Transthoracic echocardiography plays a central role in diagnosing a variety of cardiac and pericardial disorders. However its use in identifying extra-cardiac thoracic pathology is less well recognised. We describe an unusual case of intrathoracic intestinal strangulation detected by transthoracic echocardiography. The recognition of bowel loops within the left hemithorax enabled rapid confirmatory computed tomographic imaging and subsequent life-saving surgery This case demonstrates the utility of bedside echocardiography in the assessment of intrathoracic pathology and emphasises the need for cardiologists to be familiar with the echocardiographic appearance of these disorders. (Heart, Lung and Circulation 2012;21:831-835) (C) 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

Long term dual anti-platelet therapy (DAT) can lead to increase gastrointestinal haemorrhage (GIH). The addition of proton pump inhibitor (PPI) after percutaneous coronary intervention (PCI) may be protective against GIH. Long term clinical outcomes associated with concomitant use of DAT and PPI are limited with conflicting results. Aims: To determine the long term clinical outcome of patients treated with PPI and DAT following PCI (elective or acute) at a single tertiary centre. Methods: A total of 362 consecutive patients referred to our institution between January 2006 and December 2007 were included. Patients were divided retrospectively into those with or without planned long-term PPI treatment. Baseline characteristics, H. pylori status, concomitant use of IIbIIIa inhibitor or anticoagulation, PCI results and major adverse events during hospitalisation and 36-month follow up were analysed. Results: Mean age (S.D.) of patients was 65(±9.5) years and 71% of them were male. Proton pump inhibitor were used in 30.1% (109) of patients. Patients not on PPI are associated with significant cardiovascular events (13.3% vs. 8.3% p = 0.03). Non-PPI patients have increase GIH risks (3.6% vs. 1.7%); however this result was not statistically significant (p = 0.54). Patients positive for H. pylori were more likely to be on DAT and PPI and have a previous history of GIH. Conclusion: Our data suggest that a combined use of DAT and PPI does not significantly influence the long term clinical outcome in patients after PCI and stent implantation.