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INTRODUCTION & IMPORTANCE: Pulmonary Artery Aneurysm is defined as the localized dilation of the pulmonary artery >1.5 times the upper normal limit or pulmonary artery measuring 4 cm. Pulmonary artery aneurysm is considered as a rare disorder having an incidence of 1 in 14,000 post-mortem examinations. CASE PRESENTATION: Presented below is a case of a 28 year old gentleman, who presented with exertional dyspnea and orthopnea and was diagnosed with having a pulmonary artery aneurysm of 76 cm × 56 cm × 53 cm arising from the main pulmonary artery upon Computed Tomography Scan which is a rare finding according to the available literature. CLINICAL DISCUSSION: Clinical manifestations of pulmonary artery aneurysm are varying and rarely occur. However the use of radiological imaging has aided in the diagnosis. No specific treatment guidelines have been mentioned yet in the literature however, medical management, surgical resection and endovascular therapy are one of the multiple options available. CONCLUSION: Pulmonary Artery Aneurysm presents with non-specific symptoms which makes the diagnosis very challenging for the physicians, in process, delaying the accurate management of the disease. However, pulmonary artery aneurysm must be considered as a differential diagnosis and appropriate management options, whether medical or surgical should be opted for keeping in mind the size and the complications of the disease.
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INTRODUCTION: Kartagener syndrome is rare, with an incidence of 1 in 32,000 live births. It consists of a triad of bronchiectasis, situs inversus, and sinusitis. Normally, the middle lobe is part of the right lung, but due to situs inversus, the middle lobe is part of the left lung, making it prone to bronchiectasis and infections. CASE REPORT: We present a unique case of a 16-year-old adolescent with a known history of Kartagener syndrome who presented with recurrent chest infections and hemoptysis refractory to conservative management. He was diagnosed with bronchiectasis of the left middle lobe through a computed tomography (CT) scan and subsequently underwent a posterolateral thoracotomy and left middle lobectomy. This is a rare finding with limited literature available on such cases, to the best of our knowledge. DISCUSSION: Conservative treatment is usually the first line of approach. However, in cases of recurrent chest infections and hemoptysis, surgical management is considered to prevent the infection from spreading to the healthy lung and to avoid life-threatening complications when medical therapy fails. Surgical intervention, while more invasive, can provide a definitive solution and improve the patient's quality of life. CONCLUSION: Early diagnosis of Kartagener syndrome is crucial for determining the appropriate management course. In patients presenting with recurrent hemoptysis and chest infections, surgical resection is an effective treatment approach to prevent complications and enhance long-term outcomes.
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INTRODUCTION: Coronary artery aneurysm is defined as dilatation of a segment of coronary artery, greater than 1.5 times the diameter of the largest normal coronary artery of the patient. Major cause of coronary artery aneurysm is coronary artery disease. Coronary artery aneurysm maybe an incidental finding during coronary angiography or it may present with symptoms including chest pain, myocardial infarction or even death. CASE PRESENTATION: We present a rare case of a 59-year-old gentleman, who had, previously, underwent multiple left heart catheterizations and percutaneous coronary interventions. He presented to us with symptomatic diffuse ectasia of the coronary arteries with proximal aneurysm in the Left Anterior Descending Artery. DISCUSSION: Coronary artery aneurysms are very rare with an incidence of about 0.02 %-0.04 % and a prevalence of 0.3 %-12 %. Right Coronary Artery is the principal site coronary artery aneurysms with a predominance of 83.8 %. The occurrence of multiple aneurysms is a very rare finding. About 73 % patients present with single aneurysms while only 27 % present with multiple aneurysms. Coronary artery aneurysms predispose to various complications including compression of the chambers, thrombosis and rupture. CONCLUSION: From the presented case it can be concluded that even though, conservative management is available, surgical repair is the gold standard treatment, especially in the presence of multiple, symptomatic and large aneurysms in order to avoid fatal ischemic complications.
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INTRODUCTION: Intra-aortic balloon pump (IABP) insertion for diminished myocardial function is standard of care in cardiac surgery. Previous studies have suggested a possible benefit to IABP support before surgery with regards to outcomes and complications. However, there are conflicts with other studies suggesting no significant benefit. Optimal time of insertion, whether preoperative or perioperative (intra-operative and post-operative), has yet to be defined. METHODOLOGY: A retrospective, hospital records-based chart review was conducted for patients admitted to our center from January 2015 to December 2019 for coronary bypass surgery necessitating IABP insertion. Cases were stratified according to the timing of insertion and analyzed according to surgical outcomes and complication rates. RESULTS: Out of 97 patients, 84.5% underwent preoperative IABP insertion while 15.5% of patients received perioperative (Intra-operative or post-operative) insertion. In-hospital mortality was significantly higher in patients with perioperative IABP insertion as compared to the preoperative group (60% vs 20.7%, p = 0.003). However, there were no significant differences between 30-day readmission rates in the two groups (9.8% vs 6.7%, p = 1.000). Length of stay was also higher in patients with preoperative insertion of IABP (p = 0.032), with no significant difference in ICU stay (p = 0.107). Perioperative IABP patients had higher rates of arrhythmias (46.7%, p = 0.042) and reopening of patient (33.3%, p = 0.028). CONCLUSION: Our study shows improved mortality in patients with preoperatively inserted IABP. This may be beneficial for high-risk patients undergoing CABG surgery. Expanding the use of IABP before CABG in third world countries such as Pakistan may improve overall survival for patients.
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INTRODUCTION: Mediastinal seminomas arise due to abnormal migration of the totipotent stem cells during development. They occur very occasionally and makes up about 0.5-5 % of all mediastinal tumors. These usually occur in middle aged men, between 20 and 40 years. In pediatric age group, it is considered as an extremely rare finding, accounting for 3 %-7 % of all primary germ cell tumors. CASE PRESENTATION: We report a rare case of a 16-year-old boy with biopsy proven seminomatous type of germ cell tumor in anterior mediastinum who presented with productive cough and progressive dyspnea. The occurrence of mediastinal seminoma especially in pediatric population is a very infrequent finding, hence, very little literature is found in this regard as per our knowledge. DISCUSSION: The incidence of primary mediastinal germ cell tumors is approximately around 3 %-6 % of all the germ cell tumors in pediatric population. Diagnosis of mediastinal seminomas need a multipronged approach and treatment is associated with multidisciplinary procedures including chemotherapy combined with subsequent surgical resection for long term survival benefits. CONCLUSION: From the above presented case, it can be safely concluded that multimodality treatment approach of chemotherapy combined with surgical resection could ensure long-term survival benefits in extra-gonadal mediastinal seminomas.
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INTRODUCTION AND IMPORTANCE: Aspergilloma is a pathological condition that affects the pulmonary tissues, and it is usually associated with Chronic Pulmonary Aspergillosis, Aspergillus fumigatus being the most common causative pathogen. The presence of multiple asperillomas in a single lung lobe is an unusual manifestation of Aspergilloma and therefore very little literature can be found regarding this. CASE PRESENTATION: Below we report a rare case of numerous pulmonary cavities containing aspergillomas, about 15-16, as an atypical presentation of chronic pulmonary aspergillosis, all of which were present in a single lung lobe of the patient. CLINICAL DISCUSSION: The most common clinical presentation of pulmonary aspergilloma is hemoptysis. It can manifest as a single aspergilloma or multifocal aspergillomas, which usually occur in unilateral lung cavities or bilateral lung cavities. The predominant site being the upper lung lobe, therefore, the appearance of several aspergillomas in a single lung lobe, with unusual manifestation in the lower lobe, is a very rare finding. Surgical resection is considered gold standard treatment in the form of lobectomy. According to various reports, the patient mortality rate after surgical intervention for aspergilloma is reported to be 0 %-22.6 %. CONCLUSION: From the discussed case report, the conclusion can be made that even though, surgical resection holds a certain amount of risk, since there no effective alternate treatment yet, hence surgical resection of the affected segment still remains the Gold-standard treatment in both single and multiple aspergillomas.