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3027. Delayed onset adult respiratory distress syndrome in babesiosis.
Reported herein is a second case of a patient who developed adult respiratory distress syndrome secondary to babesiosis. The features of acute lung injury after babesiosis will be described.
3028. Cardiac tamponade due to primary pericardial lymphoma in a patient with AIDS.
Cardiac tamponade due to lymphomatous involvement of the heart is a dramatic and unusual complication. Because of their nonspecific clinical presentation, these tumors are seldom diagnosed antemortem. We report the case of a patient with AIDS who presented with signs and symptoms of cardiac tamponade. Emergency pericardiocentesis followed by staging studies revealed large cell B-lymphocyte lymphoma confined to the pericardial space. With combination chemotherapy, a durable complete response was obtained. This case illustrates the potential benefit of aggressive treatment of extranodal non-Hodgkin's lymphoma in a patient with AIDS. The case is of particular interest because of the unusual development of isolated pericardial involvement as the sentinel sign of lymphoma.
3029. Peripheral intrapulmonary hamartoma accompanied by a similar endotracheal lesion.
We describe a case of peripheral intrapulmonary hamartoma accompanied by a similar endotracheal lesion. A 70-year-old asymptomatic man had a polypoid lesion in the trachea and a nodular shadow in a peripheral lung area. A biopsy specimen from the trachea revealed a chondroid hamartoma, and the surgically resected tissue of the intrapulmonary tumor showed the same histologic findings. This is the second case of multiple hamartomas showing coexistence of tracheobronchial and parenchymal tumors.
3030. Liposarcoma of the posterior mediastinum in a child.
Liposarcoma is rare in children and rarely occurs in the posterior mediastinum in any age group. A massive intrathoracic tumor in a 17-year-old young man was a diagnostic dilemma; preoperative radiographic evaluation and biopsy led us to believe it was a teratoma. At operation, a poorly differentiated myxoid liposarcoma originating from the posterior mediastinum was found and excised. To our knowledge, this is the first liposarcoma of the posterior mediastinum reported in a patient less than 18 years old.
3031. Atrial-esophageal fistula shown by transthoracic echocardiogram.
Nontraumatic atrial-esophageal fistula is a catastrophic problem usually diagnosed postmortem and almost invariably fatal. We report the first case of a patient in whom the diagnosis of atrial-esophageal fistula was made from a transthoracic echocardiography antemortem. Echocardiography showed multiple microbubbles in the left atrium and ventricle emanating from the posterior aspect of the left atrium adjacent to the pulmonary veins. The literature is reviewed and the significance of the case and the echocardiogram is discussed.
3036. Environmental airborne tremolite asbestos pollution and pleural plaques in Afghanistan.
A 51-year-old man underwent pleuroscopy for radiologic pleural abnormalities. Pathologic examination of pleural and lung biopsy specimens concluded on hyalinized pleural plaques associated with mild asbestosis. Transmission electron microscopy analysis showed significant retention of tremolite asbestos fibers. The absence of any occupational exposure to asbestos and the existence of geologic deposits of tremolite in the Kabul area of Afghanistan suggest an environmental exposure during the patient's childhood spent in this region.
3037. Three-dimensional reconstruction of ultrafast chest CT for diagnosis and operative planning in a child with right pneumonectomy syndrome.
After receiving a neonatal right pneumonectomy for septic complications of unilateral pulmonary artery agenesis, a 2 1/2-year-old girl was referred to the Cardiothoracic Surgery Service for evaluation of increasing symptoms of wheezing and stridor. Extensive workup included a three-dimensional ultrafast CT image reconstruction that aided in the diagnosis and operative planning. Successful relief of the airway obstruction was achieved by aortic suspension and by placing a Silastic tissue expander prosthesis. Before operation, this child had been admitted to the hospital on 18 different occasions for respiratory symptoms. Six months after surgery, she is not receiving any medications and is symptom-free.
3038. Prolonged survival in a patient with a single ventricle without pulmonary stenosis.
Prolonged survival of the patient with a single ventricle is rare. We report the case of a 57-year-old man who has type A3 of Van Praagh's classification of single ventricle with pulmonary hypertension without pulmonary stenosis. Favorable streaming, a large bulboventricular foramen, and intact atrioventricular valves may have contributed to his long-term survival.
3039. Pericardial tamponade in chronic myelomonocytic leukemia.
We report four cases of malignant pleuropericardial effusions in patients with chronic phase myelomonocytic leukemia (CMML). Based on current literature, this event is rare and very poorly understood. Our cases shed light on three important clinical characteristics: (1) patients with CMML develop effusions during uncontrolled leukocytosis; (2) these effusions are very responsive to conventional chemotherapy; and (3) effusions may develop without clinical forms of disease in other sites of extramedullary hematopoiesis.
3040. Localized pleural mesothelioma with elevation of high molecular weight insulin-like growth factor II and hypoglycemia.
Recurrent hypoglycemia occurred in a 48-year-old woman with a localized pleural mesothelioma. During hypoglycemia, serum high molecular weight insulin-like growth factor II (IGF-II) was elevated. The tumor also contained a high level of high molecular weight IGF-II. We propose that the primary cause of the hypoglycemia in this patient was the high molecular weight IGF-II produced by the tumor.
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