41-year-old male with no significant past medical history presented as an outpatient with atypical chest pain and had positive nuclear stress test. The patient subsequently underwent left heart catheterization, which revealed a fistula between the LAD and LV circumflex artery; however, CTA failed to show any evidence of a fistula.

A document by Mohammadhosein Akhlaghpasand. Click on the document to view its contents.

Despite the increasing number of liver and kidney transplants, the number of awaiting patients for a proper donor is still exceeding. Therefore, the preservation of donor's organs is critically advocated. Herein, we presented a successful liver and kidneys transplant from a brain dead donor who was found preoperatively to have simultaneous aortic dissection and intramural hematoma, and additionally developed left subclavian artery dissection and perforation following sternotomy. This case experience highlights the key role of cardiac surgeons to preserve visceral organs by rapid repair of aorta and its branches perforation site and dissection which culminate in lifesaving organ donation.

Cardiac angiofibroma is a very rare diagnosis when a patient develops an intracardiac mass. It is a primary benign cardiac tumor with a scarcity of information in the literature.  This case report illustrates a 26-year-old man with a complaint of chronic chest tightness who was firstly diagnosed with right ventricle tumor by echocardiography then underwent cardiac MRI which confirmed the presence of a highly-vascular tumor with radiologically benign behavior. Then his tumor was excised, his postoperative course was uncomplicated and he was well within almost 2 months after discharge. Ultimately the histopathologic findings demonstrated vascular and stromal tissue in favor of angiofibroma and excluded the other diagnoses with IHC and trichrome staining.  Angiofibroma is a benign, highly vascular tumor, mostly discovered in the nasopharynx. When it is found in the heart, CMR and pathology are pivotal to rule in its diagnosis. It is isointense in T1 weighted and hyperintense in T2 weighted sequences with intense enhancement following contrast injection. Its pathology contains an admixture of vasculatures with CD31 positive immunoreactivity for endothelial cells and fibrotic tissue with bluish coloration in trichrome staining. Eventually, its treatment includes merely surgical excision given its benign nature.

We reported a case with complaint of abdominal pain, nausea, vomiting, and oral intake intolerance due to a giant thoracoabdominal aortic aneurysm with contained leak and acute rupture within the circumferential mural thrombus which presented with upper gastrointestinal obstruction manifestation. The rupture led to the patient undergoing emergency aneurysm repair.