Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy, is caused by emotional or physical stressors and mimics acute myocardial infarction. Stress-induced cardiomyopathy is characterized by acute, reversible left ventricular apical ballooning without significant coronary artery stenosis. New variants of stress-induced cardiomyo pathy with localized wall motion abnormalities or an inverted pattern with a hyperdynamic apex have been reported. We present a rare case of a sudden cardiac arrest due to atypical stress-induced cardiomyopathy (mucosal packing and the injection of epinephrine) in an elderly male patient during elective endoscopic sinus surgery with septoplasty under local anesthesia. In this case, only the basal and midportions of the left ventricle were affected, whereas the apex was completely spared. The patient rapidly and completely recovered without sequelae.

Pseudochylothorax is an uncommon pleural effusion disease characterized by the presence of cholesterol crystals or high lipid content not resulting from a disrupted thoracic duct. Most of the cases reported so far had been found in patients with long-standing pleural effusion due to a chronic inflammatory disease such as old tuberculous pleurisy or chronic rheumatoid pleurisy. Authors encountered a case of pseudochylothorax in a 45-year-old man who had been treated for tuberculous pleurisy 6 years before his visit to authors' hospital. After that, he had visited the emergency department many times for removal of pleural effusion. The patient's chest X-ray revealed dyspnea and large left-sided pleural effusion. Although a large amount of pleural fluid was removed with a drainage catheter, massive pleural effusion was likely to recur, and the underlying lung was able to fully re-expand. Accordingly, decortication was done, and the patient's symptom was improved without postoperative complications.

Klebsiella pneumoniae has been reported to be the most common pathogen causing pyogenic liver abscess. K. pneumoniae liver abscess occurs fairly often in patients with diabetes mellitus, and is commonly associated with metastatic infections such as brain abscess, endophthalmitis, lung abscess, osteomyelitis, prostatitis, necrotizing fasciitis and infection in other sites. Although septic pulmonary embolism (SPE) is uncommon, it is a serious metastatic complication of K. pneumoniae liver abscess. Chest computed tomography (CT) scans are crucial in making the early diagnosis of SPE; however, it does not provide the basis for a definitive diagnosis. A 70-year-old man was referred to the Department of Pulmonology due to cough and an abnormal chest radiography. The chest CT scans revealed relatively well-demarcated, round multiple nodules with peripheral preponderance, cavitary mass in the right upper lobe of the lung and low-density hepatic cystic masses. Bronchoscopic examination and percutaneous needle aspiration of the lung were performed, but there was no evidence of malignancy. Finally, K. pneumoniae was grown from a bronchial washing specimen and blood culture. Intravenous carbapenem was administered over a 3-week period and follow-up CT scans showed improvement in both the lung and the liver. We report a case of K. pneumoniae liver abscess complicated with SPE requiring differential diagnosis of hematogenous metastatic malignancy on CT scans in an elderly patient. Key Words: Klebsiella pneumoniae, Liver abscess, Septic pulmonary embolism, Aged . 패혈성 폐 색전증의 경우 진단이