We present the case of an 80-year old man with a Stanford Type A dissecting thoracic aortic aneurysm plus the unusual CT finding of extramural haemorrhage along the pulmonary vessels. The clinical and radiological picture has an extremely high mortality

Primary rectal melanoma is rare and only represents up to 4% of anorectal malignancies. The prognosis of such a diagnosis is significantly different to a metastatic melanoma deposit in the anorectal area and therefore differentiation between the two is of the utmost importance with regards to initial treatment and long-term management. Various immunohistochemical markers have been shown to be associated with primary melanoma and strongly aid in diagnosis. Surgical management is still widely disputed and multiple papers have been published comparing wide local excision with abdominoperineal resection. Here a case of primary rectal melanoma is presented with a brief discussion exploring diagnostic techniques, treatment options and prognostic factors.

We report the case of an immunocompetent 83-year-old man with metastatic neoplastic infiltration of the heart from primary squamous cell carcinoma (SCC) of the skin. Death was from cardiopulmonary collapse due to left ventricular failure with features of right ventricular inflow tract obstruction. Metastatic tumours involving the heart rarely originate from cutaneous SCC though have been reported in the literature in both immunocompetent and postrenal-transplant recipient patients. Most involve the pericardium and only rarely the endocardium or the myocardium. While the prognosis is generally poor, palliative radiotherapy may provide significant symptom relief. Cardiac metastases should be considered in patients with advanced cancer, especially when they show cardiac symptoms and signs.

An 80 year old female was admitted with an eight week history of fever associated with painful swelling of her right thigh, and a long history of poor dentition. Culture of blood stained fluid aspirated from the abscess grew Aggregatibacter actinomycetemcomitans (Aa) sensitive to ampicillin and cephalosporins. Transoesophageal echocardiography indicated endocarditis. Four weeks treatment with intravenous ceftriaxone and appropriate dental care was followed by full recovery.