Severe brachiocephalic artery stenoses are relatively rare obstructions of the extracranial arteries and can cause significant changes to hemodynamics and spectral Doppler waveform patterns, complicating diagnosis. This case study presents disease progression from stenosis to occlusion and resulting complex steal phenomena extending to the contralateral upper extremity, which has not been widely reported. The sonographic findings of disease progression and collateral pathways were confirmed by magnetic resonance angiography and contrast-enhanced computed tomography.
The conventional 12-lead electrocardiogram (ECG) has limited value for assessing the etiology of cardiac symptoms. Approximately 2% to 10% of patients with coronary artery disease (CAD) and acute myocardial infarctions (AMI) are missed by this method. 1 New research on ECG devices with increased numbers of leads shows that enlarging the sample area of the ECG can improve diagnostic capability. One of these methods is a technology known as a body surface map (BSM). 2 The 80-lead BSM is an innovative technology that comprises 80 unipolar signals: an anterior surface of 64 electrodes, including limb leads and central terminal, and a posterior surface of 16 electrodes. 3 Studies have shown that the 80-lead BSM demonstrates
A woman in her late 50s was admitted to the hospital with a 4-week history of persistent mild cough, intermittent fever and chills, and generalized fatigue. Her past medical history includes hypertension, dyslipidemia, and rheumatic fever as a child with resultant mitral sclerosis and aortic stenosis. Past surgical history includes appendectomy, tonsillectomy, left mastectomy, and a Toronto stentless aortic valve replacement in 2002. Two weeks prior to admission, she had a hypotensive episode considered related to recurrent fever and dehydration.On physical examination, her temperature was 101°F and blood pressure was 107/52. Her weight was stable at 108 pounds. She appeared mildly ill but not in acute distress. Her heart rate was regular at 88, and respirations were 16. Auscultation of the heart revealed a 3/6 systolic ejection murmur heard best at the apex with radiation to the neck. Electrocardiogram demonstrated an old left bundle branch block. Chest X-ray was unremarkable.Infective endocarditis of the aortic valve usually presents with vegetations attached to the ventricular surface of the valve. Vegetations can be large, pedunculated, and freely mobile, making the risk of embolization high. The author reports a case of bioprosthetic aortic valve endocarditis caused by the rare organism Cardiobacterium hominis with an atypical presentation of the vegetation on the aortic surface.
Congenital coronary artery fistula (CAF) is a rare anomaly of the heart presenting in 0.002% of the general population. This case study presents an adult patient with an undiagnosed heart murmur and symptoms of chest pain, fatigue, and lightheadedness that demonstrated an incidental finding of CAF diagnosed by transthoracic echocardiography. Transthoracic echocardiography revealed an aneurysmal, tortuous right coronary artery terminating in a dilated coronary sinus. Sonographic findings were compared with angiography and computed tomography. This study highlights the potential of transthoracic echocardiography to assess heart structure and physiology and detect a CAF.
This case illustrates incidental findings of internal jugular vein (IJV) impingement and thrombosis caused by a metastatic tumor. Sonography of an asymptomatic adult female demonstrated nonocclusive deep venous thrombosis in the left IJV and an impinging vascular mass. Contrast-enhanced computed tomography confirmed compression, displacement, and obstruction of the IJV and metastasis. This case highlights the utility of sonography to identify unsuspected pathologies.
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