Intrapericardial diaphragmatic hernia (IPDH) is a rare condition that commonly occurs after trauma, in which abdominal contents herniate through the central tendon of the diaphragm into the pericardial sac. Diagnosis is frequently delayed due to nonspecific cardiopulmonary symptoms and subtle imaging findings. We performed a narrative review of cases of traumatic IPDH to identify diagnostic challenges and operative strategies and present a case of a 71-year-old woman who developed IPDH following a motor vehicle collision. Initial imaging demonstrated rib, liver, and pelvic fractures without evidence of diaphragmatic injury. After orthopedic surgery, the patient developed chest pain and dyspnea, prompting repeat imaging suggesting IPDH. Robotic-assisted repair revealed a 9-cm anterior diaphragmatic defect containing stomach and omentum, which was repaired with mesh. Postoperatively, the patient developed pericarditis confirmed by cardiac evaluation. This review highlights the diagnostic challenges of IPDH, limitations of imaging, and the importance of multimodal evaluation and timely surgical intervention.

This report describes a rare case of a girl with constrictive pericarditis (CP), coexisting with atrial septal defect (ASD) and cardiac diverticulum. Her echocardiographic features changed in accordance with the hemodynamic alterations as treatment progressed. During a routine echocardiography before surgery, a 9-year-old girl with ASD was unexpectedly diagnosed with CP. This explains why her symptoms and signs were inconsistent with isolated ASD, including lower limb edema and hypoalbuminemia caused by impaired diastolic ventricular function. Contrast-enhanced computed tomography confirmed the diagnosis of CP and identified a right ventricular diverticulum. To minimize surgical trauma, a step-by-step surgical approach was adopted. Complete pericardiectomy without cardiopulmonary bypass was first performed to alleviate the pathophysiological abnormalities of CP, followed by percutaneous ASD closure to reduce the excessive right heart volume overload. The diverticulum was not treated because of its small size. The patient had an uneventful postoperative recovery.

Juvenile idiopathic arthritis (JIA) represents the most common cause of chronic arthritis in childhood; however, not all early-onset arthropathies are inflammatory in origin. We report the case of a 4-year-old girl initially diagnosed with oligoarticular JIA and treated with methotrexate followed by a tumor necrosis factor inhibitor, without significant clinical improvement and despite persistently normal inflammatory markers. Clinical reassessment raised suspicion of a non-inflammatory arthropathy, supported by characteristic radiographic findings including metaphyseal flaring of the distal femora and proximal tibiae. Genetic analysis identified compound heterozygous pathogenic variants in the PRG4 gene, confirming the diagnosis of camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome (OMIM #208250). PRG4 encodes lubricin, a mucin-like glycoprotein essential for boundary lubrication of articular cartilage and maintenance of synovial joint homeostasis. Loss-of-function variants disrupt joint lubrication, leading to mechanical synovial hyperplasia and chronic non-inflammatory joint effusion. This case highlights common diagnostic pitfalls in pediatric rheumatology and underscores the importance of considering genetic causes of chronic arthropathy when clinical and laboratory features are atypical for inflammatory disease. Early molecular diagnosis prevents unnecessary immunosuppressive therapy and enables appropriate multidisciplinary management.

Cardiologists consider degenerative or infectious causes when evaluating valvular heart disease. However, the role of autoimmune disorders, though less frequent, remains clinically significant. This report describes a young male patient presenting with persistent coronary disease and a suspected valvular cusp perforation initially attributed to infective endocarditis, which ultimately proved to be a manifestation of IgG4-related disease. IgG4-related disease is a rare condition, more prevalent in Asian populations, that typically affects the pancreas, salivary glands, lacrimal glands, and the retroperitoneum. Cardiac involvement, although uncommon, can present in various ways, including pericarditis, pulmonary arterial hypertension, valve dysfunction, cardiac pseudotumor, and coronary disease. Diagnosing and managing IgG4-related cardiac involvement requires heightened clinical suspicion, serological and histopathological assessment, and prompt interdisciplinary collaboration. Notably, involving rheumatologists in the management of these rare yet impactful autoimmune cardiac diseases is essential.

Avian infective endocarditis is an uncommon but severe disease that is typically diagnosed postmortem because of nonspecific clinical signs and rapid progression. In the present study, five broiler chickens (n = 5) from a commercial flock were examined with septicemia and lesions suggestive of endocarditis. This study reports the first molecularly confirmed and characterized case of valvular endocarditis associated with multidrug-resistant Vagococcus fluvialis in poultry and provides a comprehensive review of bacterial endocarditis in avian species. The case involved a broiler chicken that presented with sudden death and septicemic lesions, including vegetative valvular endocarditis, pericarditis, and multiorgan involvement. Bacterial isolates recovered from cardiac lesions were identified as V. fluvialis using MALDI-TOF mass spectrometry and confirmed by 16S rRNA gene sequencing. Antimicrobial susceptibility testing revealed a multidrug resistance profile, with resistance to several antimicrobial classes commonly used in poultry production. The literature review identified published studies describing avian infective endocarditis, which predominantly affects poultry and is caused mainly by Gram-positive bacteria, with clinical signs and necropsy findings largely overlapping across etiologies. These findings highlight the novelty of V. fluvialis as a potential etiological agent of avian infective endocarditis and underscores the diagnostic challenges associated with avian endocarditis, particularly when uncommon pathogens are involved, and underscore the importance of advanced identification methods for an accurate etiological determination. Collectively, the results of this study expand the spectrum of bacterial species associated with avian infective endocarditis and emphasize the relevance of antimicrobial resistance and improved diagnostic strategies in poultry health and disease surveillance.

Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related condition defined by somatic mutations in hematopoietic stem cells that result in clonal expansion, without overt hematologic malignancy. It is now recognized as a potent risk factor for atherosclerotic cardiovascular disease, with emerging associations across a broader spectrum of cardiovascular phenotypes, including myocarditis, pericarditis, arrhythmias, valvular heart disease, and heart failure. The authors of this article review the epidemiology, pathophysiology, and management of this condition.

Targeted intra-atrial delivery of GMP-grade human cardiac extracellular vesicles (EVs) was evaluated for prevention of postoperative atrial fibrillation (AF). EVs were manufactured under serum-free, xenogen-free GMP-compatible conditions and tested in rat and porcine sterile pericarditis models. In rats, intra-atrial EV delivery resulted in selective atrial retention without systemic toxicity. In pigs, EV administration was technically feasible, well tolerated, and completely prevented spontaneous AF while significantly reducing inducible AF. EV therapy also attenuated atrial inflammation and fibrosis without adverse end-organ effects. These findings support localized cardiac EV therapy as a first-in-human-ready, disease-modifying biologic strategy for postoperative AF prevention.

Bronchogenic cysts are rare congenital anomalies arising from abnormal budding of the ventral foregut during early embryogenesis. They are typically located in the mediastinum or pulmonary parenchyma and are mostly asymptomatic. However, complications such as infection, compression, hemorrhage, or rupture may cause significant morbidity. Surgical resection is recommended in symptomatic or complicated cysts and may also be justified in asymptomatic patients to prevent future complications. We report the case of a 40-year-old male who presented with chest pain and dysphagia. A presumptive diagnosis of a mediastinal bronchogenic cyst complicated by acute pericarditis and probable secondary infection was made based on the clinical presentation and imaging findings. The patient underwent robot-assisted thoracoscopic surgery, and histopathological analysis confirmed the diagnosis of a bronchogenic cyst. This case highlights a rare but clinically significant complication of a bronchogenic cyst.