Traumatic pseudoaneurysm of limb arteries are relatively rare. A 70-year-old gentleman, with history of mechanical aortic valve implantation on warfarin, presented to the emergency department with pain and swelling in the right leg. He had sustained blunt injury to the leg, a week prior to presentation. On examination, the lateral compartment of the leg was swollen, ecchymotic, and tense. Distal pulses were well palpable. An ultrasound Doppler evaluation revealed a large intramuscular hematoma in the lateral compartment with a pseudoaneurysm of a muscular branch of the anterior tibial artery. An ultrasound-guided compression of the pseudoaneurysm was initially attempted for 24 hours, which failed in closing off the pseudoaneurysm. He was subsequently taken up for thrombin injection into the pseudoaneurysm, which resulted in instant thrombosis of the pseudoaneurysm, with an uneventful clinical course thereafter. Thrombin injection is an effective and safe modality to treat pseudoaneurysms of limb arteries.The radial artery route is being increasingly used by interventional cardiologists as a default access site for both diagnostic and interventional coronary procedures, and although rare, serious complications can occur. We herein report a potentially catastrophic complication of radial percutaneous coronary intervention (PCI) in the form of a large mediastinal and retro-left-atrial hematoma from possible subclavian artery injury with tracheal compression and stridor in a 60-year-old female presenting with anteroseptal myocardial infarction having undergone PCI of the left anterior descending artery through right radial access and then planned for a second stage PCI of the right coronary artery. The patient was managed conservatively with close hemodynamic and echocardiographic monitoring, inotrope support, and blood transfusions. Transradial PCI, despite having a better safety profile in terms of bleeding compared to transfemoral PCI, is not without complications. Manipulation of hydrophilic guidewires as well as diagnostic catheters while performing radial procedures can cause injury to conduit vessels, potentially leading to intrathoracic, axillary, and arm hematomas may remain undetectable in the cath lab, presenting late and can pose a diagnostic and management challenge. Decision to proceed toward repeat interventional/surgical/"wait and watch" strategy should be guided by the patient's clinical status and noninvasive imaging.An entrapment and breakage of coronary angioplasty catheter during coronary intervention is a rare but serious complication. Percutaneous transluminal coronary angioplasty (PTCA) catheter got entrapped and broken inside the left anterior descending artery (LAD) in a 58-year-old male patient. The whole length of the PTCA catheter was retrieved through an arteriotomy incision in LAD along with reversed saphenous vein graft to LAD, under cardiopulmonary bypass and cardioplegic arrest. We discuss here the various percutaneous retrieval techniques and surgical management of entrapped broken PTCA catheter and also the role of transesophageal echocardiography intraoperatively.Radiotherapy is an important treatment modality for various thoracic malignancies but is associated with long-term risk of radiation-associated valve disease (RAVD). We hereby report a case of a lady who had received radiotherapy 30 years back for carcinoma breast and was now found to be having clinically significant RAVD involving all the four cardiac valves. Simultaneous involvement of all the four valves in RAVD is extremely rare and has not been reported previously.Takotsubo cardiomyopathy (TCM) was first initially reported in 1990 in Japan and has been increasingly recognized in clinical practice. It is characterized by transient regional left ventricular dysfunction without evidence of obstructive coronary artery disease, often precipitated by emotional and physical stressors. UCLTRO1938 Although TCM does occur in young women and men, it is most commonly seen in postmenopausal women. Sepsis induced TCM is an infrequently encountered entity. We present a case of TCM in a middle age gentleman who presented with septic shock due to acute cholecystitis. Two days later, the patient developed clinical features of acute myocardial infarction. Echocardiography revealed hypokinesis of the left ventricle. Coronary angiography revealed normal arteries without any obstruction. Diagnosis of sepsis induced TCM was finally made. The patient made a dramatic recovery and discharged home in stable condition. Follow-up echocardiography showed improvement in left ventricular systolic function.Pulmonary embolism (PE) is a life-threatening condition. High-risk PE is defined as pulmonary embolism with either hemodynamic collapse, persistent hypotension, and/or organ hypoperfusion. The overall mortality rate associated with high-risk PE remains at approximately 30%. Intermediate-high risk PE is a new term introduced to identify hemodynamically stable PE patients with evidence of right ventricular dysfunction. Thrombolytics therapy is the first choice for treatment of high-risk PE with hemodynamic instability; however, in a patient who failed thrombolytics or have contraindication to thrombolytics, thrombus removal either with open surgical or catheter embolectomy is a good alternative. We report a case of a patient who presented with hemorrhagic stroke complicated by intermediate-high-risk PE that rapidly deteriorated before undergoing successful surgical embolectomy.Echocardiography plays a vital role in the diagnosis and management of cardiovascular conditions. Echocardiography use is progressively increasing nowadays, and this is correlated to the evolving echo indications, to the relatively new available echocardiography modes (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, etc.) and modalities (transthoracic, transesophageal, and intracardiac) along with the various available clinical approaches (point of care echo, portable echo, etc.). Quality assurance in echocardiography is correlated to appropriate use criteria, adequate equipment, standardization of performance and reporting, along with timely storage and archiving. Quality improvement plan must target strategic planning, with metrics and timeline for assessment and re-assessment of results. Improvement project aims to ensure and enhance conformity with appropriate use criteria and standardization, timely completion of exams and reports, detection of discrepancies, and continuous improvement of knowledge and skills.