Primary spindle cell sarcoma of the left atrium is an extremely rare tumour. Surgical excision is the mainstay of treatment since it responds poorly to chemotherapy or radiotherapy. In spite of all the treatment, the prognosis remains poor due to inadvertent delay in diagnosis, few therapeutic options and propensity to metastasize. We present a 47-year-old male who underwent a surgical excision of a left atrial mass in February 2010. It was proved to be a high-grade spindle cell sarcoma on histopathology. He presented again in October 2010 with recurrence of the tumour for which he was re-operated. However, the tumour recurred again within one month, to which the patient succumbed.
The current recommendations by Indian experts who are focused on the challenges in the management of patients with acute coronary syndrome (ACS) in rural areas, due to limited catheterization (CATH) lab facilities and interventional cardiologist coverage across the country, are described. 120 cardiologist experts drafted recommendations during ten advisory board meetings conducted from April to May 2022. Experts framed statements based on experience, collective clinical judgment from practical experience, and available scientific evidence regarding ACS. The consensus positioned fondaparinux as highly useful in non-CATH-lab-based hospitals for patients diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS) and ST elevation acute coronary syndrome (STE-ACS) patients who cannot be shifted to percutaneous coronary intervention (PCI)-capable centres, or for patients who are thrombolysed at peripheral centres.
Coexistent aneurysms of the coronary and inominate arteries are extremely rare. We present the case of a 28-year-old male with an aneurysm of the left anterior descending coronary artery and an aneurysm of the inominate artery presenting with hoarseness and severely depressed left ventricular function (ejection fraction of 25%). He underwent successful surgical resection of both aneurysms. The inominate artery aneurysm was excised and the brachiocephalic trunk was reconstructed off-pump. The coronary artery aneurysm was excised and distal aorto-coronary bypass grafting was done on cardiopulmonary bypass.
A 32-year-old kidney transplant recipient presented with Klebsiella pneumonia. He developed sudden tension pneumothorax with pneumopericardium on chest radiography ( Figure 1). Pericardiocentesis revealed a continuous flow of air from the pigtail catheter, raising suspicion of a broncho-pleuro-pericardial fistula. Computed tomography confirmed the findings, although a fistula could not be demonstrated ( Figure 2). Despite prompt treatment with broadspectrum antimicrobials and drainage, the patient's condition deteriorated and he died after 3 days. Pneumopericardium is an emergency, presenting as cardiac tamponade with mortality > 50%. The etiology is traumatic, post-thoracic surgery, infectious (gasproducing organisms) or broncho-pericardial fistulas. It is diagnosed by the halo sign on chest radiography and confirmed by computed tomography. Tension pneumopericardium calls for fluid resuscitation and urgent pericardiocentesis. Spontaneous resorption usually occurs in 2 weeks. In our case, the exact etiology was unknown, but infectious etiology is a possibility.
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.