RESUMO
A 29-year-old woman with severe ulcerative colitis presented with complicated recurrent pericarditis. Cardiac magnetic resonance imaging showed improvement in pericardial inflammation with a prolonged course of anti-inflammatory therapy, but she developed several relapses on biologics. Rilonacept (newer interleukin-1 antagonist), disease-modifying antirheumatic drugs, and pericardiectomy may be considered in such patients. (Level of Difficulty: Intermediate.).
RESUMO
The presence of human coronavirus HKU1 infection associated with pericardial inflammation is not reported. We are reporting a young woman with systemic lupus erythematosus, who was positive for HKU1 during her pericarditis flare. Diagnostic imaging demonstrated pericardial effusion, edema, and late gadolinium enhancement on cardiac magnetic resonance imaging and echocardiography. She was on multiple anti-inflammatory medications and achieved remission with anakinra. Her management and a brief literature review is also presented.
Assuntos
Coronavirus , Lúpus Eritematoso Sistêmico , Pericardite , Meios de Contraste , Feminino , Gadolínio , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Pericardite/complicações , Pericardite/diagnósticoRESUMO
Coronary subclavian steal syndrome (CSSS) is a rare cause of angina. It occurs in patients with prior coronary artery bypass grafting and, specifically, a left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft and co-existent significant subclavian artery stenosis. In this context, there is retrograde blood flow through the LIMA to LAD graft to supply the subclavian artery beyond the significant stenosis. This potentially occurs at the cost of compromising coronary artery perfusion dependent on the LIMA graft. In this review, we present a case of a middle-aged female who suffered from CSSS and review the literature for the contemporary diagnosis and management of this condition.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/complicações , Síndrome do Roubo Coronário-Subclávio/etiologia , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Síndrome do Roubo Subclávio/complicações , Angina Pectoris/etiologia , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/cirurgia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
About one-third of ischemic strokes may be associated with a patent foramen ovale (PFO). This article presents an unusual case of a 68-year-old woman with simultaneous paradoxical thrombo-embolization to different systemic sites. The patient presented initially with visual deficits and intracerebellar hemorrhage but was found to have concomitant saddle pulmonary embolism, sub-acute cerebral infarction with focal neurological deficits, and thromboembolism to the superior mesenteric artery (SMA) that resulted in an ischemic bowel. The unifying diagnosis was paradoxical embolism through a PFO and an atrial septal aneurysm with high-risk features. The patient underwent percutaneous closure of the PFO with an Amplatzer device.
