We present a forensic case of a man in his late 50s who lost consciousness while driving, resulting in a lowspeed (approximately 10 km/h) collision with a wall. He was found unresponsive at the scene and transported to a hospital. Despite resuscitative efforts, he was pronounced dead. A judicial autopsy was conducted 5.5 days postmortem after refrigerated storage. Externally, postmortem marbling was distinctly observed in the head, neck, and upper limbs, whereas the trunk and lower extremities remained unaffected. Internally, approximately 300 mL of hemopericardium was found due to a tear in the anterior wall of the left ventricle. Histological examination revealed acute coronary artery occlusion with intraplaque hemorrhage, indicating an ischemic origin of the myocardial rupture. This case illustrates a rare and regionally selective manifestation of decomposition, with marbling limited to the upper body. We hypothesize that venous congestion caused by cardiac tamponade created a localized microenvironment favorable to bacterial proliferation, facilitating selective marbling. Although refrigeration delays decomposition, it does not prevent it. Our findings demonstrate that antemortem circulatory conditions may influence the regional distribution of early postmortem changes, which should be considered in forensic interpretation.

Cardiac hemangioma is very rare and accounts for 2%-3% of the primary cardiac tumors. They are classified into capillary, cavernous, epitheloid, and arteriovenous types. Although commonly asymptomatic, haemangiomas can cause arrhythmia, pericardial effusion, congestive heart failure, right ventricular outflow tract obstruction, coronary insufficiency, and sudden death; the symptoms depend on their location and size. Accurate preoperative diagnosis is challenging and elusive. Advanced imaging modalities, including echocardiography, CT, and cardiac magnetic resonance (CMR), are useful for further characterizing cardiac hemangioma and providing a diagnosis Coronary angiography is sometimes useful in revealing how the tumor is fed and its characteristic tumor blush. Cardiac haemangiomas are still recommended for surgical excision due to the risks of embolism, rupture, and sudden death.

Automated analysis of computed tomography (CT) scans is an active area of medical imaging research. Classification tasks often rely on scan-level labels without providing spatial information. When using frozen encoders from pretrained models, such as foundation models, enforcing anatomical focus by input-space cropping can shift the input distribution and degrade performance. We investigated whether organ masks can provide scalable anatomical guidance for weakly supervised classification using a frozen self-supervised Swin Transformer. Two strategies were evaluated: input-space organ centering and feature-space cropping, which applies organ masks to intermediate feature maps before pooling. Across three datasets and seven binary tasks, feature-space cropping matched or improved performance relative to full-image baselines, whereas input-space centering showed task-dependent effects. Feature-space cropping achieved a pooled improvement of 0.018 (95% confidence interval: 0.009-0.028) in area under the receiver operating characteristic curve, with the largest gains for liver lesion and pericardial effusion classification. Feature-space cropping reduced embedding dimensionality without loss of performance while preserving input distribution. In an ablation experiment of input-space centering, tighter crops reduced performance, highlighting the importance of peri-organ context. These findings demonstrate that feature-level anatomical guidance offers an efficient strategy to improve weakly supervised CT classification without retraining the encoder.

Coronary artery aneurysms are rare, and mycotic coronary aneurysms arising secondary to bacterial infection are even rarer.

Advances in genetic engineering have enabled the development of highly modified porcine models for xenotransplantation. Among available technologies, somatic cell nuclear transfer (SCNT) remains the most reliable method for generating multi-genic pigs carrying complex genetic modifications, including the knockout of porcine xenoantigens and the insertion of human immune regulatory genes. Despite these advances, the physiological viability of highly engineered cloned animals remains a major challenge. In our previous study, we generated cloned pigs carrying a knockout of α-1,3-galactosyltransferase (α-gal) and knock-in of five human immune-related genes: human decay-accelerating factor (hDAF), CD39 (hCD39), tissue factor pathway inhibitor (hTFPI), C1 inhibitor (hC1INH), and TNF-α-induced protein 3 (hTNFAIP3). Although genomic integration and cellular expression of these transgenes were confirmed, all piglets in this cohort died within 48 h after birth. Necropsy revealed no evidence of external trauma or systemic abnormalities in major organs. However, hemorrhagic lesions were observed in the left ventricular myocardium of all necropsied piglets, and histological examination confirmed localized intramyocardial hemorrhage without ventricular rupture or pericardial effusion. We propose that incomplete epigenetic reprogramming associated with SCNT, combined with the physiological burden of multi-gene expression, may have compromised myocardial microvascular integrity. Under the abrupt hemodynamic transition that occurs after birth, this structural vulnerability may predispose the left ventricle to intramyocardial hemorrhage and rapid cardiogenic collapse. These findings suggest that left ventricular hemorrhage may represent a previously underrecognized cause of early neonatal death in highly engineered SCNT-derived pigs.

Background and Objectives: Transcatheter aortic valve implantation (TAVI) is the standard therapy for patients with severe aortic stenosis at intermediate or high surgical risk. Mitral annular calcification (MAC) is frequently observed in this population and has been linked to adverse cardiovascular outcomes. This study evaluated the association between MAC and TAVI-related complications and mortality, and identified predictors of all-cause mortality and permanent pacemaker implantation (PPI) following TAVI. Materials and Methods: Patients undergoing self-expanding TAVI between January 2010 and June 2020 were retrospectively analyzed. Outcomes included TAVI-related complications, in-hospital and long-term mortality, and predictors of all-cause mortality and PPI. Results: A total of 245 patients (98 men [40%], mean age 76.3 ± 8.3 years) were included. Mean left ventricular ejection fraction was 54.8 ± 11.4%, and aortic valve area was 0.74 ± 0.14 cm[2]. MAC was present in 148 patients (60.4%). Pericardial effusion (26.4% vs. 12.4%, p = 0.013) and acute kidney injury (21.6% vs. 7.2%, p = 0.005) were significantly more frequent in patients with MAC. PPI was required in 42 patients (17.8%). In-hospital mortality occurred in 14 patients (5.7%), and all-cause mortality was observed in 89 patients (36.3%) during a median follow-up of 23.1 months (IQR, 11.6-44.3). MAC extension into the left ventricular outflow tract was the only independent predictor of PPI (OR: 3.32, p = 0.002). Independent predictors of all-cause mortality included use of renin-angiotensin-aldosterone system blockers (HR: 0.54, p = 0.012), hemoglobin level (HR: 0.79, p = 0.006), severe MAC (HR: 1.94, p = 0.024), and post-TAVI atrial fibrillation (HR: 2.39, p = 0.002). Conclusions: MAC is common in TAVI patients and is associated with increased procedural complications, including higher rates of pericardial effusion and acute kidney injury. Greater MAC severity independently predicts higher all-cause mortality. In addition, MAC extension into the left ventricular outflow tract is an independent predictor of PPI following self-expanding TAVI, emphasizing the importance of comprehensive pre-procedural imaging.

Erdheim-Chester Disease (ECD) constitutes a rare and clinically heterogeneous non-Langerhans cell histiocytosis, characterized by the systemic infiltration of tissues by foamy, lipid-laden histiocytes. These cells typically exhibit an immunophenotypic profile positive for CD68 and negative for CD1a. The disease's multifaceted presentation, which can span from isolated bone lesions to fulminant multi-organ failure, frequently results in considerable diagnostic delay. In this case-based review, we describe the case of a 58-year-old who presented with a primary complaint of exertional dyspnoea and fatigue. The initial diagnostic evaluation revealed a hemodynamically significant circumferential pericardial effusion and imaging findings suggestive of aortitis. Clinical presentation of ECD depends on the organs and tissues involved, and may range from bone pain to neurological symptoms, endocrine dysfunction, and cardiac involvement. Cardiovascular involvement occurs in at least 40% of ECD patients, although it is frequently underdiagnosed. Cardiac ECD is heterogeneous and may mimic many alternative aetiologies. The infiltration of the right atrioventricular sulcus, right atrial walls, or interatrial septum is one of the most typical cardiac manifestations of ECD. Recognition of pseudo-tumour intra-atrial mass, pericardial involvement, as well as the circumferential encasement of the entire aorta, the so-called coated aorta, are other frequent findings. Diagnosis often requires a multimodal approach, in particular when cardiac symptoms represent the onset of clinical manifestation of ECD. The combined use of computed tomography, fluorodeoxyglucose positron emission tomography, dedicated cardiac and abdominal magnetic resonance imaging, and X-ray of long bones can collectively reveal a constellation of findings diagnostic of ECD.

Background and Clinical Significance: We report an exceptionally rare case of mechanical aortic valve replacement necessitated by self-inflicted needle penetration with aortic valve and left ventricular involvement in a patient with recurrent self-harm behavior. Case Presentation: A 24-year-old female with post-traumatic stress disorder and emotionally unstable personality disorder, borderline type, presented with dyspnea two weeks after self-inserting multiple needles into her thorax. Computed tomography revealed a needle lodged in the aortic root and an intramyocardial needle with hemorrhagic pericardial effusion. Emergency sternotomy revealed inflammatory destruction of the right coronary aortic cusp with complete perforation. Following failed reconstruction attempts, mechanical aortic valve replacement was performed. The patient survived the immediate postoperative period but demonstrated recurrent non-adherence to oral anticoagulation, including multiple episodes of over- and under-anticoagulation. More than six years after surgery, she presented with cardiogenic shock due to prosthetic valve thrombosis after discontinuing warfarin for two weeks. Despite venoarterial ECMO and fibrinolytic therapy, she died from refractory left ventricular failure. Conclusions: This case highlights critical challenges in managing patients with severe psychiatric disorders requiring mechanical valve prostheses and suggests that bioprosthetic valves may warrant careful consideration in patients with major concerns regarding long-term anticoagulation adherence.

Perinatal lymphangiomas are rare benign congenital malformations of the lymphatic system, whose potential for rapid growth and local invasiveness may pose significant risks to fetal well-being. This report presents a case of a large fetal lymphangioma diagnosed prenatally during a second-trimester ultrasound examination. The lesion was initially asymptomatic but subsequently progressed, resulting in ascites and pericardial effusion. In light of progressive fetal deterioration, prenatal sclerotherapy was performed using ultrasound-guided transabdominal administration of bleomycin. Despite the technical success of this procedure, the neonate developed severe cardiorespiratory failure and died shortly after delivery. This case highlights both the potential benefits and limitations of prenatal intervention in severe lymphatic malformations. This study also includes a concise review of current perinatal and postnatal management strategies. Despite advances in prenatal imaging and therapy, further studies are needed to optimize treatment and improve neonatal outcomes.

Background/Objectives: In individuals with a genetic predisposition, acute rheumatic fever (ARF) can manifest as arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. It occurs after a latent period of 1-3 weeks of untreated upper respiratory tract infections caused by group A beta-hemolytic streptococci. The presence and severity of carditis determine the prognosis for ARF. Carditis manifests as pancarditis, and although all patients have pericarditis, not all experience a pericardial effusion. Patients with severe carditis exhibit pericardial effusion more frequently. The physiopathology of ARF remains unclear, specifically which patients will experience carditis, arthritis, or chorea. However, the Turkish population has fully clarified the physiopathology and clinical features of Familial Mediterranean fever (FMF), a common rheumatic disease. In the Turkish population, the heterozygous positivity rate for the FMF gene mutation is 15-35%. For these reasons, we examined the presence of FMF gene mutations in our patients to determine whether there is a correlation between the clinical course of ARF and the FMF gene mutation. Methods: The study included 60 patients with arthritis (n = 11), carditis (n = 26), or both (n = 23), as well as 60 healthy controls. These pediatric patients underwent screening for mutations in exons 2 and 10 of the MEFV gene. Results: There was no statistically significant difference between the patient and control groups in terms of the incidence of MEFV gene mutations in exon 10. However, in patients with ARF, the exon 2 E148Q variant was significantly more common than in the control group. Conclusions: This study suggests a relationship between certain clinical manifestations of ARF and MEFV gene mutations in children.

Background: Cardiovascular complications are increasingly recognized in patients undergoing hematopoietic stem cell transplantation (HSCT). Early detection of subclinical myocardial dysfunction may improve risk stratification, and global longitudinal strain (GLS) is emerging as a sensitive marker of early cardiac impairment. Methods: We conducted a single-center observational cohort study including 518 adult patients undergoing autologous (n = 64) or allogeneic (n = 454) HSCT between 2004 and 2025. Baseline cardiovascular risk factors, transplant characteristics, and echocardiographic parameters-including GLS in a subset-were recorded. Abnormal GLS was defined as less negative than -20%. The primary outcome was the occurrence of cardiovascular events (composite of cardiovascular death, myocardial infarction, stroke, atrial fibrillation/flutter, pericardial effusion, pulmonary embolism, and left ventricular systolic dysfunction). Multivariable logistic regression was used to identify independent predictors. Results: Median age was 53 years; 58% were male. Cardiovascular events were predominantly atrial fibrillation, pericardial effusion, and reduced left ventricular function, whereas ischemic events were rare. Over 90% of events occurred within 100 days post-transplant. Multivariable analysis identified older age (OR 1.28 per 10-year increment; 95% CI 1.10-1.48; p = 0.002), chronic kidney disease (OR 2.44; 95% CI 1.18-5.02; p = 0.01), pre-transplant atrial fibrillation (OR 2.12; 95% CI 1.04-4.31; p = 0.03), and abnormal baseline GLS (OR 1.89; 95% CI 1.02-3.52; p = 0.04) as independent predictors. Importantly, the prognostic value of GLS remained significant after excluding clinically insignificant pericardial effusions from the composite endpoint. GLS deterioration during follow-up occurred more frequently in patients receiving reduced-intensity conditioning compared with myeloablative conditioning (25% vs. 12.7%; p = 0.006). Conclusions: Subclinical myocardial dysfunction detected by GLS identifies HSCT recipients at increased cardiovascular risk. These findings support the incorporation of strain imaging into routine pre- and post-transplant cardiovascular evaluation to enable earlier detection and guide targeted interventions.

Background and Clinical Significance: Left ventricular free-wall rupture (LVFWR) is a rare but devastating mechanical complication of acute myocardial infarction (AMI), with reported in-hospital mortality approaching 90% without surgical intervention. Although its incidence has declined in the contemporary primary percutaneous coronary intervention (PCI) era, LVFWR remains an important cause of early post-infarction death, particularly after delayed reperfusion or fibrinolytic therapy. Subacute or contained "oozing" ruptures pose a unique diagnostic challenge because hemodynamic stability and nonspecific symptoms can mask the underlying catastrophe, and standard transthoracic echocardiography may fail to visualize a sealed defect. Contrast-enhanced cardiac computed tomography (CT) has emerged as a valuable adjunct in this setting, enabling early recognition and surgical planning. Case Presentation: We report a case of a 51-year-old male, a heavy smoker, with acute lateral ST-segment elevation myocardial infarction (STEMI) treated with thrombolysis at a referring hospital, followed by percutaneous coronary intervention (PCI) to the obtuse marginal branch. Despite reperfusion, he developed persistent pleuritic chest pain and a small pericardial effusion. Cardiac computed tomography (CT) demonstrated a contained (sealed) lateral-wall oozing-type left ventricular free-wall rupture (LVFWR) with thrombus sealing the defect. A multidisciplinary heart team initially opted for diligent observation with frequent echocardiography. Within the first 24 h, the pericardial effusion increased, and echocardiography showed circumferential effusion with lateral wall thickening and hematoma, prompting emergent sternotomy. Intraoperatively, a large posterolateral infarct with an oozing-type LV free-wall rupture was identified. Surgical repair was performed using interrupted pledgeted sutures, native pericardial patch, BioGlue, and an overlying Teflon patch, with intra-aortic balloon pump (IABP) support. This case demonstrates the complementary diagnostic value of multimodality imaging-echocardiography for serial monitoring of the pericardial effusion and regional wall changes, and cardiac CT for direct characterization of the contained (sealed) defect-and the timely transition from conservative to surgical management in oozing-type rupture. The patient recovered uneventfully and was discharged in stable condition. Conclusions: This case highlights the diagnostic value of multimodality imaging-particularly cardiac CT-in detecting contained (sealed) LVFWR when echocardiography is inconclusive. Early recognition and prompt surgical intervention enabled a successful outcome in this otherwise frequently fatal complication.

Background: Cardiac point-of-care ultrasound (POCUS) is widely used in emergency and acute care settings. Still, broader use remains limited by operator dependence and variability in image acquisition and interpretation. Artificial intelligence (AI), including machine learning and deep learning methods, has been applied to cardiac POCUS to support image acquisition, automate quantitative measurements, and assist interpretation. Methods: We performed a narrative review of current applications of AI-assisted cardiac POCUS. A targeted literature search of PubMed and Google Scholar from 2018 to 2026 was conducted using terms related to AI, machine learning, deep learning, and cardiac ultrasound. Studies evaluating AI-assisted cardiac ultrasound in clinical, educational, or image-acquisition settings were included, with emphasis on recent, clinically relevant applications. Results: The most developed application of AI-assisted cardiac POCUS is an automated assessment of left ventricular systolic function, particularly the left ventricular ejection fraction (LVEF), where multiple studies report agreement with expert interpretation or formal echocardiography and improved performance among novice users. AI-assisted tools have also been evaluated for pericardial effusion detection, guidance for image acquisition, and education. More complex applications, including diastolic function assessment and hemodynamic measurements such as LVOT-VTI, remain less well validated and more dependent on image quality. Across studies, performance is closely linked to image acquisition quality and has often been evaluated under controlled rather than real-world conditions. Conclusions: Current evidence supports AI-assisted cardiac POCUS primarily as a decision-support tool, with the strongest data for automated assessment of LVEF. Other applications remain investigational.

The increasing use of cardiac implantable electronic devices (CIEDs) in pediatric and adolescent populations has led to a growing need for transvenous lead extraction (TLE). However, data on long-term outcomes remain limited. This study aimed to evaluate the efficacy and safety of TLE using mechanical rotational dilator sheaths in a pediatric cohort. This retrospective single-center study included 35 patients who underwent TLE between 2007 and 2025. Outcomes were compared between Evolution® (Cook Medical, Bloomington, IN, USA) and TightRail™ (Spectranetics/Philips, Colorado Springs, CO, USA) sheath systems. A total of 40 leads were extracted (mean age at extraction: 15.1 ± 4.2 years; 57% male). The most common indication for extraction was lead fracture/dysfunction (22/35-63%). Complete success with the procedure was achieved in 23 (66%) patients, and clinical success in 30 (86%). Major complications requiring surgery occurred in 5 (14%) patients, and minor complications in 2 (6%). Notably, all major complications occurred in patients with implantable cardioverter-defibrillator (ICD) leads (p = 0.013), including innominate vein injury, pericardial effusion, tricuspid entrapment, and cardiac perforation. A comparison of the Evolution® (n:20) and TightRail™ (n:15) sheath groups showed no statistically significant differences in complete procedural success (p = 0.603), clinical success (p = 0.604), or the incidence of major complications (p = 0.640). No procedure-related mortality was observed. TLE using mechanical rotational dilator sheaths in pediatric patients is feasible and provides acceptable clinical success rates. However, the risk of major complications remains considerable, particularly in patients with ICD leads. These findings highlight the importance of careful procedural planning and performing TLE in experienced centers with immediate surgical backup.