The acute tumor lysis syndrome occurs rarely in nonhematologic malignancies. This patient, a 34‐year‐old woman with metastatic medulloblastoma, was receiving palliative radiotherapy for a rapidly expanding abdominopelvic mass. After a total of 300 rad, the patient developed the biochemical hallmarks of the acute tumor lysis syndrome, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. This was complicated by oliguria from hyperuricemic acute renal failure. The patient responded well to hydration, alkaline diuresis, phosphate and potassium binders, and allopurinol. The potential for acute tumor lysis syndrome should be anticipated when treating metastatic medulloblastoma.

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This is a case report documenting an acquired coronary artery fistula from the left anterior descending artery through a mural thrombus into the left ventricle by serial coronary arteriography. This abnormality may be an early clue to mural thrombus formation and help provide guidance in making therapeutic anticoagulation decisions.

A case is described in which hugging balloons were used to perform coronary angioplasty through a single catheter. A discussion concerning selection of balloon combinations and technique is included.