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Diagnosis of vascular anomalies of the aortic arch is often delayed in adolescents and adult patients. In presence of dyspnea that cannot be explained through a pulmonary and/or cardiac disease, and sudden dysphagia in children and adult patients, a cross-sectional imaging examination of the chest is mandatory to exclude or confirm malformation or malposition of the aortic arch and/or aberrant supra-aortic vessels.
Background: Direct oral anticoagulants (DOACs) are considered advantageous compared to vitamin K antagonists in eligible atrial fibrillation patients but the efficacy and the safety of DOACs are not well defined in the morbidly obese population.
Methods: We report the case of a 59-year-old woman patient (160 cm, 188 kg, BMI 73.5 kg/m²) with multiple comorbidities including non-valvular atrial fibrillation anticoagulated with apixaban 5mg twice a day who was admitted to our hospital because of acute renal failure.
Results: We report changes in apixaban concentration levels over the course of management. Apixaban concentrations were quantified using Liquid Anti-Xa HemosIL® Werfen. Table and Figure report apixaban concentration according to therapeutic modifications and renal function.
Conclusion: This case illustrates the interest of measuring occasionally the DOAC concentration in case of intercurrent pathology, in particular acute renal insufficiency, or in case of using topic drugs medication known to interact with DOAC by the oral route. Plasma DOAC measurement would be also interesting in case of co-medication unknown for drug interaction. This case also shows an effective and safe anticoagulation by DOAC in a superobese patient.
Terlipressin is a vasopressin synthetic analogue recommended as a vasoactive drug with relative specificity for the splanchnic circulation in patients with portal hypertension and bleeding esophageal varices or hepato-renal syndrome. We report a relapsing terlipressin-induced acute pulmonary edema in a 59 year-old man with Child B9 alcoholic liver cirrhosis.
Aims
Bring to light the necessity of further work-up in young patients with syncope.
Methods and Results
A 26-year old male was admitted after a syncope after complaining of chest pain and breathing difficulties. Transthoracic echocardiography showed tamponade and pericardiocentesis was performed with removal of hemorrhagic fluid. Cardiac magnetic resonance showed a heterogeneous, highly perfused mass in the right atrium (RA) with necrotic areas. Histopathology determined a high grade angiosarcoma in the RA and R0 margins. Adjuvant chemotherapy was started but a local relapse occurred followed by multiple metastases and death.
Conclusion
Hemorrhagic pericardial effusion is highly suspicious of cardiac malignancies and warrants further work-up.
