We report a case of thymic hyperplasia accompanied by pericardial lipomatosis and right facial hemihypertrophy in an 8-year-old boy. On imaging studies, the hyperplastic thymus had prominent curvilinear and nodular fatty areas simulating a fat-containing anterior mediastinal mass, which is an unusual finding in children. To our knowledge, this is the first report on a child with a combination of thymic hyperplasia, pericardial lipomatosis, and right facial hemihypertrophy. The radiologic findings are presented with a brief discussion.
Child ; Diagnosis, Differential ; Facial Asymmetry/complications/*diagnosis ; Heart Diseases/complications/*diagnosis/surgery ; Humans ; Hypertrophy/pathology ; Lipomatosis/complications/*diagnosis/surgery ; Magnetic Resonance Imaging ; Male ; Pericardium/*pathology ; Thymus Hyperplasia/complications/*diagnosis/surgery ; Tomography, X-Ray Computed

Anti-Bacterial Agents ; therapeutic use ; Echocardiography, Doppler ; Endocarditis, Bacterial ; complications ; diagnosis ; therapy ; Female ; Heart Atria ; diagnostic imaging ; pathology ; surgery ; Heart Diseases ; diagnosis ; therapy ; Heart Ventricles ; diagnostic imaging ; pathology ; surgery ; Humans ; Infant

The clinical data for a patient with sick sinus syndrome was retrospectively analyzed. The patient was treated because of his heart palpitations and the increased chest pain. The patient admitted to the hospital under consideration for the left atrial tumor dependent on the echocardiography findings. After the CT scan and the dynamic ECG examination, the patient successfully underwent the left atrial tumor resection, atrial septal repair and cardiac pacing lead installation. The postoperative pathological diagnosis showed that the infective endocarditis and left atrial thrombus in left atrium was cured. The patient was discharged after postoperative anti-inflammatory therapy. By analyzing the reasons for misdignosis before or during surgery, the possible mechanisms for left atrial subendocardial thrombus have been found. This study suggests that it is necessary to combine imaging diagnosis and clinical observations to distinguish tumor from excrescence.
Anti-Inflammatory Agents ; therapeutic use ; Arrhythmias, Cardiac ; etiology ; surgery ; Atrial Septum ; surgery ; Computed Tomography Angiography ; Diagnosis, Differential ; Diagnostic Errors ; Echocardiography ; Endocarditis ; diagnosis ; therapy ; Heart Atria ; diagnostic imaging ; surgery ; Heart Diseases ; etiology ; surgery ; Heart Neoplasms ; complications ; diagnostic imaging ; surgery ; Humans ; Male ; Pacemaker, Artificial ; Retrospective Studies ; Sick Sinus Syndrome ; etiology ; surgery ; Thrombosis ; etiology ; surgery

Systemic infection with Aspergillus is an opportunistic disease that affects mainly immunocompromised hosts, and is associated with a high mortality rate. It typically occurs in patients with several predisposing factors, but Aspergillus endocarditis of native valves is rare and experience in diagnosis and treatment is limited. We report a case of native valve endocarditis caused by Aspergillus. A 35-yr-old male patient who underwent pericardiocentesis four months previously for pericardial effusion of unknown etiology presented with right leg pain and absence of the right femoral artery pulse. Cardiac echocardiography revealed severe mitral insufficiency with large mobile vegetations, and computed tomographic angiography showed embolic occlusion of both common iliac arteries. We performed mitral valve replacement and thromoembolectomy, and Aspergillus was identified as the vegetation. We started intravenous amphotericin B and oral itraconazole, but systemic complications developed including superior mesenteric artery aneurysm and gastrointestinal bleeding. After aggressive management, the patient was discharged 78 days post surgery on oral itraconazole. He was well at 12 months post discharge but died in a traffic accident 13 months after discharge.
Administration, Oral ; Adult ; Amphotericin B/administration & dosage ; Antifungal Agents/administration & dosage ; Aspergillosis/complications/*diagnosis/drug therapy ; Aspergillus/isolation & purification ; Endocarditis/*diagnosis/surgery/ultrasonography ; Heart Valve Diseases/*diagnosis/microbiology/surgery ; Humans ; Itraconazole/administration & dosage ; Male ; Postoperative Complications/microbiology ; Tomography, X-Ray Computed

Adenocarcinoma ; surgery ; Candidiasis ; etiology ; Cardiac Tamponade ; diagnosis ; etiology ; Echocardiography ; Electrocardiography ; Esophageal Fistula ; complications ; diagnostic imaging ; Fever ; etiology ; Gastrectomy ; Haemophilus Infections ; etiology ; Heart Diseases ; complications ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Pericardial Effusion ; diagnostic imaging ; etiology ; Pericarditis ; diagnostic imaging ; etiology ; Postoperative Complications ; diagnostic imaging ; Staphylococcal Infections ; etiology ; Stomach Neoplasms ; surgery ; Streptococcal Infections ; etiology ; Tomography, X-Ray Computed

OBJECTIVETo explore the diagnostic and therapeutic methods for perioperative children with congenital heart disease (CHD) with airway stenosis in pediatric intensive care unit (PICU).

METHODFiberoptic bronchoscopy was used for the diagnosis of 100 CHD cases in PICU who were clinically considered to have possible airway malformation because of complicated difficult-to-control lung infection, atelectasis and failure with the ventilator after surgery from January 2010 to October 2011. Cases who were confirmed to have severe airway stenosis by bronchoscopy and weaning from the ventilator after surgery were treated with balloon expandable stents into the desired position in the bronchoscopy.

RESULTThere were 73 cases (73%) of CHD patients with airway abnormalities, including 31 cases of severe stenosis (31%), moderate stenosis in 29 cases (29%), mild stenosis in 13 cases (13%). Nine of the 10 children in whom the mechanical ventilation was hard to be stopped after surgery because of severe airway stenosis were weaned from mechanical ventilation successfully by fiberoptic bronchoscopy, while one case died from primary disease with severe sepsis after the placement of bronchial stents.

CONCLUSIONCHD children with difficult-to-control lung infection, atelectasis and failure with ventilator after surgery are often complicated with airway abnormalities. The therapeutic bronchoscopy with airway stent can be used for cases with weaning from the ventilator because of severe airway stenosis.

Airway Obstruction ; diagnosis ; etiology ; therapy ; Bronchoscopy ; methods ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; complications ; diagnosis ; surgery ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Lung Diseases ; diagnosis ; etiology ; therapy ; Male ; Perioperative Period ; Respiration, Artificial ; Stents ; Trachea ; abnormalities ; Tracheal Stenosis ; diagnosis ; etiology ; therapy ; Treatment Outcome

PURPOSE: Acute pancreatitis is one of the potentially lethal complications that occurs after cardiac surgery. We tried to identify risk factors for and the prognosis of acute pancreatitis after cardiac valve surgery with cardiopulmonary bypass. MATERIALS AND METHODS: We retrospectively analyzed a database of consecutive patients who underwent cardiac valve surgery with cardiopulmonary bypass between January 2005 and April 2010 at our institution. Patients were classified as having acute pancreatitis based on serum lipase concentration and clinical symptoms (lipase > or =180 U/L or > or =60 U/L with relevant symptoms). RESULTS: Of the 986 patients who underwent cardiac valve surgery with cardiopulmonary bypass, 58 (5.9%) patients developed post-operative pancreatitis. Post-operative hospital stay was significantly longer (29.7+/-45.6 days vs. 12.4+/-10.7 days, p=0.005) and in-hospital mortality rate was higher (15.5% vs. 2.0%, p<0.001) in patients with post-operative pancreatitis than those without. Hypertension, chronic kidney disease, and peri-operative use of norepinephrine were identified as independent risk factors for developing pancreatitis after cardiac valve surgery. CONCLUSION: We found that acute pancreatitis after cardiac valve surgery requires longer hospitalization and increases the in-hospital mortality rate. Clinicians should be aware that patients could develop pancreatitis after cardiac valve surgery, especially in patients with hypertension and chronic kidney disease treated with norepinephrine.
Acute Disease ; Adult ; Aged ; Cardiac Surgical Procedures/adverse effects ; Cardiopulmonary Bypass ; Female ; Heart Valve Diseases/*complications/*surgery ; Heart Valve Prosthesis Implantation/*adverse effects ; Humans ; Lipase/blood ; Male ; Middle Aged ; Multivariate Analysis ; Norepinephrine/therapeutic use ; Pancreatitis/*diagnosis/*etiology ; Postoperative Period ; Prognosis ; Retrospective Studies ; Risk Factors