Background Cardiac tumors in infants and children are rare. The most common cardiac tumor is rhabdomyoma, which may be associated with tuberous sclerosis. However, not all cardiac rhabdomyomas are pathognomonic for tuberous sclerosis, and not all congenital cardiac tumors are rhabdomyomas. During the prenatal period, early cardiac tumor detection provides important information about fetal wellbeing, delivery planning, and necessary postnatal care. Case presentation We report a 36-year-old African American pregnant women. At 32 weeks 5 days gestational age, the male fetus had a fetal echocardiogram due to fetal arrhythmia. The fetal echocardiogram showed two small echogenic, RV apex and septal masses, suspicious of rhabdomyomas. After a routine pregnancy and a normal spontaneous vaginal delivery (39 weeks 1 day), the male baby was admitted to the neonatal intensive care unit for further monitoring and postnatal evaluation. Conclusions Rhabdomyomas are extremely rare and unique tumors. These tumors are very dangerous, but they usually regress after birth. During the prenatal period, early cardiac tumor detection provides important information about fetal wellbeing, delivery planning, and necessary postnatal care. We present this case to share our findings with our pediatric colleagues. Although a rarely reported case, we hope this cardiac rhabdomyoma case report and literature review can increase cardiac tumor awareness.
Introduction: Acute variceal bleeding (AVB) is a life-threatening emergency with a high mortality rate. Management requires endoscopic intervention after fluid resuscitation, ideally within 12 hours of presentation. We aimed to analyze AVB hospitalizations, the timing of procedures, and outcomes such as mortality and hospital resource utilization. Methods: We extracted adult hospitalizations from Nationwide Inpatient Sample (NIS) 2004-2019yy with ICD-9 and ICD-10 Diagnosis codes of AVB (456.0,I85.01) and associated procedure codes of esophagoscopy (EGD) and esophageal variceal ligation (EVL) (42.22,42.23,42.33,42.91,44.43,45.13, 49.95,0DJ08ZZ,0W3P8ZZ,06L38CZ,06L34CZ). We divided procedure timing into early (, 24hrs) and delayed ( .24hrs). Mortality, length of stay (LOS), and mean charges (MC) were used as outcomes. These outcomes were compared between early and delayed procedure groups. Results: Over a 16-year period, AVB hospitalizations increased from 4,798 in 2004 to 8,095 in 2019, with a peak of 9,280 in 2016. Timing of procedures has not shown significant change, ranging from 76% to 80% of EGDs performed in , 24 hours across all years. There was significant male-to-female predominance (69% vs. 31% in 2004; 63% vs. 37% in 2019). The racial distribution was similar over time, except for a minor increase in Native American/Other and Asian or Pacific Islander hospitalizations and a decrease in Black patient hospitalizations. A large shift was noted in hospitalizations towards teaching institutions (39% in 2004 to 74% in 2019). Mortality of early and delayed procedure groups is demonstrated in Figure . Overall mortality was 6.4% (95% CI:6.02%-6.83%) in the early and 9.1% (95% CI: 8.18%-10.01%) in the delayed procedure group. MC has increased, by 1D $62,527.00 for early and 1D $105,406.00 for the delayed procedure group; Mean LOS was 5 (95% CI 5.0-5.1) and 9 days (95% CI 8.8-9.4) for early and delayed groups, respectively. Conclusion: From 2004 to 2019, hospitalizations for acute variceal bleeding, as well as associated therapeutic procedures, costs, and lengths of stay have steadily increased. There was a notable spike in hospitalizations in 2016, however, this coincided with ICD coding transition. Most EGD and EVL procedures (76-80%) were performed in , 24 hours from admission. Inpatient mortality is notably higher if interventions for AVB are delayed. Early and timely interventions should be strongly encouraged and performed.
Table 1. Characteristics of patients undergoing sigmoidoscopy or colonoscopy for bleeding from rectal tubes (n 516) Variable N (%) or mean (SD) Length of hospitalization (days) 67.4 (30.6) Death during hospitalization 8 (50.0) Hospitalization in intensive care unit (ICU) 13 (81.3) Age (years) 63.4 (14.9) Male sex 13 (81.3) Race White or Caucasian Black or African-American Asian 8 (50.0) 6 (37.5) 2 (12.5) Body mass index 26.9 (6.7
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