[Acute deltoid compartment syndrome]

In this article, we present a rare type of acute compartment syndrome affecting the deltoid muscle, which occurred after a crush syndrome in a patient discovered at home in a stuporous state. Although compartment syndromes are not rare, certain circumstances cause unusual consequences and localizations, shoulder impotence in the present case. The importance of an early diagnosis is obvious to avoid the risk of irreversible lesions. We describe predisposing circumstances and provide a brief review of the pathophysiology of this syndrome.

[Natural course of an aortic coarctation in a child]

Aortic coarctation is a frequent congenital heart disease that presents in form of two entities, the infant type and the child or adult type. The infant type is the most frequent and manifests acutely by heart failure or shock. The second one shows a slow and progressive course with no or few initial symptoms. For that reason, the diagnosis is usually missed until symptomatic arterial hypertension or hypertrophic cardiomyopathy develop. We report the case of an initially asymptomatic boy in whom the development of an aortic coarctation could be precisely documented over a period of 10 years by repeated bidimensional and Doppler echocardiography. The patient underwent successful balloon angioplasty of the aortic isthmus and stent implantation. This case points out the importance of strict follow-up in any young child in whom an even mild anomaly of the aortic arch is detected. This is critical in order not to miss an aortic coarctation that influences significantly morbidity in adulthood.

[Cervical spondylolysis : a rare fortuitous finding]

A young patient consulted in our physical and rehabilitation medicine department following the onset of pain on the scapula area and at the base of his right upper limb after carrying a heavy load. After a couple of weeks, the patient also developed cervical pain. Fortuitously, the cervical scanner displayed a right C6 spondylolysis. Further evaluation by bone scan confirmed that this lesion was not recent and so probably not the cause of the symptoms. Cervical isthmic spondylolysis is a rare condition, much more common at the lumbar level and often ignored at the cervical one. The etiology, pahophysiology, imaging and treatment options for this cervical pathology are discussed in this article.

Total absence of the pericardium associated with hypogammaglobulinemia and bronchiectasis in a girl

We report the case of an 8-years-old girl with recurrent pulmonary infections and wheezing since infancy, in whom asthma and immunoglobulin-G deficiency were diagnosed at the age of 7 months. Since then, the patient was treated for asthma without any satisfactory control of the disease. Cardiomegaly was finally diagnosed radiologically that led to cardiac assessment. Echocardiography suggested left sided partial anomalous pulmonary venous return that was not confirmed at angio-computed tomography scan and cardiac magnetic resonance imaging. Instead, total absence of the pericardium with relative left lung hypoplasia and left-sided bronchiectasis was diagnosed. Immune defect was confirmed. Adequate treatment by immunoglobulin supplementation and observance of the recommended care of bronchiectasis allowed favorable evolution. This case of an unusual association between an exceptional pericardial malformation and immune deficiency causing lower respiratory tract infections complicated by leftsided bronchiectasis highlights the absolute necessity to explore further any child with insufficient asthma control.

[A rare complication of acute coronary syndrome : left ventricular pseudo-aneurysm]

We report a case of left ventricular pseudo-aneurysm and we take the opportunity to briefly review the literature concerning etiologies, diagnosis and management of this pathology, emphasizing some differences with the true aneurysm.

Late gadolinium enhancement CMR in primary mitral regurgitation

AIMS

The appropriate timing for surgery in severe asymptomatic primary mitral regurgitation (MR) remains controversial. It has been shown that late gadolinium enhancement on cardiovascular magnetic resonance (LGE CMR), which may identify myocardial fibrosis, is associated with a worse outcome in various cardiomyopathies. We sought to investigate the prevalence and significance of delayed enhancement in primary MR.

METHODS

We prospectively included 41 patients with at least moderate primary MR and without overt signs of left ventricular (LV) dysfunction. Patients with evidence of coronary artery disease, arrhythmias or significant concomitant valvular disease were excluded. All patients were scheduled for transthoracic echocardiography and LGE CMR.

RESULTS

A total of 39 patients had interpretable LGE CMR images. Among them, 12 (31%) had late contrast uptake of the LV wall. LGE CMR showed an infarct pattern in three patients, a pattern of mid-wall fibrosis in seven patients and two patients had a combined pattern. Patients with delayed enhancement on CMR had significant higher LV diameters (LV end-systolic diameter 39 ± 4 vs. 34 ± 5 mm, P = 0·002; LV end-diastolic diameter 57 ± 5 vs. 50 ± 5 mm, P = 0·001). There was a trend towards a higher indexed left atrial volume (55 ± 21 vs. 44 ± 13 mL/m², P = 0·06). By contrast, there was no significant association between myocardial contrast uptake and age, LV ejection fraction and MR severity.

CONCLUSION

Left ventricular remodelling seems to be associated with the presence of delayed enhancement on CMR in primary MR. Further data are needed to determine whether LGE CMR can predict a less favourable outcome or could improve risk stratification in asymptomatic primary MR.

[Cardiac amyloidosis, about an atypical case]

A 64 year old patient with heart failure due to primary cardiac amyloidosis is described. This case offers the opportunity to review the literature dealing with the cardiac involvement associated with this disorder and the differential diagnosis of restrictive heart disease.

[Multimodal cardiovascular imaging before aortic valve transcatheter replacement]

Calcified aortic valve stenosis is the most frequent valvular heart disease in developed countries with a very poor outcome when symptoms develop. However, several of these patients are denied for surgery. The main reasons are their advanced age (elderly patient), co-morbidities, technical limitations and a very high surgical risk. It is currently possible to propose a Transcatheter Aortic Valve Implantation (TAVI). After selection of candidates, the feasibility of the intervention is analysed. The size of the aortic bioprosthesis must be selected according to the cardiac anatomy. Several cardiac imaging modalities (echocardiography, computed tomography and cardiac MRI) can be used to identify unsuitable situations. Heavy calcifications or tortuosity can thwart the retrograde approach use. The sub-clavian arteries (for the CoreValve) and trans-apical approach (for the Edwards-Sapien) constitute alternatives ways.

Supraclavicular nerve entrapment syndrome

Supraclavicular nerve entrapment syndrome, although rare, should be considered among the causes of anterior shoulder girdle pain. This syndrome is usually related to anatomic variants (involving the bone structures, fibrous bands, or muscles and tendons). Computed tomography is the most useful investigation. Medications used to treat neuropathic pain may provide relief. Otherwise, a local glucocorticoid injection or even surgical decompression should be considered.

[How I investigate... The coronary arteries in 2007: contributions of CT coronary angiography]

Cardiac imaging has always been a challenge because of the continuous movement of the heart. Cardiac computed tomography (CT) has undergone an accelerated progression over the past decade, due to the combination of the high-speed rotation of the X-ray tube, the ECG-gating technique and the infra-millimeter spatial resolution. Multidetector CT allows visualisation of the coronary artery lumen and the detection of coronary stenosis after intravenous injection of contrast medium. Studies have demonstrated a high negative predictive value of CT coronary angiography (CTCA). CTCA may be reasonably used for the assessment of symptomatic patients, especially in the setting of equivocal treadmill or functional testing. Also, CTCA allows assessment of coronary bypass graft patency and recognition of aberrant coronary arteries. Limitations in the use of this technique exist: atrial fibrillation and other cardiac arrhythmias remain a contraindication; severe calcifications are the most frequent reason for impaired assessment of coronary arteries. High radiation doses prohibit the use of this test as a screening tool for asymptomatic patients.

[Rounded atelectasis: a follow up of 10 years by CT]

We report the case of a 69-year-old man who presented with a rounded atelectasis (RA). During a 10-year follow-up by Computed Tomography (CT), the lobe showed a progressive shrinkage, and a moderate increase in size of the lesion led to a percutaneous biopsy which confirmed the diagnosis. RA is an unusual form of lung consolidation. The major cause of RA is asbestosis. RA is usually asymptomatic and may simulate a pulmonary neoplasm on chest Xray. The diagnosis is made by CT, demonstrating the pathognomonic "comet tail sign". No treatment is required.