712 Image Focus IMAGE FOCUS doi:10.1093/ehjci/jey052 Online publish-ahead-of-print 28 March 2018 .................................................................................................................................................... 1 2 1 3 1 Geetanjali Dang *, Mohammed Saleh , Tarun Tandon , Gopi Sirineni , and Venkata Mahesh Alla 1 2 Division of Cardiology, Creighton University, 7500 Mercy Road, Omaha, 68124 NE, USA; Department of Medicine, Creighton University, 7500 Mercy Road, Omaha, 68124 NE, USA; and Department of Radiology, Creighton University, 7500 Mercy Road, Omaha, 68124 NE, USA * Corresponding author. Tel: +1 773-791-3245; Fax: +1 402-280-1237. E-mail: email@example.com A 48-year-old North African gentleman presented with acute pancreatitis, and cardiology was consulted for atrial fibrillation. He spontan- eously converted to sinus rhythm. Chest radiograph showed cardiomegaly and enlarged pulmonary bay (Panel A). Transthoracic echocar- diogram demonstrated aneurysmal dilation of the main pulmonary artery (MPA) (Panel B)(Supplementary data online, Video S1). Transoesophageal echo confirmed MPA aneurysm, and pulmonary valve was normal. Interatrial and ventricular septa were intact; there was no evidence of patent ductus arteriosus. On cardiac computed tomography, MPA measured 5.8 cm. In addition, both right and left pul- monary arteries and ascending aorta (4.7 cm) were dilated (Panels C and D). Coronary arteries were ectatic without obstructive disease (Supplementary data online, Video S2). Potential diagnoses considered were syphilis, Bechet’s disease, Marfan’s disease, left to right heart shunts, giant cell arteritis (GCA), and idiopathic. Patient did not meet clinical criteria for Marfan’s, Behcet’s, or GCA. Antinuclear antibodies and skin pathergy test were negative. On right heart catheterization, there was no significant step up of oxygen saturation to suggest a shunt. On repeat questioning, patient revealed that he was told to have syphilis 14 years ago but never received treatment. He tested positive on rapid plasma regain; lumbar puncture excluded neurosyphilis. He was diagnosed with pulmonary and aortic aneurysm secondary to tertiary syphilis (though idiopathic cannot be completely excluded) and was treated with benzathine penicillin. After consultation with cardiovascu- lar surgery and review of literature which indicated a relatively lower risk of PA rupture below 6.5 cm, we elected to conservatively manage him with close follow-up. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: firstname.lastname@example.org. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/6/1/4955960 by Ed 'DeepDyve' Gillespie user on 20 June 2018
European Heart Journal – Cardiovascular Imaging – Oxford University Press
Published: Mar 28, 2018
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