Percutaneous transluminal septal myocardial ablation (PTSMA) is an established procedure for treating symptomatic hypertrophic obstructive cardiomyopathy. We report a case of urgent PTSMA for treating refractory heart failure due to exacerbated obstruction of the left ventricular outflow tract after surgical aortic valvular replacement to treat severe aortic stenosis.

We describe a 63-year-old male with systemic AL amyloidosis with cardiac, renal, and liver involvement. After 4 courses of CyBorD, mobilization with G-CSF was initiated and CART was simultaneously performed for fluid retention. Anasarca gradually disappeared and he underwent autologous hematopoietic stem cell transplantation.

A woman with single coronary.She underwent aortic valve replacement.But aortic annulus abscess occurred 2 years later. We performed aortic root replacement and coronary artery bypass grafting using the Freestyle valve and saphenous vein graft. The patient was discharged and has visited us as an outpatient without relapse of infection.

Type V Gastric Ulcer: An Unusual Etiology of Gastrosplenic Fistula Associated with Upper Gastrointestinal BleedingMuhammad Nadeem Yousaf MD1, Riyasha Dahal MBBS2, Subeena Phull MD3, Vinayak Aryal MD4, Karun Neupane MD5, Hamza Ertugrul MD6, Ebubekir Daglilar MD71Department of Medicine, Division of Gastroenterology and HepatologyUniversity of Missouri, Columbia, MO, United States2Department of Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal3Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States4Department of Pathology and Laboratory Medicine, MetroHealth System, Case Western Reserve University, Cleveland, OH, United States5Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States6Department of Medicine, Saint Mary’s Hospital, Waterbury, CT, United States7Department of Medicine, Division of Gastroenterology and HepatologyCharleston Area Medical Center, Charleston, WV, United StatesKeywords: Gastric Ulcers, Gastrosplenic fistula, Gastrointestinal bleeding, NSAIDs, Embolization, Endoscopy.Consent statement: Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

A 95-year-old man was diagnosed with left pelvis cancer which presented with rapid tumor growth, multiple metastases, and bilateral tender gynecomastia. Elevated serum human chorionic gonadotropin(hCG), prolactin, estradiol, and progesterone were detected. The patient’s condition rapidly deteriorated and he passed away.

This was a rare case of wandering spleen with splenomegaly and abdominal pain due to splenic arteriovenous torsion after childbirth.

A document by Nabil Dhayhi. Click on the document to view its contents.

Difficulties during surgery are uncommon situations in appendectomy. For granulomatous appendicitis, literature is insufficient about surgical findings. The procedure of a 17-year-old male patient was a struggle due to adhesions. I thought a surgeon could expect granulomatous diseases by evaluating the macroscopic appearance of the appendix during surgical procedure.

Atrial fibrillation is an irregular heart rhythm with increased risk of morbidity and mortality. Commonly due to thromboembolism at the left atrial appendage. Guideline therapy for atrial fibrillation is anticoagulation. Alternative treatment includes closure with the Watchman device. We present a case of Watchman device-related thrombus seven months after placement.

IntroductionCarotidodynia or Fay’ syndrome is characterized as neck pain near the carotid bifurcation (1). Three main differential diagnoses can be responsible for carotidodynia : carotid dissection, cervical osteoarthritis and large vessel vasculitis ie Takayasu disease, giant cell arteritis. The definition of carotidodynia has evolved in the past century: initially classified in the International Classification of Headache Disorders (ICHD) in 1988 and then declassified due to unspecific clinical signs in 2004 (2).Over the last decade, reports of perivascular inflammation of the carotid artery have been described in patients with neck pain called TIPIC syndrome: Transient Perivascular Inflammation of the Carotid Artery. The diagnostic criteria for this rare vascular disorder were established by Lecler et al. in 2017 : acute neck pain directly around the level of the carotid bifurcation, eccentric pericarotidian infiltration on imaging, exclusion of another vascular or nonvascular diagnosis with imaging and improvement within 14 days either spontaneously or with anti-inflammatory treatment (1). A recent multicenter retrospective study of 72 patients with TIPIC syndrome confirmed the benign nature of this disorder and that recurrence may occur in up to 20% of cases (Micieli E et al. Transient perivascular inflammation of the carotid artery (TIPIC) syndrome; Vasa 2022). However, TIPIC pathophysiology and triggers remain poorly understood.We report herein the case of a myelodysplastic syndrome (MDS) patient with granulocyte colony stimulating factor (GCSF) induced TIPIC syndrome.

Tonsilloloth Kiyoshi Shikino, MD, PhD1, and Masatomi Ikusaka, MD, PhD11Department of General Medicine, Chiba University Hospital, JapanFunding: None.Conflicts of Interest : None.Authorship: All authors had access to the data and a role in writing the manuscript.Acknowledgments: NA.Article type: Images in Clinical MedicineRunning head: TonsillolothText word count: 166 wordsNumber of figures: 2References: 2

Imaging findings of succinate dehydrogenase-deficient renal cell carcinoma

To report on a patient who developed multiple perivalvular leak (PVL) after a mechanical mitral valve replacement, and how clinicians successfully used real-time three-dimensional transesophageal echocardiography combined with 3D printing to complete transapical perivalvular closure. Additionally, we reviewed the literature to explore the advantages and disadvantages of multimodal imaging for perivalvular

IntroductionStriae Distensae (SD), a well-recognized phenomenon resulting from dermal scaring, it is usually associated with physiological conditions such as pregnancy, growth spurt, rapid weight loss or gain or iatrogenic causes such as topical or systemic corticosteroid administration1. It is aesthetically troublesome and therapeutically challenging. SD early stages appear as flesh-toned atrophic linear plaques that eventually progress to silvery-whitish atrophic plaques.1,2 Most commonly affect dispensable body areas such as the buttock, lower back, thighs, calves, breast and abdomen.3 Rare secondary changes within SD have been mentioned in the literature, including edema, urticaria, dyspigmentation, ulceration, dehiscence and subcutaneous emphysema. Fluid filling these striae are an unusual finding. Very few cases have been reported discussing this phenomenon.4,5 Upon literature review, it was notable that even in the very few case reports of BSD, almost all the patients were on long-term oral steroids as well as having hypoalbuminemia, except for one patient as demonstrated inTable 1 .4 Herein, we report a case of a 17-year-old girl with nephrotic syndrome who was treated with high dose of corticosteroids presented to the day-care unit with Bullous Striae Distensae.

A man with persistent dyspnea was brought to our hospital in an emergency. Cardiac catheterization revealed right coronary artery occlusion. The patient went into shock on the second day of treatment due to rapid pericardial effusion. The pericardial fluid was cloudy and non-bloody, which was judged purulent pericarditis.

A document by Sarah Baïli. Click on the document to view its contents.

Extrahepatic Mucinous Biliary Cystadenoma is an extremely rare clinical entity which can present with varieties of vague clinical signs and symptoms. Gastric outlet obstruction caused due to this has never been reported before. We highlighted the diagnostic dilemma we faced, when radiological investigations couldnot suggest the accurate organ of origin.

A 2-month-old boy presented to the former emergency department with a fever of 38 ° C and hypoxemia and respiratory failure. He was transferred to our hospital on suspicion of myocarditis because he had an enlarged chest X-ray, a 30% EF, a decrease in left heart function, and an increase in myocardial deviation enzyme(CK-MB 149.8 IU/L, TnT-1（＋）). Echocardiography revealed dilation and poor contraction of left ventricle and no abnormalities in the origin of the coronary arteries (Figure1A, B), and treatment with cardiac stimulants, antibiotics, and IVIG was started for myocarditis. After that, his cardiac function did not improve, and contrast-enhanced CT was taken on day 12. He was diagnosed with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). The LCA diverged from the right PA instead of the main PA (Figure1C). Coronary transplantation was performed on day 13. The postoperative course was uneventful, and he was transferred to our hospital on the 21st day after the operation.ALCAPA mostly originates from the left posterior sinus at the root of the PA, which can lead to coronary steal syndrome and myocardial ischemia, and the incidence of the disease is approximately 1/3,00,000, accounting for 0.25% to 0.5% of congenital heart disease(1, 2). In this case, the LCA diverged from the right PA instead of the main PA, which is extremely rare and has never been reported before. This difference in bifurcation might make the diagnosis of ALCAPA on echocardiography more difficult.ALCAPA should be considered in the differential diagnosis of myocarditis, and contrast-enhanced CT or catheterization should be considered even if coronary artery abnormalities are not detected on echocardiography.