Cardiac CT helped identify differences in extracellular volume fraction, myocardial blood volume, and myocardial blood flow in participants with amyloidosis compared with healthy individuals and th... Background CT can provide information regarding myocardial perfusion and expansion of the extracellular space, which is relevant to patients with cardiac amyloidosis (CA). Purpose To evaluate the r...

Background: Evaluate the impact of valvular calcifications measured on cardiac computed tomography (CCT) in patients with infective endocarditis (IE). Methods: Seventy patients with native IE (36 aortic IE, 31 mitral IE, 3 bivalvular IE) were included and explored with CCT between January 2016 and April 2018. Mitral and aortic valvular calcium score (VCS) were measured on unenhanced calcium scoring images, and correlated with clinical, surgical data, and 1-year death rate. Results: VCS of patients with mitral IE and no peripheral embolism was higher than those with peripheral embolism (868 (25–1725) vs. 6 (0–95), p < 0.05). Patients with high calcified mitral IE (mitral VCS > 100; n = 15) had a lower rate of surgery (40.0% vs.78.9%; p = 0.03) and a higher 1-year-death risk (53.3% vs. 10.5%, p = 0.04; OR = 8.5 (2.75–16.40) than patients with low mitral VCS (n = 19). Patients with aortic IE and high aortic calcifications (aortic VCS > 100; n = 18) present more frequently atypical bacteria on blood cultures (33.3% vs. 4.8%; p = 0.03) than patients with low aortic VCS (n = 21). Conclusion: The amount of valvular calcifications on CT was associated with embolism risk, rate of surgery and 1-year risk of death in patients with mitral IE, and germ’s type in aortic IE raising the question of their systematic quantification in native IE.

Double aortic arch (DAA) is reported to be found in <1% of congenital heart diseases due to the failure of regression of the right aortic arch.¹ A DAA is the most common cause of a symptomatic vascular ring as the trachea and oesophagus are completely encircled and may be compressed by the two arches.² In our case, the oesophagus is compressed by the DAA causing dysphagia and no compression of the trachea (Panel B). Double aortic arch has bilateral common carotid and subclavian arteries originating from each arch, and therefore, there is a symmetric appearance of the branch vessels called the ‘four-artery sign’ (Panel D). In the setting of a DAA, the right arch is usually larger and higher than the left arch,^1,2 the same as in our case (Panel A). The descending aorta is typically opposite the dominant arch, with the most common configuration being a larger right arch, left-sided descending thoracic aorta² (Panel B).

A 70 years old patient consulted for acute chest pain spreading to the back. First clinical examination, electrocardiogram and echocardiography were consistent with the diagnosis of pericarditis with pericardial effusion. A computed tomography (CT) scan was performed to ruled out an acute aortic dissection, showing a pericardial effusion (Panel A: black stars), pneumopericardium (Panel B: arrow) and a thick pericardium (Panel A, arrow) with a thin linear oesophageal foreign body [arrowhead on Panels A–C (3D volume rendering)]. Because of symptom worsening with sign of acute tamponade, surgical drainage of the pericardium was performed, revealing a purulent effusion associated with small fragment of rice leading to us to suspect an oesophageal fistula. A second CT scan with upper digestive opacification (Panel D, arrow) showing less pericardial effusion following surgical drainage (Panel E, arrow—drain, circles) and a pericardial-oesophageal fistula with passage of the contrast from the oesophagus to the pericardium (Panels D–F arrowheads. D and F are thin maximum intensity projection). The fistula was surgically closed (Panel G: oesophagus, right arrowhead and pericardium, left arrowhead—and Supplementary data online, Video S1) and the foreign body removed which was finally a chicken bone fragment (Panel H). Additionally, broad-spectrum antimicrobial therapy was initiated. The patient was discharged from intensive care unit few days after.