P687 Left atrial mass - a potential pitfall Skarlovnik, A; Erzen, B
European heart journal cardiovascular imaging,
01/2020, Letnik:
21, Številka:
Supplement_1
Journal Article
Recenzirano
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Abstract
Background.
Echocardiography is an important diagnostic tool in differential diagnosis of retrosternal pain. Despite the high prevalence of hiatus hernia, a relatively small number of ...echocardiographically manifested cases have been reported.
Case summary.
A 75 y old female patient with rheumatic polymialgia and diabetes was admitted for progressive weakness, retrosternal pain and dyspnoea. Due to elevated levels of D-dimer and troponin I an urgent CT angiography was performed and a diagnosis of pulmonary embolism was confirmed in the ER. Echocardiography showed a mildly hypertrophied left ventricle with normal EF, a mildly dilated right ventricle, moderate pulmonary hypertension 45 mmHg, and an apparent mass in the left atrium (picture).
To further characterize the left atrial mass a cardiac MR angiography was made, that excluded potential cardiac tumor and confirmed that the suspected mass was a large hiatus hernia impressing the left atrium. Patient was treated with anticoagulant therapy due to PE and corticosteroids due to polymialgia and was discharged in improved condition. We also consulted thoracic surgeons regarding hernia and did not decide to operate on the hernia urgently but opted for conservative reflux measures and an outpatient follow up with barium contrast oesophagus imaging.
Discussion.
Hiatal hernia may exert a wide spectrum of manifestations mimicking acute cardiovascular events, from ECG changes to angina, dyspnoea and even syncope as a consequence of total compression of the left atrium. A history of known hiatus hernia and aforementioned clinical correlates postprandially may shed some clues. Echocardiographic features that may suggest a hiatus hernia include:
1. A large ill-defined mass filling the left atrial chamber from posteriorly, with its maximal size seen when imaged in a posterior plane.
2. Respiratory variation in the degree of encroachment of the mass on the left atrium.
3. Loss of the normal sharply defined sonolucency of the descending thoracic aorta in the apical 4-chamber and long-axis views due to superimposition of the hiatus hernia.
4. A swirling motion seen within the mass after consumption of effervescent fluids.
5. Occasionaly, identification of an inner lining reminiscent of gastric mucosa is possible.
Various intracardiac or extrinsic lesions can resemble the echocardiographic appearance of hiatus hernia. Other potential causes of extracardiac masses that could encroach on the left atrium include structures such as aneurysm or dissection of the aorta, dilation of coronary sinus, abcesses, oesophageal carcinoma and other mediastinal space occupying structures.
Conclusion.
Hiatus hernia can simulate clinical and sonographic characteristics of cardiac disorders. Its echocardiographic manifestation may mimic a left atrial mass and must therefore be differentiated from such lesions.
Abstract P687 Figure. Hiatal hernia mimicking LA mass(PLAX)
Abstract Background After successful kidney transplantation, hyperparathyroidism can persist in 10%–50% of patients and can harmfully affect bone metabolism. Calcimimetic cinacalcet is a new ...treatment option in the management of persistent hyperparathyroidism in these patients. Methods This prospective, clinical study of 11 patients included those who had a serum intact parathyroid hormone (iPTH) concentration >65 ng/L, a serum creatinine concentration was <200 μmol/L, stable kidney graft function, and were >1 year since transplantation. Patients were not treated with drugs other than calcitriol that could influence bone metabolism. During the 6-month observation period, in which the stability of measured parameters was determined, and in the 12-month treatment period (cinacalcet 30 mg/d), we followed serum concentrations of calcium, phosphate, iPTH, creatinine, vitamin 25OH D3 , bone-specific alkaline phosphatase (ALP), osteocalcin, collagen degradation fragments (CTX), urinary calcium excretion, and bone mineral density (BMD). Results During the treatment period, the serum calcium concentration decreased significantly (from 2.50 ± 0.12 to 2.32 ± 0.12 mmol/L; P < .01). Serum iPTH concentration decreased significantly (from 247 range, 199–362 at time 0 to 198 range, 165–233 ng/L after 1 month of treatment; P < .05), but increased slightly thereafter. After 6 months of treatment, the serum concentration of ALP and CTX increased significantly, but decreased thereafter. There were no significant changes in the other parameters assessed. Renal function remained stable during the treatment period. The BMD of the lumbar spine, hip, and forearm did not change during the 12 months of treatment. Conclusion Cinacalcet was effective in treating posttransplant hyperparathyroidism, resulting in decreased calcemia and transient decreased iPTH. ALP and CTX transiently increased during therapy, but other markers of bone metabolism remained unchanged. Twelve months of cinacalcet treatment did not result in a change in BMD. Cinacalcet seems to be a safe drug with no negative effect on renal function.
Abstract
Background
Catheter-related right atrial thrombosis is a rare, but potentially life threatening complication in patients with central venous catheters (CVCs). Echocardiography is an ...indispensable tool in the diagnosis of right atrial thrombosis. We present a case of a young man with lymphoma, Staphylococcus aureus sepsis and a peripherally inserted central catheter (PICC) who had a septic thrombus in the right atrium.
Case summary
A 23-year-old male patient with recently diagnosed Hodgkin’s lymphoma had an inserted PICC for the purpose of chemotherapy application. Three days after the first chemotherapy application a thrombosis of the cephalic and subclavian veins at the site of PICC was found. The PICC was removed and the patient was treated with therapeutic doses of dalteparin. A day after the discovery of thrombosis, the patient became clinically septic, with high inflammatory markers and Staphylococcus aureus was isolated from his blood cultures. He was promptly treated with flucloxacillin. Due to pain in his left knee, a knee puncture was performed, and Staphylococcus aureus was isolated also from the knee synovial fluid. A transthoracic echocardiography revealed a 2.8 x 2.8 cm sessile thrombus on the lateral wall of the right atrium. There were no vegetations on the tricuspid or other valves. Due to increasing pain in his left knee and an increase in inflammatory markers a synovectomy was performed. After the operation the clinical status improved and the inflammatory parameters decreased. A magnetic resonance imaging of the heart was performed, which confirmed the thrombus described by echocardiography and excluded the presence of abscesses.
All the time the patient was treated in the intensive care unit with standard heparin, flucloxacillin, and piperacillin/tazobactam due to neutropenia. The inflammatory markers slowly decreased and all further blood cultures were negative. Follow-up echocardiography after 16 days of antibiotic and anticoagulant therapy revealed that the mass in the right atrium, attached on the lateral atrium wall, was slightly smaller than before. The mass was centrally un-echogenic with echogenic cover, appearing as a partial regression of the septic thrombus with a central colliquation. The heart valves remained free of vegetations. There was a minor pericardial effusion, with no signs of constriction. Due to improved clinical status the patient was able to start with chemotherapy again after a pause of three weeks.
Conclusion
The patient had three important risk factors for thrombosis: PICC, sepsis and malignancy.
Echocardiography is an important tool for mass diagnosis and the exclusion of vegetations in a septic patient. Often there is a need for further specification of the mass etiology or for the exclusion of other pathology, like abscesses in our case. Magnetic resonance is an important tool that can complement the echocardiographic examination.
Abstract P1498 Figure. Right atrial thrombus
Generative models are a class of machine learning models capable of producing digital images with plausibly realistic properties. They are useful in such applications as visualizing designs, ...rendering game scenes, and improving images at higher magnifications. Unfortunately, existing generative models generate only images with a discrete predetermined resolution. This paper presents the Continuous Space Generative Model (CSGM), a novel generative model capable of generating images as a continuous function, rather than as a discrete set of pixel values. Like generative adversarial networks, CSGM trains by alternating between generative and discriminative steps. But unlike generative adversarial networks, CSGM uses only one model for both steps, such that learning can transfer between both operations. Also, the continuous images that CSGM generates may be sampled at arbitrary resolutions, opening the way for new possibilities with generative models. This paper presents results obtained by training on the MNIST dataset of handwritten digits to validate the method, and it elaborates on the potential applications for continuous generative models.
Operation, optimisation, and performance of the DELPHI RICH detectors Albrecht, E.; van Apeldoorn, G.; Augustinus, A. ...
Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment,
1999, Letnik:
433, Številka:
1
Journal Article, Conference Proceeding
Recenzirano
The Ring Imaging Cherenkov detectors of DELPHI represent a large-scale particle identification system which covers almost the full angular acceptance of DELPHI. The combination of liquid and gas ...radiators (C
4F
10, C
5F
12, and C
6F
14) provides particle identification over the whole secondary particle momentum spectrum at LEP I and LEP II. Continuing optimisation on the hardware as well as on the online and offline software level have resulted in a stable operation of the complete detector system for more than five years at full physics performance.
Analysis of the DELPHI RICH data at LEP II Erzen, B.; Kjaer, N.; Kluit, P. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
08/1999, Letnik:
433, Številka:
1
Journal Article
Recenzirano
The DELPHI RICH has been operated successfully at LEP I energies. With the increase of the centre of mass energy at LEP II the changed running conditions set new challenges: a very short period at ...the Z
0 pole to provide calibration data and a long data taking period at high energy with the low event rate typical for operation away from the pole. These conditions require to revise the strategy for calibration and alignment of the DELPHI RICH. The most relevant improvement was the development of a new alignment program. In addition, the detector stability had to be monitored more carefully due to the long data-taking periods. As a result it will be shown that a similar data quality has been obtained as during LEP I operation. The new procedures also decrease dramatically the time necessary to perform the detector analysis.
It has not been established yet whether patients who suffer myocardial infaction (MI) in the absence of classic risk factors also have endothelial dysfunction (ED), as has been shown for patients ...with risk factors, and if so, to what extent it is manifested. Young male patients in the stable phase after MI were included in the study. At the time of MI, 20 patients had high and 21 patients low expression of risk factors. The control group consisted of 35 healthy age-matched males. ED was estimated by ultrasound measurement of the endothelium-dependent dilation of the brachial artery, induced by the reactive hyperemia test. Compared to the control group, the level of endothelium-dependent vasodilation was significantly reduced in both groups of patients (controls: 9.1% ± 5.6%; patients with high risk: 5.5% ± 5.1%; patients with low risk: 5.6 ± 3.5 %; ANOVA, p<.01). There was no difference between both groups of patients. These results showed that ED is not associated or due only to classic risk factors. It appears that ED may occur and precede development of atherosclerosis in the absence of classic risk factors. These novel findings can have important clinical implications.
It is assumed that endothelial dysfunction due to arterial hypertension could be improved or even normalized by antihypertensive treatment. The present study was designed to explore that assumption ...in patients with essential hypertension treated with an angiotensin-converting enzyme (ACE) inhibitor-enalapril. Twenty-eight patients (mean age: 55.1 years) who fulfilled the following criteria were included: essential arterial hypertension present for more than 2 years, monotherapy with enalapril for at least 1 year, adequate treatment (blood pressure in the last year <140/90 mm Hg) and absence of other factors (smoking, hypercholesterolemia, diabetes, obesity), which could importantly influence endothelial function. The flow-mediated (endothelium-dependent) dilation (FMD) of the brachial artery was assessed by high-resolution ultrasound and compared with that of 22 age-matched healthy normotensive controls. The patients and controls did not differ in regard to body mass index, lipids, and plasma glucose and insulin; there were no smokers. FMD of the brachial artery was significantly decreased in patients in comparison to controls (7.9% vs 13.5%, p<0.01). FMD in patients was inversely correlated with the duration of hypertension (r =-0.52, p<0.01) and with both systolic (r =-0.72, p<0.01) and diastolic (r =-0.43, p<0.05) blood pressure (measured after temporary withdrawal of treatment). This study showed that the adequate control of blood pressure achieved with enalapril is not followed by normalization of endothelial function, measured by FMD of the brachial artery.
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