RESUMO
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or broken heart syndrome, generally has a good prognosis but occasionally causes serious complications. It is often triggered by physical and emotional stressors. Burns have been associated with takotsubo cardiomyopathy in six cases in the literature. We report here the seventh case. The patient, an 86-year-old woman with burn injuries to her face and hands due to a fire in her home, developed takotsubo cardiomyopathy. The condition was suspected soon after presentation due to precautionary electrocardiogram and then laboratory findings of elevated myocardial biomarkers. The diagnosis was then confirmed by left ventriculography. The cardiomyopathy resolved spontaneously without complications. The burn in our patient affected only 5% of total body surface area, but its impact may have been augmented by emotional stress caused by the patient losing her home in the fire. Our review of the six burn-related takotsubo cardiomyopathy cases in the literature showed that two of the cases also had small burns in combination with severe emotional stress. Since all six cases developed serious complications, the possibility of takotsubo cardiomyopathy should be suspected, even with small burns.
RESUMO
Fibroma of tendon sheath (FTS) is a rare soft tissue tumor that usually occurs in the upper extremity. Moreover, of the few cases reported in the feet, nearly all occur in the plantar region. We report the case of a large FTS in the dorsum of the left foot that grew quickly into a 4 cm-diameter lesion. The 44-year-old Japanese man noticed the tumor incidentally one year before presentation and could not recall any possible cause. Physical examination showed an elastic hard mass that spread over the third to fifth metatarsal bones. MRI showed iso-intense signals with central hypo-intensity on T1-weighted images and hypo-intense signals on T2-weighted images. Since a biopsy did not reveal any malignant findings, the lesion was excised surgically. The tumor was found to be multilocular, encapsulated, and to arise from the extensor digitorum brevis tendon. Histopathology showed scattered spindle fibroblasts and slit-like vascular structures within the dense collagenous matrix. The tumor was diagnosed on the basis of the clinical, demographic, surgical, and histopathological findings as an FTS arising from the extensor digitorum brevis tendon. A review of the literature revealed seven cases of FTS of the dorsum of the foot, which indicates its rarity. More than one-half of these cases were from Japan. While the cause of FTS remains unclear, trauma has been implicated. We suggest that the cultural background of the patient, which could promote kneeling-induced dorsal foot trauma, may have contributed to the onset/progression of our case. Level of Clinical Evidence: 4.
