158
￭ S-237 ￭
심부전과 반복적 다형성심실빈맥으로 발현한 그레이브스병 1예
가톨릭대학 여의도성모병원 순환기내과
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김민영, 정우백, 이영복, 김성준, 유진석, 김주연, 최윤석, 박철수, 이만영
We report the case of a 54-year old man who was presented with congestive heart failure and recurrent polymorphic ventricular tachycardia asso- ciated with Graves' disease. When he arrived at emergency room, he complained exertional dyspnea and pretibial pitting edema which was ag- gravated 10 days ago. Initial electrocardiogram showed atrial fibrillation with rapid ventricular response. During evaluation at ER, frequent VPCs were observed and suddenly Torsade de pointes (TdP) attacked. Defibrillation was performed immediately, and TdP recurred 44 times for next 14hrs. Initial laboratory findings showed hypomagnesemia (Magnesium 1.5 mg/dL). Other electrolyte level, such as sodium, potassium, calcium and phosphorus showed unremarkable (sodium 139 mmol/L, potassium 3.9 mmol/L, calcium 8.1 mg/dL). Thyroid function was suggestive of hy- perthyroidism (freeT4 4.78 ng/dL, T3 3.93 ng/dL, TSH 0.007 uIU/mL) and auto-antibody test confirmed Graves’ disease. Coronary angiogram was not remarkable, which ruled out acute coronary syndrome or coronary spasm. On echocardiogram, all chambers were dilated and left ven- tricular ejection fraction was 34%. After management of electrolyte imbalance, there was no more TdP attack, but still prolonged corrected QT interval was observed. It is well known that Graves’ disease can affect cardiac function, but this is the first case of recurrent TdP associated with Grave’s disease in Korea.
￭ S-238 ￭
Acupuncture induced infectious aortitis leading to aortic dissection: a case report-
1인제의대 해운대백병원 내과, 2흉부외과
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이주원
1, 진규복
1, 박봉수
1, 김양욱
1, 정희정
1, 노태훈
1, 서민교
1, 민호기
2Infectious aortitis has become a rare disease thanks to the use of antibiotics, but remains a life-threatening complication. We present a case of an 83 year-old woman with an acupuncture-induced aortitis leading to aortic dissection. Chest CT scan revealed Stanford type A aortic dissection with large pericardial effusion (Fig. 1). With the impression of acute aortic dissection with impending rupture, an emergent operation was performed. In field, infectious aortitis was recognized and she underwent resection of the infected aorta and surrounding tissues and in-situ aortic hemi-arch replacement with a prosthetic graft. The infected tissue and blood culture revealed methicillin-sensitive Staphylococcus aureus (MSSA) and prolonged antibiotics therapy was followed according to sensitivity test. After 10 days of ICU treatment because of acute renal failure and 46 days of hospitalization, the patient was discharged. Clinical manifestations of infectious aortitisare often nonspecific, depending upon the site of infection and its localized impact. It is extremely important to establish an early diagnosis of infectious aortitis, because this condition is asso- ciated with a high rate of aortic rupture and mortality if left untreated.Optimal management for infectious aortitis requires complete surgical ex- cision and reconstruction of the infected aorta combined with prolonged antibiotic administration. In conclusion, early diagnosis and complete sur- gical excision of the infected aorta in combination with prolonged antibiotics is the best treatment modality.
Fig. 1. Enhanced chest CT scan with axial (A) and coronal imges (B) show the dissection flap of the ascending aorta with pericardial effusion and thickening of aortic wall, which is suggested a soft tissue infection. (C) Abscess on the Lt. buttock (white arrow) was found incidentally at CT scan.
