary artery. On aortic root angiography, the origin of the RCA could not be determined. The patient's surgical risk was deemed unacceptably high and she was not considered a surgical candidate. Her symptoms were controlled conservatively. CONCLUSIONS By reporting this case, we shed some light on a rare congenital anomaly involving the coronary arteries. Variable presentations have been described for ARCAPA, however, many patients remain asymptomatic. Diagnosis can be confirmed by coronary angiography. Surgical correction is the definitive treatment.

A novel surgical approach to cardiac autotransplantation in complex cardiac sarcoma resection.

A 28-year-old woman was admitted to our institution, reporting progressive dyspnea, cough, and weight loss of 14 kg. Two-dimensional echocardiography revealed a left atrial mass, and cardiac magnetic resonance imaging showed localized involvement of the mass with adjacent structures. These clinical signs and radiographic images were highly suggestive of cardiac sarcoma. The patient underwent emergent mediastinal exploration, and an incisional biopsy of the mass showed high-grade sarcoma. Removing the tumor required radical en bloc resection of the left atrium, including the mitral valve, the left pulmonary vein, and the left lower lobe of the lung. Autotransplantation was necessary for the resection and reconstruction. We report a unique method of handling the right atrium to avoid the potential complications associated with bicaval anastomoses after autotransplantation.