Noncommunicating cysts of the septum pelludicum are rare and diagnostic experience with CT scan is scanty. They may cause hydrocephalus because of obstruction of Monro’s foramina. In this report we describe a young patient with acute Korsakoff’s syndrome. The CT scan revealed a cyst of the septum pellucidum without hydrocephalus. Surgery disclosed a noncommunicating cyst compressing structures of the limbic system. After surgery symptoms disappeared.
ABSTRACT. Intrathoracic impedance monitoring is used to guide management of congestive heart failure. We describe a marked shift in intrathoracic impedance because of a pocket abscess. A 69-year-old male with an active pectoral implantable cardioverter-defibrillator (ICD) (Medtronic, Minneapolis, MN), an abandoned 23-year-old abdominal ICD, and a tunneled transvenous lead from the abdomen through the ipsilateral subclavian vein contiguous with both devices presented with frank abdominal ICD infection and epicardial patch infection. The abdominal system and epicardial leads were removed by abdominal incision and sternotomy, and the aforementioned transvenous lead was cut below and left to retract into the pectoral pocket. The patient was treated with a course of antibiotics and discharged. Four months later he presented with persistent swelling and drainage from his pectoral ICD pocket. The patient underwent explant of the device and extraction of the existing three transvenous leads, with the discovery of frank pus and an abscess cavity in the device pocket. Device interrogation showed an abrupt and persistent decrease in the intrathoracic impedance (OptiVol s , Medtronic, Minneapolis, MN) correlating with the time of abdominal device removal. There were no signs or evidence of congestive heart failure. All other impedance measurements (right ventricle [RV], RV high voltage [HV], superior vena cava [HV]) were unchanged. Given that the intrathoracic impedance is measured between the ICD generator and the RV coil and can be impacted by fluid in the device pocket, we hypothesize that the finding of decreased intrathoracic impedance was a consequence of a pocket abscess. We considered that the change could have been a result of the sternotomy but dismissed this because of the absence of any other changes in lead impedance measurements. Intrathoracic impedance is typically used for monitoring of heart failure, but a pocket abscess should be considered in the differential diagnosis in the setting of device infection and associated symptoms.KEYWORDS. Intrathoracic impedance, lead management, pocket infection. Case presentationA 69-year-old Caucasian man presented with implantable cardioverter-defibrillator (ICD) pocket infection with drainage and swelling of the left pectoral site. Four months prior, he had presented with septic pericarditis in the setting of an abandoned 23-year-old abdominal ICD with epicardial patches and an old tunneled transvenous pace/sense lead from the abdominal pocket through the left subclavian vein, and an active left pectoral ICD with more recently placed transvenous leads. The abdominal system and epicardial leads were removed through the abdominal incision and sternotomy, and the tunneled transvenous lead was cut belowThe authors report no conflicts of interest for the published content.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.