The JL4 Fr6 guiding catheter was used to cannulate the right coronary artery. Visu- alization of the right coronary arteries, PDA and PLA branches were done. Note of visualized vessel on injection of dye to the RCA. Initial consideration was a collateral to an occluded distal LCx segment or OM branch. A Heartrail II JL4 Fr6 guiding catheter was then used to cannulate the left main coronary artery. An Asahi Soft PTCA wire was then inserted to the left circumflex and was placed distally. Upon injection of dye to the LMCA, there was no note of occlusion. A Heartrail II JR4 Fr6 guiding catheter was then used to cannulate the RCA to further examine. Simultaneous injection of dye to both the LMCA and the RCA were done. The visualized vessel on injection of dye to the RCA was, in fact, the distal LCx, which was visualized via intercoronary communications. Case Summary: Impression at this point was an intercoronary communication between the RCA and distal LCx segment. Due to absence of any significant stenosis, the patient was managed medically and was discharged on anti-ischemic medications and was advised lifestyle modification. On follow-up after two weeks, the patient remained stable and asymptomatic. TCTAP C-172 Fibrinous Pleuritis and Necrotizing Pericarditis: Unique and Serious Complications of Degos Disease Muhammad Anis Haider , Maria Karas, Evelyn Horn, James Horowitz, Francine Garrett, Cynthia Magro, Maria DeSancho, Harsimran Singh Weill Cornell Medical College, New York Presbyterian Hospital, USA [Clinical Information] Patient initials or identifier number: N/A Relevant clinical history and physical exam: Degos Disease, also known as malignant atrophic papulosis, is a very rare, genetic disease with an unclear etiology. It is a distinctive vasculopathy syndrome charac- terized by a thrombotic diathesis affecting capillaries and venules in concert with an obliterative intimal arteriopathy involving small and medium sized vessels, therefore it is called a vasculopathy or endovasculitis. There have been very few published reports of cardiopulmonary and pleural complications related to DD. To date, most of these reported cases describe deceased patients and autopsy findings. In our clinical case, we describe a living patient with DD who was diagnosed with necrotizing pericarditis and fibrinous pleuritis. Relevant test results prior to catheterization: Our patient is a 46-year-old male with a history of DD with pathognomonic skin lesions, and perforation of the small intestines at diagnosis s/p laparotomy and ileostomy. He presented after three months of treatment with several days of cough, pleuritic chest pain, and worsening shortness of breath. Upon initial evaluation, he was febrile to 39.8  C, tachycardic at 119 bpm, hypo- tensive at 82/47 mmHg, and tachypneic at 26 breaths/min with normal air saturations of 100%. Pertinent findings on physical exam included a pericardial rub and distant heart sounds. Chest x-ray showed a large left pleural effusion. Contrast chest CT confirmed a left sided pleural effusion with a normal sized heart in addition to a pericardial effusion. A transthoracic echocardiogram found the pericardial effusion to be moderate with dilated right heart chambers and echocardiogram evidence of tamponade. A therapeutic thoracentesis was performed and 1L of green exudative fluid with pH 7.26, WBC 260 cells/mm3 (PMN 16%), LDH 746 IU/L, trigylcerides 20 mg/dL, and total protein 5.4 g/dL was removed. A pericardial window was performed to treat the patient’s tamponade and pericardial effusion. All pleural and pericardial fluid cultures were negative except for candida. The pericardial biopsy demonstrated autoimmune inflammatory microscopic vasculitic changes. Labs and diagnostic workup indicated necrotizing pericarditis and fibrinous pleuritis. There was a striking thrombogenic vasculopathy extensively involving the pericardium resulting in ischemic changes and secondary inflammation. The patient was discharged with the following medications: cyclosporine, eculizumab, and enoxaparin sodium. Relevant catheterization findings: A role for vascular C5b-9 deposition along with enhanced interferon alpha expression appear to be pathogentically significant at least in idiopathic cases of DD. Secondary forms of DD in the setting of other known diseases such as lupus erythematosus and dermatomyositis have been described. It is also called cutaneous systemic disease and is differentiated into two types: benign5, with only skin involvement, and malignant, S172 JACC Vol 63/12/Suppl S j April 22–25, 2014 j TCTAP Abstracts/CASE/Other (Unclassified) CASES 19th CardioVascular Summit: TCTAP 2014