MediAI

When Palpitations Are Not Just an Arrhythmia A man in his seventies presented with palpitations. At first glance, the clinical problem appeared straightforward. Palpitations in an older adult commonly lead to an electrocardiogram, ambulatory rhythm monitoring, and evaluation for ischemic or structural heart disease. But his chest radiograph contained a second message. The cardiac silhouette was enlarged, the main and central pulmonary arteries were prominent, and there was a suggestion of a small left pleural effusion. The combination raised a more important question: Why is the right side of the heart enlarged? That question changes the diagnostic pathway. The eventual CT examination demonstrated a complex but highly characteristic anatomy. The right upper pulmonary vein drained toward the superior vena cava, while the right middle pulmonary venous drainage also entered the right-sided circulation in association with a superior sinus venosus atrial septal defect. The right lower pulmo...

  Clinical Hook A 60-year-old man with coronary artery disease, ischemic cardiomyopathy, an implanted cardioverter-defibrillator, and atrial fibrillation presented with chest pain and bilateral arm numbness. During his initial presentation, he suddenly collapsed and lost consciousness. CT angiography of the chest, abdomen, and pelvis was obtained because acute aortic dissection was an important clinical consideration. The striking finding was not aortic dissection. There was gas within the left-sided cardiac chambers . At first glance, intracardiac gas can be interpreted as an iatrogenic phenomenon, particularly in a patient with previous vascular instrumentation. But in this case, the distribution of gas was the diagnostic clue. Careful review demonstrated gas in the left atrium and a communication between the left atrium and the adjacent esophagus. His family subsequently reported that he had undergone radiofrequency ablation for atrial fibrillation approximately six weeks earlie...