Holter electrocardiogram recording revealed symptomatic prolonged ventricular standstill lasting for about two minutes which terminated without any external cardiopulmonary resuscitation.

A 36-year-old man presented 2 months back with complaints of dyspnea on exertion (class 3), cough, low-grade fever, anorexia, and weight loss. He was diagnosed as a case of pulmonary tuberculosis and was put on antitubercular therapy. However, he did not responded to therapy and discontinued treatment himself. Presently he was admitted with severe dyspnea, signs of right-sided heart failure, profuse sweating, and episode of transient blurring of vision. Initially transthoracic echocardiography was performed followed by transesophageal echocardiography (Figs. 1 and 2), which revealed a large heterogeneous sessile mass approximately 10 × 8 cm in right atrium, adherent to right atrial free wall, occupying most of right atrium extending into right ventricle and pericardial space, patent foramen ovale with left to right shunt and pulmonary hypertension. The echocardiographic findings explained the cause of signs of right-sided heart failure, which were due to mass effect, transient ischemic attack due to paradoxical embolization across patent foramen ovale, and pulmonary hypertension due to pulmonary embolism. Contrast-enhanced computed tomography of chest (Fig. 3) was performed, which also revealed same findings as transesophageal echocardiography. Right atrial angiosarcoma was the most probable diagnosis, which was further confirmed after biopsy. In our case transesophageal echocardiography turned out to be valuable and accurate modality in assessing cardiac mass, so timely assessment can help in early diagnosis and treatment. Figure 1. Transesophageal ultrasound demonstration at 0 degree. 1 = PFO (patent foramen ovale); 2 = large right atrial mass occupying right atrium; 3 = mass prolapsing through tricuspid valve orifice into right ventricle; 4 = infiltration of mass into pericardium. RA = right atrium; RV = right ventricle; LA = left atrium; LV = left ventricle; IAS = interatrial septum; IVS = interventricular septum; MV = mitral valve.

A 2-year-old female child was brought to the emergency department after she was accidentally shot by her father, while cleaning his air rifle loaded with the pointed type 0.22 (5.5 mm) caliber pellet. The pellet hit the front of chest from a distance of about 10-15 m. On physical examination, it was found that there was entrance wound in right lower parasternal area but no exit wound. She was hemodynamically stable with normal auscultatory findings. Chest roentgenogram (Fig. 1) demonstrated a bullet overlying cardiac silhouette with no other findings. Two-dimensional transthoracic echocardiography (Figs, 2, 3, and movie clip 1) showed an echogenic density in the interventricular septum just beneath the insertion of tricuspid and mitral leaflets. The atrioventricular valves appear normal with no regurgitation. The biventricular function also appeared normal with no regional wall motion abnormalities. There was no pericardial effusion present. The echogenicity is most likely the pellet that punctured the chest wall and continued inward to lodge in the interventricular septum. Computed tomographic scan of the chest showed an intracardiac foreign body without other abnormalities. Up to 11 months, repeated scans have shown no changes. She will continue to receive ongoing follow-up to assess for late complications (migration, erosion, conduction, disturbance, etc.) To the best of our knowledge, she may be the youngest living patient having cardiac trauma with clinically stable presentation and asymptomatic short-term follow-up.

No abstract

No abstract