A 67-year-old gentleman with a prior history of coronary artery disease and a four-vessel coronary artery bypass graft five years prior to admission, presented to the hospital complaining of a 12-day history of midsternal chest pain. A chest radiograph performed 18 months prior to this presentation revealed a normal cardiovascular silhouette and normal mediastinum. Upon presentation, a new chest radiograph revealed a wide mediastinum. A computed tomography done emergently revealed an aortic thrombus starting at superior mediastinum and large (6 cm) pseudoaneurysm in anterior mediastinum.
Mechanical ventilation has always been a cornerstone of respiratory support for patients with respiratory muscle paralysis. In selected patients, diaphragm pacing (DP) through electrical stimulation of the phrenic nerves provides an alternative to mechanical ventilation with signifi cant advantages in life quality. We report an interesting case of unilateral diaphragmatic paralysis in which unilateral diaphragmatic pacing produced signifi cant improvement in quality of life.
A 25 year-old Hispanic gentleman without any significant past medical history, presented to the emergency department with a 3 hour history of sudden onset shortness of breath and acute progressive quadriparesis. He specifically denied any recent viral infection, recent travel or illicit drug use. He worked as a “chef” in a local restaurant. On initial physical examination, the patient was a slender male in moderate-to-severe respiratory distress. Blood pressure was 160/90 mmHg, heart rate 150 bpm, respiratory rate 32/minute, temperature 38.5 oC and oxygen saturation by pulse oximetry of 98%.
Myxomas are the most common type of primary cardiac tumors, comprising 30-50% of the total in most pathological series. The incidence of atrial myxomas ranges between 0.5 and 1 per million of population/year.
Hypothyroidism is common disease with multisystem involvement. Pericardial tamponade secondary to hypothyroidism is extremely rare. In current paper we describe a case of middle age Hispanic man presenting with pericardial tamponade due to severe hypothyroidism, and discuss the relevant literature.