Mediastinal haematoma in Ehlers-Danlos syndrome

Perioperative Hemostatic Management in Ehlers-Danlos Syndrome: A Report of 2 Cases and Literature Review

Ehlers-Danlos syndrome (EDS) is associated with easy bruising and bleeding complications in the majority. Although bleeding complications are frequently observed during surgery in these patients, the perioperative hemostatic prophylaxis of patients with EDS is not standardized. We present 2 cases of effective perioperative hemostatic management of patients with EDS and review the literature to raise awareness of hemostatic issues during surgery and discuss medical options to consider for perioperative hemostatic management based on our clinical experience and literature review.

Spontaneous coronary artery rupture and cardiac tamponade in Ehlers-Danlos syndrome type IV

Spontaneous coronary artery rupture resulted in cardiac tamponade in a man with Ehlers-Danlos syndrome (type IV) presenting with acute onset of cardiac chest pain. Electrocardiograms suggested acute myocardial infarction. The haemopericardium was drained and angiography showed a ruptured distal branch of the left circumflex coronary artery. The patient remains well.

Fatal vascular catastrophe in Ehlers-Danlos syndrome: a case report and review

The Ehlers-Danlos syndrome (EDS) is a group of hereditary connective tissue disorders that are characterized by abnormalities of the skin, joints, and a diversity of other phenotypic manifestations. An awareness of the disease is vital for optimal outcome in this rare group of patients who may present with a variety of life-threatening illnesses. Ehlers-Danlos type IV has been associated with vascular catastrophes, perforated viscous, ruptured uterus, and pneumothorax (1-4). We present a case of aneurysmal formation and spontaneous rupture of the great vessels in a 15-year-old male with EDS type IV, who remained undiagnosed until the time of autopsy.

Right ventricular outflow tract and pulmonary artery obstruction by postoperative mediastinal hematoma: delineation by multiplane transesophageal echocardiography

A 53-year-old man with osteogenesis imperfecta underwent valve replacement and coronary artery bypass surgery. Unexplained symptoms of dyspnea and fatigue in the late postoperative period prompted further evaluation. Transthoracic echocardiography demonstrated obstruction of the right ventricular outflow tract and pulmonary artery by a mass, with a maximum gradient of 50 mm Hg. Multiplane transesophageal echocardiography revealed that the mediastinal hematoma was more extensive than was suggested by the transthoracic echocardiogram. This finding prompted the decision to resort to a more extensive surgical procedure. Surgical drainage continued until no residual hematoma could be visualized by multiplane transesophageal echocardiography. This case report demonstrates the value of multiplane transesophageal echocardiography in the assessment of mediastinal masses.