First case of cough-induced combined intercostal artery rupture with partial diaphragm tear.

We describe a case of vigorous cough-induced left intercostal artery rupture with partial diaphragmatic tear in a 60-year-old obese male with chronic obstructive pulmonary disease. He presented with left hemothorax, a rapidly spreading chest and abdominal wall hematoma, and progression of anemia. Computed tomography (CT) scan revealed a bleeding focus from the left 8th intercostal artery. CT-guided surface marking of the bleeding point was done over the chest wall. The patient underwent open thoracotomy with drainage of clotted hemothorax and ligation of bleeding intercostal artery. Incidentally, a partial diaphragm tear was detected during the surgery which was repaired. The combined presentation of cough-induced intercostal artery rupture with partial diaphragm tear is not reported earlier. Awareness of these co-existing pathologies can facilitate timely diagnosis and appropriate life-saving management.

Fever and large pericardial effusion after valve surgery: can be malaria.

A 37-year-old man underwent mechanical mitral valve replacement for rheumatic heart disease. One week after discharge, he presented with high-grade fever with chills, malaise, and shortness of breath. Echocardiography showed pericardial effusion with no evidence of vegetation. A blood malaria antigen test was positive for Plasmodium falciparum. One week after initiation of antimalarial medication, echocardiography revealed almost complete resolution of the pericardial effusion. Infective endocarditis is a common cause of fever after valvular heart surgery. Malaria can be considered in the differential diagnosis of fever and pericardial effusion after valvular surgery, especially in malaria-endemic countries.

Pseudomesotheliomatous Type of Sarcomatoid Squamous Cell Lung Cancer Presenting With Hemothorax.

A 44-year-old man presented with spontaneous massive hemothorax. Computed tomographic scan revealed thickened and nodular pleura with no evidence of lung tumor. The patient underwent right open total pleurectomy. Histopathologic and immunohistochemical studies of the pleura confirmed poorly differentiated sarcomatoid squamous cell carcinoma of the lung with metastasis to the pleura. The carcinoma was psuedomesothelimatous type because of its presentation as diffuse pleural thickening. This presentation of sarcomatoid cancer as pseudomesotheliomatous type with massive hemothorax is rare and can be considered as a differential diagnosis in diffuse pleural thickening or hemothorax, especially in the absence of a clinically identifiable primary lung tumor.

Tracheobronchopathia Osteochondroplastica as a Single Mass in Lingular Bronchus.

We describe a rare case of tracheobronchopathia osteochondroplastica (TBO) in a 35-year-old man who presented with recurrent chest infection and hemoptysis. Bronchoscopy and computed tomography scan revealed a single 1.5-cm hard nodular mass lesion in the lingular bronchus associated with collapse and bronchiectasis of the lingula. The patient underwent open left lingulectomy with removal of the mass. Histopathology of the lesion showed characteristic features of TBO. TBO is generally characterized by multiple nodules in the trachea or main bronchi. The presentation of TBO as a single dominant mass is rare and can be considered as a differential diagnosis for intrabronchial calcified mass lesions.

Bivalirudin and transcatheter aortic valve replacement: a cautionary tale.

Bivalirudin is an accepted alternative to heparin for anticoagulation during select cardiac procedures. Its use has not been well described during transcatheter aortic valve replacement. Herein is the report of a transcatheter valve replacement case that was complicated by catastrophe and need for emergent cardiopulmonary bypass. A successful outcome was achieved. However, the inability to rapidly reverse the anticoagulation effect of bivalirudin proved troublesome, and that provides for a cautionary tale about its use during transcatheter valve replacement.