A 65-year-old obese woman with an oversized neck and dysphagia underwent transesophageal echocardiography (TEE). The procedure was complicated by difficulty in insertion from the pharynx to esophagus, and her head and neck gradually swelled. Computed tomography (CT) revealed extensive emphysema from the neck to superior mediastinum, which suggested pharyngeal perforation. A nasogastric tube was inserted, and the patient received antibiotics to prevent secondary mediastinitis. CT performed 1 week later showed improvement of emphysema and no evidence of mediastinitis. Perforation along the orogastric pathway during TEE is a rare but life-threatening complication to which physicians performing TEE should pay attention.
Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oor preservation of wall motion (WM) after acute myocardial infarction (MI), even with adequate mechanical reperfusion therapy, is not uncommon, even within the golden time. In such cases, the restored epicardial blood flow is insufficient to protect the myocardium, because necrosis of myocytes and capillaries in the infarcted area and the occlusion of capillaries by dying blood cells and debris prevents the infarct core from promptly reperfusing. 1 This microvascular obstruction (MO) is called the "no-reflow" phenomenon. 2 Contrast-enhanced magnetic resonance imaging (MRI) allows us to visualize in vivo regions of MO in patients who have suffered an acute MI. 3 These MO regions appear as hypoenhanced areas surrounded by hyperenhanced myocardium and correspond to experimentally produced no-reflow regions. 4 With the availability of excellent visualization of the MO region by cardiac MRI (CMR), many studies have been conducted to elucidate the prognosis of MO after acute MI. The extent of MO determines the magnitude of myocardial damage and thus the short-term prognosis. 1 Additionally, with regard to the long-term prognosis, the presence of MO is an important predictor of remodeling and unfavorable outcome in patients with a successfully reperfused MI. 5 Studies that have aimed at analyzing the characteristics of MO regions have also been performed using CMR. Experimental data have shown the accuracy of first-pass enhancement MRI in determining the extent of MO. 6 Delayed enhancement (DE) images of hypoenhanced regions that are surrounded by hyperenhancement have been described and could relate to persistent MO (PMO) in the core of infarcted myocardium. 7 However, few studies have evaluate MO regions after acute MI using CMR in combination with other modalities such as scintigraphy.Lesions that result in myocardial cell death, such as isch- Yasutoshi Nagata, MD; Shigeo Umezawa, MD; Akihiro Niwa, MDBackground: Few studies have compared the ability of cardiac magnetic resonance (CMR) with that of scintigraphy using 201-thallium (201-Tl) and 99m-technetium pyrophosphate (99m-Tc PYP) to evaluate microvascular obstructions (MOs). In the present study the relationship between the scintigraphic and CMR characteristics of MOs after acute myocardial infarction (MI) was examined.
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