Atrial Myxoma - An unusual cause of ischemic stroke in young.

Atrial myxomas are rare primary cardiac tumours with neurological manifestations being reported in 30% of cases. Though a rare cause of ischemic stroke in young patients, considering it as a possibility in absence of any obvious risk factors can help avoid misdiagnosis at early stages. We present a case of left atrial myxoma in a 36-year-old male with no known co-morbidities, showing an unusual clinical presentation of isolated bilateral painless vision loss. With multiple infarcts on Non Contrast Computerised Tomography (NCCT) and a suspicion of Atrial Myxoma on Transesophageal Echocardiography (TEE), patient was successfully managed surgically with confirmation of diagnosis on histopathology.

Atrial Myxoma - An unusual cause of ischemic stroke in young

Atrial myxomas are rare primary cardiac tumours with neurological manifestations being reported in 30% of cases. Though a rare cause of ischemic stroke in young patients, considering it as a possibility in absence of any obvious risk factors can help avoid misdiagnosis at early stages. We present a case of left atrial myxoma in a 36-year-old male with no known co-morbidities, showing an unusual clinical presentation of isolated bilateral painless vision loss. With multiple infarcts on Non Contrast Computerised Tomography (NCCT) and a suspicion of Atrial Myxoma on Transesophageal Echocardiography (TEE), patient was successfully managed surgically with confirmation of diagnosis on histopathology.

The "sausage" abscess: abscess of the liagamentum teres hepatis.

An abscess of the ligamentum teres hepatis is a very rare cause of acute abdomen and can present a diagnostic dilemma. A 40-year-old diabetic male presented with obstructive jaundice and cholangitis. An ill-defined, sausage-shaped, tender parasagittal supraumbilical mass was palpable on the right side. Murphy's sign was negative. Laboratory investigations revealed polymorphonuclear leukocytosis (total leukocyte count 19,000 mm-3), elevated alkaline phosphatase (400 IU l-1), conjugated hyperbilirubinaemia (16 mg dl-1) and elevated blood glucose (240 mg dl-1). Ultrasonography and MR cholangiopancreatography revealed cholecystolithiasis, obstructive choledocholithiasis, abscess of the ligamentum teres hepatis and left portal thrombosis. Under ultrasound guidance, pus was aspirated from the abscess and the patient was started on broad-spectrum intravenous antibiotics, insulin and low-molecular-weight heparin. He subsequently underwent endoscopic retrograde cholangiopancreatography with sphincterotomy and stone extraction. On the tenth day post admission, he underwent laparoscopic cholecystectomy and excision of the ligament. The patient made an uneventful recovery and was discharged on the seventh post-operative day. On follow-up, the patient remained asymptomatic with normal biochemical parameters. This article highlights the importance of suspecting and identifying an abscess of the ligamentum teres hepatis when a patient with acute abdomen presents with a sausage-shaped right parasagittal mass, especially in the setting of cholangitis, cholecystitis or omphalitis.