Aortic insufficiency from iatrogenic valve perforation from nonaortic valve operations is rarely reported despite the prevalence of these procedures. Rapid diagnosis of these defects is essential to prevent deterioration of cardiac function. In this paper, we describe a young man who reported to our institution after two open cardiac surgeries with new aortic regurgitation found to be due to an iatrogenic perforation of his noncoronary aortic valve cusp. This defect was not appreciated by previous intraoperative transesophageal echocardiography and was inadequately visualized on follow-up transthoracic and transesophageal echocardiograms. In contrast, cardiac gated computed tomography clearly visualized the defect and its surrounding structures. This case highlights the utility of cardiac gated computed tomography for cases of suspected valvular perforation when echocardiography is not readily available or inadequate imaging is obtained.

Coagulase-negative staphylococci are generally not considered to be very virulent; they are an uncommon cause of native valve endocarditis. Staphylococcus lugdunensis is an important exception and causes more severe infections, clinically mimicking S. aureus. We present a case of direct Gerbode defect associated with S. lugdunensis native valve infective endocarditis (IE) requiring cardiac surgery.

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The purpose of this article is to report on the evaluation of vague abdominal pain and anemia in the deployed military environment resulting in the diagnosis of a giant gastric ulcer. This patient's abdominal pain was initially thought to be attributable to a lower digestive tract process and her anemia was insidious in onset but progressive. A computed tomography examination was obtained. Circumferential gastric wall thickening, more prominent posteriorly with ulceration, adjacent inflammation, and perigastric lymphadenopathy suspicious for a malignancy or a giant gastric ulcer was identified. Referral and medical evacuation to a tertiary care facility out of the deployed setting resulted in an endoscopy showing a giant gastric ulcer with no evidence of malignancy. Prompt evaluation of the patient with the most expeditious radiologic imaging modality available at hand, rather than delayed sequential evaluation, revealed an uncommon finding and conceivably saved this patient's life. Close cooperation among appropriate specialists in the deployed setting resulted in an optimal outcome in a suboptimal environment.

Mediastinal lesions occur in a wide variety of clinical conditions. Metastatic granulosa cell tumour (GCT) in the mediastinum is a rare occurrence. We report a case of a woman who had a metastatic (GCT) in her mediastinum 40 years after treatment of the initial neoplasm. Surgical resection of the mediastinal mass revealed a low‐grade epithelioid neoplasm with coffee bean‐shaped nuclei and immunohistochemical stains that were consistent with metastatic GCT.