No abstract

Multi-slice computed tomography technology is emerging as a realistic investigation in patients with suspected disease in native, stented or grafted coronary arteries. A non-invasive diagnostic tool is desirable as these patients are at high risk for complications of invasive angiography. A 64-slice CT may achieve the desired diagnostic accuracy, and overcome the limitations of spatial resolution, respiratory motion, artifacts from calcification and stents, and radiation dose considerations to produce reliable image quality. These advances, as well as the capacity for integrated functional cardiac assessment, may change the referral patterns in patients who have had previous bypass surgery or percutaneous intervention. This review outlines the debated issues about 64-slice cardiac CT in patients before and after coronary artery bypass surgery, as well as coronary stenting and functional assessment. A review of the recent literature on native coronary artery and bypass graft assessment by multi-slice CT is also performed.

Background:Identification of the nature of cardiac murmurs during the periodic health evaluation (PHE) of athletes is challenging due to the difficulty in distinguishing between murmurs of physiological or structural origin. Previously, computer-assisted auscultation (CAA) has shown promise to support appropriate referrals in the nonathlete pediatric population.Hypothesis:CAA has the ability to accurately detect cardiac murmurs of structural origin during a PHE in collegiate athletes.Study Design:Cross-sectional, descriptive study.Level of Evidence:Level 3.Methods:A total of 131 collegiate athletes (104 men, 28 women; mean age, 20 ± 2 years) completed a sports physician (SP)–driven PHE consisting of a cardiac history questionnaire and a physical examination. An independent CAA assessment was performed by a technician who was blinded to the SP findings. Athletes with suspected structural murmurs or other clinical reasons for concern were referred to a cardiologist for confirmatory echocardiography (EC).Results:Twenty-five athletes were referred for further investigation (17 murmurs, 6 abnormal electrocardiographs, 1 displaced apex, and 1 possible case of Marfan syndrome). EC confirmed 3 structural and 22 physiological murmurs. The SP flagged 5 individuals with possible underlying structural pathology; 2 of these murmurs were confirmed as structural in nature. Fourteen murmurs were referred by CAA; 3 of these were confirmed as structural in origin by EC. One such murmur was not detected by the SP, however, and detected by CAA. The sensitivity of CAA was 100% compared with 66.7% shown by the SP, while specificity was 50% and 66.7%, respectively.Conclusion:CAA shows potential to be a feasible adjunct for improving the identification of structural murmurs in the athlete population. Over-referral by CAA for EC requires further investigation and possible refinements to the current algorithm. Further studies are needed to determine the true sensitivity, specificity, and cost efficacy of the device among the athletic population.Clinical Relevance:CAA may be a useful cardiac screening adjunct during the PHE of athletes, particularly as it may guide appropriate referral of suspected structural murmurs for further investigation.

In the following case study an atypical presentation of myositis ossificans (MO) in the superior anterolateral thigh of a young soccer player is discussed. This case demonstrates that MO can present without obvious history of trauma, which makes the diagnosis of this condition more challenging. The most important differential diagnosis is malignant osteosarcoma or soft-tissue sarcoma, which usually presents without trauma. Additionally both pathologies typically occur in the same population.

This case report describes chronic exertional compartment syndrome in the forearm of a professional rower. We consider this to be a rare anatomical location for this type of syndrome. Morever, not much is known about its clinical presentation and the subsequent optimal medical management thereof.