41-year-old male with no significant past medical history presented as an outpatient with atypical chest pain and had positive nuclear stress test. The patient subsequently underwent left heart catheterization, which revealed a fistula between the LAD and LV circumflex artery; however, CTA failed to show any evidence of a fistula.

Background: Pulmonary thromboembolism (PTE) is a common complication of SARS-CoV-2, which raises the COVID-19 disease’s fatality rate from 3% to 45%. Nevertheless, due to fairly indistinguishable clinical symptoms and a lack of validated clinical prediction models, PTE diagnosis in COVID-19 patients is challenging. This study aims to investigate the applicability of hematological indices to predict PTE incidence and its severity in SARS-CoV-2 patients. Methods: A retrospective cohort study was conducted on hospitalized patients with a confirmed diagnosis of SARS-CoV-2 infection who underwent CT angiography to assess probable PTE in them. The correlation between CBC parameters one day prior to CT angiography and CT angiography outcomes, and simplified Pulmonary Embolism Severity Index (s-PESI) was investigated. Results: We discovered that among individuals with a probable PTE, males and those with higher platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios had a greater likelihood of PTE incidence. PLR was a significant and independent predictor of PTE. Moreover, a higher neutrophil count was associated with a higher s-PESI score in COVID-19 patients developing PTE. Conclusions: Among haematological indices, NLR and more precisely PLR are cost-effective and simply calculable markers that can assist physicians in determining whether or not COVID-19 patients with clinically probable PTE require CT angiography and the higher neutrophil count can be employed as an indicator of PTE severity in COVID-19 patients. Further large multicenter and prospective studies are warranted to corroborate these observations.

A 34-year-old woman presented with acute abdomen, and her paraclinical data showed evidence concerning renal failure and its consequences in addition to ascites upon ultrasonography. Her symptoms did not abate after dialysis, and she underwent laparotomy, which revealed bladder perforation. Consequently, cystorrhaphy and cystoplasty were done without postoperative complications.

Mucocutaneous complications or adverse events due to SARS-CoV-2 infection or vaccination have been well-delineated in the literature, respectively. Most eruptions are considered to be mild and self-limiting; however, for the atypical cases which have a tentative clinical diagnosis, performing a biopsy and histopathological assessment is pivotal to confirm the diagnosis and subsequently prescribe a more tailored treatment. Despite the diverse reporting of such incidents globally, the rate of biopsied cases is restricted to less than 15% in most studies.    This case series elucidates 20 patients referred to the tertiary dermatology clinic, including 14 COVID-19 infection-related eruptions such as Lichen Planus (LP), Cutaneous vasculitis, Pityriasis rosea (PR), Discoid lupus erythematosus, Guttate psoriasis, Sarcoidosis, Raynaud’s phenomenon, non-specific lesions resembling genital warts, Beau’s line and one severe case of purpura fulminans with a promising outcome. Moreover, we presented 6 vaccine-induced cases comprising LP, Urticarial vasculitis, PR, Parapsoriasis, and Localized Morphea. The diagnosis of all cases has been proven by histopathological evaluation. We included pertaining anamnesis details of each patient together with vivid classifying images to pinpoint the morphologic features of each condition.   In line with our previous studies, the vaccine-induced eruptions were less severe compared to infection-related complications of COVID-19 and are mostly controllable by antihistamines and corticosteroids administration. Therefore, reporting such events should not hinder COVID-19 vaccination in the general population.

Despite the increasing number of liver and kidney transplants, the number of awaiting patients for a proper donor is still exceeding. Therefore, the preservation of donor's organs is critically advocated. Herein, we presented a successful liver and kidneys transplant from a brain dead donor who was found preoperatively to have simultaneous aortic dissection and intramural hematoma, and additionally developed left subclavian artery dissection and perforation following sternotomy. This case experience highlights the key role of cardiac surgeons to preserve visceral organs by rapid repair of aorta and its branches perforation site and dissection which culminate in lifesaving organ donation.

Cardiac angiofibroma is a very rare diagnosis when a patient develops an intracardiac mass. It is a primary benign cardiac tumor with a scarcity of information in the literature.  This case report illustrates a 26-year-old man with a complaint of chronic chest tightness who was firstly diagnosed with right ventricle tumor by echocardiography then underwent cardiac MRI which confirmed the presence of a highly-vascular tumor with radiologically benign behavior. Then his tumor was excised, his postoperative course was uncomplicated and he was well within almost 2 months after discharge. Ultimately the histopathologic findings demonstrated vascular and stromal tissue in favor of angiofibroma and excluded the other diagnoses with IHC and trichrome staining.  Angiofibroma is a benign, highly vascular tumor, mostly discovered in the nasopharynx. When it is found in the heart, CMR and pathology are pivotal to rule in its diagnosis. It is isointense in T1 weighted and hyperintense in T2 weighted sequences with intense enhancement following contrast injection. Its pathology contains an admixture of vasculatures with CD31 positive immunoreactivity for endothelial cells and fibrotic tissue with bluish coloration in trichrome staining. Eventually, its treatment includes merely surgical excision given its benign nature.