Double-chambered left ventricle with a thrombus in an asymptomatic patient:A case report

BACKGROUND Double-chambered left ventricle(DCLV)is an extremely rare congenital disease in which the left ventricle(LV)is divided by abnormal muscle tissue.Due to its rarity,there is a lack of data on the disease,including its diagnosis,treatment,and prognosis.Accordingly,we report a case in which DCLV was diagnosed and followed up.CASE SUMMARY A 45-year-old man presented to our hospital due to abnormal findings on an electrocardiogram recorded during a health check.He had no specific cardiac symptoms,comorbidities or relevant past medical history.Echocardiography revealed that the LV was divided into two by muscle fibers.There were no findings of ischemia on coronary angiography and coronary computed tomography angiography performed to exclude differential diagnoses.After comprehensive analysis of the images,DCLV was diagnosed.As it seemed to be asymptomatic DCLV,we decided the patient was to be observed without administering any medication.However,follow-up echocardiography revealed a thrombus in the accessory chamber(AC).Anticoagulant medication was initiated,the thrombus resolved,and the patient is currently undergoing follow-up without any specific symptoms.CONCLUSION Asymptomatic,uncomplicated DCLV was diagnosed through multimodal imaging;however,a thrombus in the AC occurred during the follow-up.The findings highlight that multimodal imaging is essential in diagnosing DCLV,and that anticoagulation is important in its management.

Coronary sinus endocarditis in a hemodialysis patient:A case report and review of literature

BACKGROUND Infective endocarditis is more common in hemodialysis patients than in the general population and is sometimes difficult to diagnose.Isolated coronary sinus(CS)vegetation is extremely rare and has a good prognosis,but complicated CS vegetation may have a poorer clinical course.We report a case of CS vegetation accidentally found via echocardiography in a hemodialysis patient with undifferentiated shock.The CS vegetation may have been caused by endocardial denudation due to tricuspid regurgitant jet and subsequent bacteremia.CASE SUMMARY A 91-year-old man with dyspnea and hypotension was transferred from a nursing hospital.He was on regular hemodialysis and had a history of severe grade of tricuspid regurgitation.There was no leukocytosis or fever upon admission.Repetitive and sequential blood cultures revealed absence of microorganism growth.Chest computed tomography showed lung consolidation and a large pleural effusion.A mobile band-like mass on the CS,suggestive of vegetation,was observed on echocardiography.We diagnosed him with infective endocarditis involving the CS,pneumonia,and septic shock based on echocardiographic,radiographic,and clinical findings.Infusion of broad-spectrum antibiotics,fluid resuscitation,inotropic support,and ventilator care were performed.However,the patient died from uncontrolled infection and septic shock.CONCLUSION CS vegetation can be fatal in hemodialysis patients with impaired immune systems,especially when it delays the diagnosis.