Case Of Pericardial Effusion Research Articles

Dysphagia: The Primary Indicator of Esophageal Compression by a Pericardial Effusion

Introduction: Dysphagia is a relatively common symptom seen in late adulthood and can be classified as oropharyngeal or esophageal. Esophageal dysphagia typically presents due to scarring from acid reflux, strictures within the lumen, a tumor causing obstruction or an infection causing inflammation. A rare occurrence of dysphagia is reported here as an outcome of extrinsic compression of the esophagus by a large pericardial effusion. Case: A 61-year-old male with a history of DM, epilepsy, schizophrenia, vertigo and hyperlipidemia presented with an episode of hemoptysis and dysphagia for 3 weeks duration. Although this was the first account of hemoptysis, he admitted to a dry cough for a few months. He noted his dysphagia was predominantly to solids and unless he ate slowly, he would regurgitate. He denied any fever, shortness of breath, chest pain, weight loss or night sweats. On initial examination the patient was an obese male with stable vitals except for a slightly low oxygen saturation of 94%. Inspection of the neck revealed no masses. On auscultation, heart sounds were difficult to appreciate. Labs initially revealed an elevated WBC of 15.3, platelet count of 110, a blood sugar of 222 and the remaining results were within normal limits. Chest X-Ray showed infra-hilar infiltrates suggesting pneumonia and cardiomegaly. Modified barium swallow was negative. An esophagogastroduodenoscopy revealed mild extrinsic compression in the mid-esophagus but no strictures. CT of the chest showed a large pericardial effusion of 3.3 cm compressing the esophagus and chronic atelectasis with small bilateral pleural effusions. An echocardiogram confirmed a worsening pericardial effusion from 1 year previous and a dropping left ventricular ejection fraction (40-45% to 20-25%). Initial option for treatment was a pericardial window, but a cardiac catheterization revealed 2-vessel CAD with left main involvement. The patient ended up having a CABG and having his pericardial effusion drained. Follow up echocardiogram one month later revealed no pericardial effusion and a complete resolve of his dysphagia. Discussion: While there are documented cases of pericardial effusion resulting in compression of the esophagus, it is a rare occurrence. This case emphasizes that while dysphagia is often an esophageal complaint, the origin of the symptom may be non-GI and communication between GI and cardiac specialists is essential.

Computed tomography-guided pericardiocentesis: a systematic review concerning contemporary evidence and future perspectives.

Pericardial effusion (PE) can develop in several pathological scenarios, and is often initially evaluated by means of echocardiography. Computed tomography (CT) has been used as an aid in the management of patients presenting with PE, in selected cases. The role of CT-guided pericardiocentesis in contemporary practice, however, remains not fully ascertained. We aimed at presenting a systematic review concerning the state-of-the-art of this technique. A systematic review of published data on the use of CT for guiding pericardiocentesis was carried out (search performed on PubMed, ISI Web of Knowledge and Scopus databases). From title and abstract analysis, 14 articles were included that met the prespecified criteria. After full-text analysis, six articles were excluded. The eight articles under analysis included a total of 635 procedures performed in 571 patients. CT guidance was mostly used in a postoperative setting (364 procedures). Most procedures were done mainly for therapeutic purposes (528 procedures). Success rates ranged from 94% to 100%. Complications ranged from 0% to 7.8%. CT-guided pericardiocentesis is a useful technique in the approach to PE, in several clinical scenarios. Its use can be especially relevant in the postoperative period, as well as in individuals with suboptimal image quality (as assessed by echocardiography, for the moment the first choice in the approach to most cases of PE).

Cardiac tamponade by peripherally inserted central catheter in preterm infants: role of bedside ultrasonography and therapeutic approach.

to determine the incidence of pericardial effusion with cardiac tamponade in preterm infants in a pediatric intensive care unit, with emphasis on the relationship between pericardial effusion and peripherally inserted central catheter, and to evaluate the role of bedside ultrasound in approaching these cases. we conducted a retrospective analysis of patients admitted to a pediatric intensive care unit between July 2014 and December 2016, who presented pericardial effusion with hemodynamic repercussion, evaluated by ultrasonography. we studied 426 patients admitted to the five beds of the neonatal unit. In the period, there were 285 bedside ultrasound exams. We found six cases of pericardial effusion, four of which with obstructive shock and need for pericardial drainage. There was no procedure-related mortality, and all patients evolved with hemodynamic improvement after the procedure. The incidence of pericardial effusion was 2.4 cases per year. the incidence of pericardial effusion is low in neonates, but early diagnosis is fundamental due to high morbidity and mortality, especially in cases of abrupt onset. All cases were diagnosed by bedside ultrasonography, demonstrating its importance in the screening of these cases, especially in shocks of uncertain etiology and neonates with sudden onset hemodynamic instability who are using central venous access.

Endomyocardial Biopsy via the Femoral Vein Using a Long, Curved Sheath

BackgroundEndomyocardial biopsy (EMB) has been defined as the gold standard method for surveillance of rejection after heart transplantation, and it has also been used in the diagnosis of myocarditis and the unknown causes of cardiomyopathies. The procedure, however, is not free from complications. Access through the jugular vein or the femoral vein is the standard approach. In this study, we performed biopsies by using a long, curved sheath and evaluated the rate of complications with this technique. MethodsIn this descriptive case series study, 97 EMBs were performed in 72 patients who were referred to a cardiovascular and medical research center in Tehran, Iran, between October 2011 and May 2013. The procedures were performed via the femoral approach by using a long bioptome with a long, curved sheath. ResultsAdequate specimens were obtained in 97.9% of the total EMBs, with an average of 5 fragments per procedure. No deaths occurred, and there were no cases of pericardial effusion, myocardial rupture, papillary muscle rupture, increase in the severity of tricuspid regurgitation, atrioventricular block, sustained and nonsustained ventricular tachycardia, or atrial fibrillation. There was one case of persistent right bundle branch block. ConclusionsUsing a long, curved sheath can facilitate access to the interventricular septum compared with common sheaths and can be used safely in EMB via the femoral approach.

Simultaneous Transcatheter Closure of Multiple Atrial Septal Defects Using Dual Amplatzer Septal Occluder Devices

BackgroundTranscatheter closure has been a recognised treatment strategy for multiple atrial septal defects (mASDs). This study aimed to examine the feasibility, effectiveness, and safety of transcatheter closure of mASDs using dual Amplatzer septal occluder (ASO) devices. MethodsWe retrospectively reviewed 34 patients who underwent transcatheter closure of mASDs using dual ASO devices from April 2005 to December 2014. ResultsEight men and 26 women who successfully underwent transcatheter closure of mASDs were included. Ten (29.4%) patients had 3 defects or more. The mean diameters of the larger and smaller defects were 14.0±3.9 mm (8–20 mm) and 9.1±2.6 mm (4–15 mm), respectively. The mean diameters of the larger and smaller devices were 22.2±4.8 mm (13–30 mm) and 17.3±4.1 mm (10–26 mm), respectively. Devices were deployed by the “sandwiches” technique or an interleaved pattern. Immediately after the procedure, 23 (67.6%) patients had complete closure and 11 patients had a residual shunt (6 trivial, 3 small, 1 moderate, 1 large). During the 6 months of follow-up, 30 (88.2%) patients had complete closure of the shunt and 4 patients had a residual shunt (1 large, 3 small). Complications included 2 cases of pericardial effusion, which disappeared at 3 months. ConclusionsSimultaneous device implantation in transcatheter closure of mASDs is feasible and effective. The incidence rate of residual shunts is slightly high in the short term, but tends to decrease during mid-term follow-up.

Pericardial Effusion in the Setting of Takosubo Cardiomyopathy

We present a case of pericardial effusion in the setting of Takosubo Cardiomyopathy. Our case is instructive in highlighting the importance of careful clinical observation in the setting of decreased left ventricular function and also in challenging out understanding of the pathophysiology of Takosubo Cardiomyopathy. This case demonstrates how Takosubo Cardiomyopathy can extend beyond the myocardium into the pericardium where the inflammatory response can present in the form of a pericardial effusion. Here we report an incident of Takosubo Cardiomyopathy with the development of pericardial effusion.

Pericardial effusion: A paradoxical presentation of tuberculosis treatment

Paradoxical reactions (PRs) in patients of tuberculosis on antitubercular treatment (ATT) are a well-known entity, but pericardial effusion as a PR to ATT is almost an unheard phenomenon. Here, we report a rare case of pericardial effusion developing after the initiation of ATT in an immunocompetent patient, which resolved after the addition of steroids to his treatment.

艾滋病合并肺结核187例患者胸部CT表现

目的：通过总结艾滋病(AIDS)合并肺结核的胸部CT表现，探讨其影像学特征。方法：回顾性分析187例AIDS合并肺结核病人的胸部CT影像资料。结果：157例患者双肺均受累，170例累及两叶及两叶以上；CT表现为粟粒性肺结核者98例，干酪样肺炎35例，空洞样病变24例，并发纵隔淋巴结肿大101例，胸腔积液80例，心包积液22例。结论：艾滋病合并肺结核患者胸部CT表现多不典型，病变部位不典型，累及范围广泛，以粟粒样结核干酪样肺炎常见，常合并纵膈淋巴结肿大及胸腔积液，CT能显示AIDS合并肺结核的各种影像特征。 Objective: To explore the CT imaging features by summarizing the chest CT image of AIDS patients with pulmonary tuberculosis. Methods: The chest CT imagines of 187 AIDS patients with pulmonary tuberculosis were retrospectively analyzed. Results: 157 cases of patients with two lung are involved, 170 cases involve more than two leaves and two leaves; CT showed miliary tuberculosis 98 cases, 35 cases of pneumonia-like cheese, hole-like lesions in 24 cases, 101 cases of concurrent mediastinal lymphadenopathy. Pleural effusion was 80 cases, 22 cases of pericardial effusion. Con- clusion: The chest CT finding of AIDS patients with pulmonary tuberculosis is atypical, the lesion is not typical, involving a wide range, with miliary tuberculosis Caseous pneumonia common, often associated with mediastinal lymphadenopathy and pleural effusion. Imaging features of pulmonary tuberculosis with AIDS can be showed by CT.

Pericardial effusion in the setting of Takosubo Cardiomyopathy

We present a case of pericardial effusion in the setting of Takosubo Cardiomyopathy. Our case is instructive in highlighting the importance of careful clinical observation in the setting of decreased left ventricular function and also in challenging out understanding of the pathophysiology of Takosubo Cardiomyopathy. This case demonstrates how Takosubo Cardiomyopathy can extend beyond the myocardium into the pericardium where the inflammatory response can present in the form of a pericardial effusion. Here we report an incident of Takosubo Cardiomyopathy with the development of pericardial effusion.

Sanguineous Pericardial Effusion and Cardiac Tamponade in the Setting of Graves' Disease: Report of a Case and Review of Previously Reported Cases.

Introduction. Pericardial effusion in the setting of hyperthyroidism is rare. We present a patient with Graves' disease who developed a sanguineous pericardial effusion and cardiac tamponade. Case Description. A 76-year-old man presenting with fatigue was diagnosed with Graves' disease and treated with methimazole. Two months later, he was hospitalized for uncontrolled atrial fibrillation. Electrocardiography showed diffuse low voltage and atrial fibrillation with rapid ventricular rate. Chest radiograph revealed an enlarged cardiac silhouette and left-sided pleural effusion. Thyroid stimulating hormone was undetectable, and free thyroxine was elevated. Diltiazem and heparin were started, and methimazole was increased. Transthoracic echocardiography revealed a large pericardial effusion with cardiac tamponade physiology. Pericardiocentesis obtained 1,050 mL of sanguineous fluid. The patient progressed to thyroid storm, treated with propylthiouracil, potassium iodine, hydrocortisone, and cholestyramine. Cultures and cytology of the pericardial fluid were negative. Thyroid hormone markers progressively normalized, and he improved clinically and was discharged. Discussion. We found 10 previously reported cases of pericardial effusions in the setting of hyperthyroidism. Heparin use may have contributed to the sanguineous nature of our patient's pericardial effusion, but other reported cases occurred without anticoagulation. Sanguineous and nonsanguineous pericardial effusions and cardiac tamponade may be due to hyperthyroidism.

Initial experience and treatment of atrial fibrillation using a novel irrigated multielectrode catheter: Results from a prospective two-center study

BackgroundPV electrical isolation has become the cornerstone of catheter ablation for the treatment of atrial fibrillation (AF). Several strategies have been proposed to achieve this goal. The aim of this study was to assess the efficacy and safety of AF ablation using a new circular irrigated multielectrode ablation catheter designed to achieve single-delivery pulmonary vein (PV) isolation. MethodsThirty-five patients with drug refractory paroxysmal AF and normal ejection fraction from two centers were prospectively enrolled in this study. All patients underwent PV isolation with an nMARQ circular irrigated multielectrode ablation catheter guided by an electroanatomic mapping system. Magnetic resonance imaging was performed to exclude PV stenosis. ResultsPV isolation was achieved in 138 of 140 (98.57%) targeted veins. The mean procedure time was 79.5min (SD 39.3min). During a mean follow up of 16.8±2.8 months, 27 of 35 (77.2%) patients were free of AF. No PV narrowing was observed. One case of pericardial effusion due to perforation of the left atrial free wall during catheter manipulation did occur. ConclusionsPV isolation with a circular irrigated multielectrode ablation catheter is a feasible technique with a high acute success rate. The majority of patients remained asymptomatic during the midterm follow-up period. PV stenosis was not detected. While only a single serious adverse event occurred, this technique׳s safety profile should be tested in larger studies.

Abstract A41: Life-threatening pericardial effusion following resolution of transient myeloproliferative disorder (TMD).

Abstract Objective: Transient myeloproliferative disorder (TMD) is an abnormal myelopoiesis seen in approximately 10% of newborns with Down Syndrome (DS). It is typically asymptomatic and regresses within 3 months. During active disease, complications include: hepatic fibrosis, organomegaly, bleeding, and pericardial effusions (PE). We report what we believe to be a first case of PE following remission of TMD. Our case involved a 5 week old female infant, former 35 week gestation, with Down Syndrome. On the first day of her life, she had WBC = 36,000 with a left shift and 27% blasts, without organomegaly, consistent with Children's Oncology Group (COG) “low risk” TMD, and was transferred to our institution. In addition the infant had prenatally diagnosed PE. Both the TMD and the PE resolved prior to discharge at 14 days of life, confirmed by echocardiogram. There was no congenital heart disease or hypothyroidism. The infant was feeding well and gaining weight until she re-presented at 4 weeks of life in cardio-respiratory failure and acidosis, requiring emergency resuscitation secondary to cardiac tamponade. Her initial pH was 6.9 with base excess of -17. She rapidly improved following drainage of the pericardial effusion; repeat pH 1 hour later was 7.32 with base excess -8.7. At the time the CBC and differential was completely normal. The pericardial fluid showed excess of eosinophils (10%) , however there were no blasts. She has done well since that time, with a subsequent normal ECHOs and CBCs. Methods: We conducted a literature search via PubMed for cases of pericardial effusion following resolution of Transient Myeloproliferative Disorder and found no similar cases. Our search included MeSH terms “transient myeloproliferative disorder” and keywords “Down Syndrome review” and “pericardial effusion.” Publications not involving pericardial effusion in Down Syndrome patients were excluded. Results: Our PubMed search of the MeSH term “transient myeloproliferative disorder” with keywords “Down syndrome review” and “pericardial effusion” yielded 55 and 7 articles respectively. PE with active TMD or hypothyroidism is well described in DS patients. The COG trial A2971 identified 10-15% with PE, in the presence of active TMD. Shenoy (2008) and Strobelt (1995) each described cases of pericardial effusion in a Down Syndrome patient with proliferative TMD. Discussion: PE is a known cause of morbidity in TMD when linked to active TMD or hypothyroidism. Pericardial effusion is a known cause of morbidity in TMD and can occur in isolation, however it is extremely rare that it would occur in resolved TMD. There are reported cases of pericardial tamponade in Down Syndrome individuals, but these have been linked to TMD or hypothyroidism. Gamis' (2011) review of the COG trial A2971, which studied the natural history of TMD, identified mortalities within a risk stratification system, however these patients all had active TMD. Shenoy (2008) described another case of an eosinophilic pericardial effusion in a DS patient, but again, the patient had proliferative TMD. We believe our case is the first description of PE in a patient in remission from TMD. Conclusion: Our case highlights a potentially life-threatening and unexpected sequelae in Down Syndrome patients, with apparently resolved TMD. Future direction could include regularly screening patients with resolved TMD for PE, particularly if there is a history of PE in the past. Citation Format: Nitya A. Narayan, Damien Kenny, Paul Kent. Life-threatening pericardial effusion following resolution of transient myeloproliferative disorder (TMD). [abstract]. In: Proceedings of the AACR Special Conference on Hematologic Malignancies: Translating Discoveries to Novel Therapies; Sep 20-23, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(17 Suppl):Abstract nr A41.

An unexpected cause of pericardial effusion.

We present a case of pericardial effusion due to embolization of a fragment of an inferior vena cava (IVC) filter, with subsequent perforation of the right ventricle. This is a rare and unexpected cause of pericardial effusion. Fracture or embolization of IVC filters is a relatively uncommon complication, but these events may have serious clinical implications. Although IVC filters are often placed with the intent of removal, the device in many patients is never removed. The long-term implications of IVC filter placement must be kept in mind when making decisions about device placement and subsequent removal.

Clinical presentation and cytopathologic features of malignant pericardial cytology: a single institution analysis spanning a 29-year period

Pericardial effusion can be a consequence of various diseased states, including infection, autoimmune disease, renal failure, myocardial disease, and neoplasms. Although multiple case reports of malignancy-associated pericardial effusion have been published, few database analyses are available in these published reports. In this study, we retrospectively reviewed 1022 cytology cases and assessed malignancy-associated pericardial effusion. We reviewed our cytology reports for pericardial effusion cases from January 1, 1983 to July 31, 2013. These cases were classified as benign, atypical, malignant, and nondiagnostic. The malignant cases were further characterized based on either immunohistochemical staining results or patients' history. We identified 1022 cases and grouped them as follows: 824 benign (80.6%), 38 atypical (3.7%), 158 malignant (15.4%), and 2 unsatisfactory (0.1%). Malignant cases included 131 adenocarcinoma (82.9%), 12 lymphoma (7.9%), 6 poorly differentiated carcinoma (3.8%), 4 mesothelioma (2.5%), 2 squamous cell carcinoma (1.3%), 1 melanoma (0.6%), 1 sarcoma (0.6%), and 1 small cell carcinoma (0.6%). Of these 131 adenocarcinomas, 83 cases had clinical history and/or immunohistochemical study available for further classification, which included 44 lung, 18 breast, 7 esophagogastric adenocarcinomas, 6 adenocarcinomas of unknown primary sites, 5 ovarian, and 2 rectal adenocarcinomas. The clinical presentation, prognosis, and cytopathologic features for malignant pericardial effusions are summarized. In this study, 15.4% of pericardial effusion cases were caused by metastatic malignancy, with lung adenocarcinoma being the most common primary site, followed by breast and lymphoma. Relatively young patients are affected, with average age being 56 years. Prognosis is poor for patients with malignant pericardial effusion. However, targeted therapy showed improved survival.

Genexpert technology: A new ray of hope for the diagnosis of tuberculour pericardial effusion

Tuberculous pericardial effusion is a well-known complication of tuberculosis (TB). However, the greatest challenge in front of clinicians is its diagnosis as the conventional methods lack the required sensitivity and specificity of detection. The emergence of drug resistance and co-infections such as human immunodeficiency virus further complicates the situation making it difficult to diagnose such cases. GeneXpert technology is a major breakthrough in the field of TB diagnosis and has opened newer avenues for many new molecular tests to be launched in the future. The World Health Organization endorsed this technology in 2010 for rapid and simultaneous detection of Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. GeneXpert-MTB/RIF assay was highly recommended as an initial diagnostic platform in high burden countries for early and quick detection of TB cases. Until date, very few studies have evaluated the performance of this brilliant assay in pericardial effusion cases, thus, more studies are required to address the unanswered questions left so far. Our review attempts to recapitulate the achievements, the potential impacts and the prospective use of this novel technology in early diagnosis of TB, especially focussing pericardial effusion cases.

Post-operative pericardial effusion following treatment of small hepatocellular carcinoma with radiofrequency ablation: A case report

Radiofrequency ablation (RFA) is a minimally invasive technique used to treat liver tumors. The current study presents the case of a patient with hepatocellular carcinoma who suffered from post-operative pericardial effusion following RFA treatment. We hypothesize that RFA thermal conduction may damage the diaphragm and pericardium, leading to local edema in the pericardium. RFA is a minimally invasive technique, however, adequate preparatory work must be performed prior to surgery, including a comprehensive assessment of the patient. During surgery, the location and extent of the region to receive RFA must be determined precisely in order to reduce the range of damage and to avoid post-operative complications. This study describes a case of pericardial effusion caused by RFA of liver cancer. We analyzed the causes and preventive measures for pericardial effusion in order to contribute to the prevention pericardial effusion that is complicated by RFA of liver cancer.

A case of spontaneous chylous pericardial effusion in Poland syndrome

Chylous pericardial effusion is an uncommon entity that is most commonly associated with post-cardiac surgery, in particular aortic valve and minimally invasive cardiac surgery. Post-radiation therapy, infection, mediastinal neoplasm, lymphoma and a small group of idiopathic, spontaneous chylous pericardial effusion have also been reported as the causes. Here, we report a rare case of pericardial effusion secondary to chylous fistula in a 63-year-old man with Poland syndrome. The case highlights an unusual thoracic duct anomaly as a cause of our reported chylous pericardial effusion.

Case report: Methotrexate-induced pericardial effusion

We report a case of pericardial effusion induced by methotrexate in a patient with low risk gestational trophoblastic neoplasia, who had been taking the first course of sequential methotrexate-folinic acid treatment. After aspiration of pericardial effusion another methotrexate-folinic acid course was given and the pericardial effusion did not relapse.

Etiological Profile, Clinical Features and Medical Management of Acute Pericarditis in Burkina Faso

Diagnosis of acute pericarditis is sometimes difficult but the first challenge to the clinician is to establish an etiologic diagnosis. This study aimed to describe etiologies of this pathology and its clinical pictures, and expose the medical treatment and outcome, at the time of the success of antiretroviral treatment. Through a prospective study, we follow up a sample of patients presenting acute pericarditis from January 2010 to December 2011. There were 43 cases composed of 20 men and 23 women. The average age was 41.4 ± 16.1 years. The leading clinical signs were infectious syndrome (100%), dyspnea (86%), and chest pain (79.1%). Right heart failure was found in 27.9% of cases, hypotension in 23.2% of cases and pulsus paradoxus in 20.9% of cases. Echocardiography found pericardial effusion in 88.4% of cases. This effusion was of great amount in 26.3% of cases of pericardial effusion. Cardiac tamponade was encountered in six cases. We identified an etiology in 88.4% of cases. These etiologies were tuberculosis in 47.4% of cases. As treatment, anti-tuberculous drugs associated to corticosteroids were systematic in tuberculous forms. In other cases, we used aspirin associated to corticosteroids or colchicine as appropriate. Six cases of recurrence were observed in exclusively tuberculous forms. Two cases of deaths were occurred.

Letter by Kern Regarding Article, “High-Pressure Loculated Pericardial Effusion in Postpericardiotomy Syndrome”

To the Editor: Drs Syros and Maysky1 present a remarkable case of pericardial effusion due to post pericardiotomy syndrome in an 81-year-old man. I am confused about the hemodynamics displayed in Figure 2, which shows a pericardial pressure that appears to be exactly like that of a right ventricular …