A case of false aneurysm of the left atrium after closed mitral commissurotomy which was demonstrated by cineangiography is here reported. It is believed that the false aneurysm resulted from a tear of the left appendage which accidentally occurred during the surgical procedure. The diagnosis was suspected in plain chest X-ray and fluoroscopy. Angiography demonstrated the presence of a false aneurysm of the left atrium which was confirmed at surgery.

Angiocardiography↗

PubMedDate not supplied

Hemopericardium: a late complication after repair of pectus excavatum.

Hemopericardium and tamponade occurred in a 12 year old boy with Marfan's syndrome, two years after surgical repair of pectus excavatum. This life-threatening complication resulted from penetration of a fractured metal plate through the pericardium into the right atrium. The clinical details are reported and discussed.

Child↗

PubMedDate not supplied

Multiple tumor emboli after lung resection.

A patient with carcinoma of the lung underwent a left lower lobectomy. For technical difficulties the pulmonary vein was not ligated prior to extensive manipulations of the involved lobe. Following the pulmonary surgery the patient sustained a massive aortic occlusion by a tumor embolus, that was removed by bilateral femoral embolectomies. Three additional documented episodes of peripheral arterial emboli subsequently took place, two of which were tumoral. One tumor embolus into the carotid artery territory eventually caused metastatic spread in the brain. All peripheral emboli were successfully treated by embolectomy. This unique display of multiple tumor emboli, following lung resection for carcinoma, reemphasises the significance of early interruption of the pulmonary vein, in an attempt to reduce the incidence of tumor emboli.

Brain Neoplasms↗

PubMedDate not supplied

Spontaneous transmural rupture of esophagus--Boerhaave's syndrome.

Spontaneous transmural esophageal perforation is a rare condition with high morbidity and mortality. It is traditionally associated with alcohol abuse. Experience of the syndrome at a large medical center in Israel, a country where alcohol is not a national problem, is reviewed, and eight cases are described. The clinical picture was varied and confusing, only one patient presenting with the classic triad of vomiting, chest pain and subcutaneous emphysema, though abdominal pain occurred in six cases. The diagnosis consequently was delayed (average 2.8 days) in three patients and two died undiagnosed. Contrast studies, when performed, were diagnostic. Early rupture (less than 24 hours) was treated with primary repair (n = 3). Late rupture (greater than 24 hours) was successfully managed by drainage alone (without esophageal exclusion) in three cases, but required long hospital stay (mean 52 days). Five of the six patients diagnosed ante mortem survived. Late reconstructive procedures were not required. The key to successful outcome is awareness of the condition, with early diagnosis and aggressive surgical intervention--repair or drainage.

Adult↗