Mediastinal lung herniation in an adult patient with Scimitar syndrome.

Early cardiac abnormalities in obese children: importance of obesity per se versus associated cardiovascular risk factors. Delle Donne MG et al. Obesity cardiomyopathy: is it a reality? An ultrasonic tissue characterization study. Abnormal myocardial deformation properties in obese, non-hypertensive children : an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study.tions of left ventricular myocardial characteristics associated with obesity. regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy. Kisrieva-Ware Z et al. Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in young women. Multiple markers of inflammation and weight status: cross-sectional analyses throughout childhood.toxic heart disease in obese rats: implications for human obesity. Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging. A 26-year-old man was referred to our outpatient clinic with dyspnoea on exertion. He had a history of bronchial asthma and smoking. Chest X-ray was unremarkable. Transthoracic echocardiography showed slightly dilated right-sided cardiac chambers. We performed two-dimensional transeso-phageal echocardiography (2D TEE) and computed tomography (CT). 2D TEE showed that inferior vena cava (IVC) was larger than normal (Panel A and Supplementary data online, Video S1A). Coronal maximum intensity projection CT angiography image revealed anomalous drainage of a right pulmonary vein into the suprahepatic IVC (Panel B). Short-axis CT image revealed enlarged right ventricle (Panel C). Axial CT image demonstrated that medial segment of the right middle lobe lung protruded towards the left side behind the heart (Panel D, asterisk) and its pulmonary vein drained into the left lower pulmonary vein (Panel E, white arrow). Anterior segment of the left upper lobe lung drained directly the left atrium (Panel E, black arrow). The scimitar syndrome is characterized by partial or complete anomalous pulmonary venous connection of right lung into to the IVC. Mediastinal lung herniation should be differentiated from horseshoe lung. Mediastinal lung herniation may protrude to the opposite side while horseshoe lung is characterized by fusion of the posterobasal segment of the right and left lungs. The pulmonary-to-systemic blood flow ratio was 1.3, thus surgery was not performed. To the best of our knowledge, there are no reports in the literature on mediastinal lung herniation associated with Scimitar syndrome. Multimodality imaging can establish the diagnosis and enable a correct description of this anomaly. RV, right ventricle; IVC, inferior vena cava; LA, left atrium. Supplementary data are available at European Heart Journal …