Faculty Bibliography

A 74-year-old man underwent transesophageal echocardiography to evaluate the possibility of dissection of the descending aorta. The study demonstrated a round lumen that contained an echogenic mass mimicking aortic aneurysm with thrombus. However, computerized tomographic scanning identified the lumen as the pleural cavity containing a collapsed lung. The esophagus was on the right side of the spine, and the transesophageal technique could not visualize the descending aorta

The destructive potential of Pneumocystis carinii infection in patients with AIDS has been amply documented. This report describes a homosexual man with P. carinii pneumonia (PCP) complicated by pneumatocoeles and pneumomediastinum. The pneumomediastinum almost completely resolved with successful antimicrobial therapy. Pneumomediastinum, like pneumothorax, should be anticipated in patients with AIDS and PCP

Echocardiography is a valuable modality for imaging thrombi and vegetations. Although patients with systemic lupus erythematosus may develop Libman-Sacks endocarditis, in which punctate verrucous plaques are found histologically on valvular endocardial tissue, these lesions are ordinarily too small for ultrasonic imaging. We describe a patient with systemic lupus erythematosus complicated by systemic embolization, who had a large mobile aortic valve thrombus, which was discovered with the aid of echocardiography and was confirmed by surgical resection

Patients presenting to the emergency room with unstable angina are a challenge to physicians whose responsibility it is to ration access to coronary care unit beds, a resource that is often in short supply. In this study, initial cardiac enzyme analysis was not helpful in identifying patients having an acute myocardial infarction. However, using two enzyme determinations, performed at least six hours apart, we were able to identify a large percentage of our patients with unstable angina who were at low risk for myocardial infarction. Patients with two consecutive normal creatinine kinase levels had only a 2% chance of having an acute myocardial infarction. We believe these data can assist physicians where monitored beds are in short supply to make judicious use of this limited resource; the subsequent reduction in critical care unit admissions and duration of stay could result in substantial monetary savings