Case Of Pericardial Effusion Research Articles

Application of cell blocks to assist in precise cytological diagnosis of serous effusion

Objective: To investigate the importance of cell block and immunohistochemistry in the accurate diagnosis of serous effusion. Methods: A retrospective study was conducted on 3 124 cases of serous effusion from the Department of Pathology, Beijing Hospital from 2018 to 2022, include 2 213 cases of pleural effusion, 768 cases of peritoneal effusion, 143 cases of pericardial effusion. There were 1 699 males (54.4%) and 1 425 females (45.6%), average age 69 years old. Of which 1 292 cases were prepared with cell blocks and examined with immunohistochemical stain. Results: The percentage of malignant diagnosis increased from 64.9% (839/1 292) to 84.0% (1 086/1 292) after cell block preparation, and 1 086 cases were accurately diagnosed with histological type and/or origin of primary tumor. The undetermined diagnosis of suspected malignancy decreased from 13.3% (172/1 292) to 0.1% (1/1 292) and that of atypical hyperplasia from 18.8% (243/1 292) to 0.4% (5/1 292). The negative result for malignancy rate increased from 3.0% (38/1 292) to 15.5% (200/1 292). The differences highlighted above were statistically significant (Pearson's chi-squared test=12.739, P<0.01). Conclusion: Application of immunohistochemistry based on cell block can significantly improve malignant diagnosis in serous effusion, identify tumor origin and histological type as well as decrease the uncertain diagnosis.

The challenge of transseptal access for catheter ablation of left-sided arrhythmia substrate in infants and small children under 6 years of age

Abstract Background Young age and small cardiac dimensions are increased risk factors for catheter ablation (CA), therefore ablation below 15 kg should be recommended only in selected drug-refractory cases. The need for a transseptal puncture (TSP) may be an additional risk factor. Persistent foramen ovale (PFO) in infants can mitigate this risk and paradoxically, decrease the complication rate in the very young. Purpose This study aimed to compare the results of left-sided CA in infants under 1 year and in children between 1-6 years of age. Methods Between January 2010 and September 2023, 1703 pediatric CAs were performed, of which 17 left-sided ablations in children under 6 years without structural heart disease were retrospectively evaluated. CA results below 1 year and between 1-6 years of age were compared in terms of body size, procedural parameters, left atrial (LA) access, complication, and success rate. Results The patient group below 1 year (Group 1, n=5) has a mean age=0.13±0.03 years, mean body weight=3.6±1.1 kg, mean height=52.3±3.6 cm. Patients between 1-6 years (Group 2, n=12) have mean age=5.0±1.1 years, mean body weight=17.9±2.2 kg, mean height=111.2±7.4 cm. The arrhythmia substrate was an overt pathway in 3 pts (17.6%), concealed accessory pathway in 7 pts (41.2%), and focal LA tachycardia in 7 pts (41.2%). Foramen ovale was persistent in all 5 children in Group 1 and TSP was not required. In Group 2, only 2 pts (16.7%) had PFO, and, all other procedures required TSP. TSP was successful in 9/10 cases (90%). No complications related to LA access or other adverse events occurred in Group 1. In Group 2, there was one case of pericardial effusion that spontaneously regressed and one case of mechanical-induced advanced AV block that resolved after six days. There were no significant differences in procedure time, fluoroscopic time, and radiation dose between the two groups (Group 1: 126.4±47.0 min, 6.4±4.5 min, 4.0±5.3 cGycm2 vs. Group 2: 162.6±49.2 min, 7.9±9.4 min, 9.0±12.4 cGycm2, p&amp;gt;0.05). All CAs were performed with RF energy. The acute success rate of the procedures was 100%. Conclusion CA of left-sided arrhythmias in infants and small children may offer a safe and effective therapeutic option in selected cases. The high prevalence of PFO may explain the paradoxically less complication under 1 year of age.

Focused assessment with sonography for trauma exam for diagnosis of pericardial effusion in penetrating thoracic trauma – A retrospective review from a level 1 trauma center

IntroductionPoint of care ultrasound has long been used in the trauma setting for rapid assessment and diagnosis of critically ill patients. Its utility for diagnosis of pericardial effusion in the setting of penetrating thoracic trauma has more recently been a topic of consideration, given the rapid decompensation that these patients can experience. ObjectivesThis study aims to identify the diagnostic accuracy of point of care ultrasound in the diagnosis of pericardial effusion among patients with penetrating thoracic trauma. MethodsRetrospective review of 2099 patients brought to the trauma bay between the years 2016 and 2021 were analyzed for diagnosis of pericardial effusion. Patients who were diagnosed with a pericardial effusion were investigated for point of care ultrasound findings. Descriptive statistics were performed to identify sensitivity, specificity, positive predictive value, and negative predictive value. ResultsPrevalence was calculated to be 26.7 cases of pericardial effusion per 1000 patients presenting with penetrating thoracic trauma. Incidence was estimated to be 3.8 cases of pericardial effusion per 1000 person-years. Calculation of diagnostic capabilities of ED POCUS revealed a sensitivity of 96.36 ​%, a specificity of 100 ​%, PPV of 100 ​%, and NPV of 99.90 ​%. ConclusionsPoint of Care cardiac ultrasonography is a reliable tool for the rapid diagnosis of pericardial effusion in penetrating thoracic trauma patients. Patients with ultrasound suggestive of this condition should receive rapid surgical management to prevent decompensation.

Multisystem inflammatory syndrome in children (MIS-C) post-COVID-19 in Iran: clinical profile, cardiac features, and outcomes

BackgroundIn April 2020, an association between multisystem inflammatory syndromes (MIS-C) was observed in children with severe acute respiratory syndrome coronavirus infection (SARS-CoV-2). Most patients had heart involvement alone, and most patients had pericardial effusion. This study aimed to express and emphasize cardiac involvement in pediatric patients with respiratory symptoms who were diagnosed with COVID-19.MethodsThis study was conducted in July 2021 in Kerman province, Southeastern Iran, during a notable surge in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. The study included 904 pediatric patients diagnosed with COVID-19. Data collection involved a comprehensive assessment of clinical symptoms and manifestations. Patients with fever lasting more than five days were admitted to the hospital. Echocardiography was utilized for cardiac involvement diagnosis, with 47 patients undergoing this diagnostic procedure.ResultsOf the 904 patients, most of them had high fevers (74%). Fifty-five patients had a fever for more than five days and were hospitalized. Of the 47 patients who underwent echocardiography, 45 (81%) had heart involvement. In 75% of patients, pericardial effusion was the only cardiac involvement. Patients with pericardial effusion were treated with dexamethasone up to 3 mg every 8 h for 72 h.ConclusionsMIS-C has a wide range of clinical symptoms. In cases where the fever is prolonged and there are gastrointestinal symptoms, physicians have clinical suspicion to diagnose this syndrome. Most cases of pericardial effusion are alone and improve with treatment with glucocorticosteroids.

Feasibility of transcatheter device closure of secundum atrial septal defect under transthoracic echocardiography guidance.

Objective: To determine the usefulness and safety of transthoracic echocardiography (TTE) imaging for real time guidance in transcatheter device closure of atrial septal defect (ASD) secundum. Study Design: Cross-sectional study. Setting: Department of Paediatric Cardiology, CPEIC, Multan, Pakistan. Period: January 2022 to December 2023. Material &amp; Methods: Patients of both genders aged above 3 years with clinical and echocardiographic evidence of ASD secundum with significant left to right shunt were analysed. All cases had morphologically suitable margins of defect confirmed on TTE. Usefulness and safety of intra-procedure and immediate post-procedure transcatheter device closure of secundum ASD were noted. Results: In a total of 34 patients, 20 (58.8%) were female and 14 (41.2%) male. The mean age was 21.32±17.21 years. The TTE findings revealed that the mean ASD side was 17.47±4.32 mm. Aortic margins were deficient among 28 (82.4%) cases. The mean fluoroscopy and procedure time were 9.29±6.98 minutes and 49.91±39.76. Residual leak was noted in one (2.9%) cases while none of the cases were observed to have superior vena cava, inferior vena cava or pulmonary vein obstructions. Post-procedure, transient supraventricular tachycardia (SVT) arrhythmia was the most common type of complication reported among 2 (5.9%) cases. None of the cases needed any kind of emergency surgical exploration. No cases of pericardial effusion were found. No mortality was reported. Conclusion: Transcatheter device closure of secundum atrial septal defect was found to be effective and safe using TTE.

THU660 Pericardial Effusion Secondary To Uncontrolled Hypothyroidism

Abstract Disclosure: G.D. Cain: None. D. Goldsmith: None. E. Ruel: None. Introduction: Hypothyroidism is an endocrine disorder that can effect multiple organ systems. Pericardial effusion is a rare but significant complication of hypothyroidism. Early diagnosis and management of the pericardial effusion is important to prevent progression to cardiac tamponade and hemodynamic instability. We present a case of pericardial effusion in a 62-year-old female with hypothyroidism and medication non-compliance. Case Presentation: A 62-year-old female with past medical history of hypothyroidism and hypertension presented to the emergency department due to altered mental status. Patient's family reported that she had a progressive decline in her speech for more than a month, until she became completely aphasic on day of presentation, which prompted them to call EMS. Patient had diminished exercise capacity, dyspnea on exertion, bilateral pedal edema over the past couple of months. Family also reported that the patient had been depressed and negligent of her health following the passing of her husband three years ago. She was not taking her medications including levothyroxine. In the ED, patient was hypertensive, blood pressure was 190/100. CT head stroke protocol did not show stroke. Chest x-ray showed massive cardiac enlargement. 2D-Echo confirmed a large pericardial effusion without cardiac tamponade. Thyroid function panel showed high TSH of 77, free T4 was undetectable. Pericardial effusion was most likely secondary to hypothyroidism. Myxedema coma was suspected due to patient's progressive mental deterioration. Patient also had myxedema of bilateral lower extremities. IV levothyroxine and hydrocortisone were started with improvement in her symptoms. A pericardial window was performed by the thoracic surgeon for her large pericardial effusion. Patient had large amounts of drainage from JP pericardial drain for more than two weeks following the surgery. JP drain was removed after the amount of drainage decreased to less than 100 ml a day. Cultures and cytology for malignancy were sent and all came back negative. Patient’s symptoms improved with treatment and the she was discharged on levothyroxine 137 mcg daily. Patient was counseled to take her medication regularly. Follow-up appointments were arranged with primary care provider and endocrinology. Discussion: Pericardial effusion is a rare complication of hypothyroidism, more likely to be seen in severe, untreated hypothyroidism such as in this case. The mechanism of pericardial effusion in hypothyroidism is through increased capillary permeability in heart and decreased lymphatic drainage of albumin, resulting in accumulation of fluid in the pericardial space. The effusion develops over time and patients can have large amounts of volume at the time of diagnosis without tamponade physiology. Early diagnosis is important to avoid tamponade and hemodynamic instability. Presentation: Thursday, June 15, 2023

Feasibility and safety of a percutaneous and non-fluoroscopic procedure for left atrial appendage closure in patients for whom fluoroscopy presents risk: a cohort study.

Most patients undergoing left atrial appendage closure (LAAC) are older adult individuals with atrial fibrillation (AF) and many comorbidities, which may elevate the risk for complications associated with contrast agents with the fluoroscopic image-guided procedure. This retrospective cohort study of patients with AF at high risk for use of contrast agents compared the feasibility and safety of LAAC using percutaneous and non-fluoroscopic procedure with transesophageal echocardiography (TEE) as the only image guidance relative to those under fluoroscopic image guidance. In this retrospective study, we enrolled 126 patients with AF who underwent LAAC from September 2017 to December 2020. Patients were divided into 2 groups based on the imaging guidance modality: a TEE group (n=32) and a fluoroscopic group (n=94). We analyzed the differences in complete closure rates and device- and procedure-related complications between the 2 groups. Continuous variables were assessed using the Student t-test or Mann-Whitney test, while categorical variables were evaluated using Pearson chi-squared test or Fisher exact test. Propensity-score matching was used to adjust for baseline differences. Propensity-score matching yielded 25 pairs of patients with similarly distributed age (72.9±6.9 vs. 73.1±4.9 years; P=0.925), gender (10:15 vs. 11:14; P>0.99), weight (68.3±11.2 vs. 68.1±12.3 kg; P=0.948), and alanine aminotransferase level (20.0±9.8 vs. 22.5±14.2 U/L; P=0.482). The LAA was successfully occluded in all patients, and the TEE group showed similar results to the fluoroscopic group in terms of success rate (100% vs. 100%; P>0.99) and hospitalization duration [5.0 (IQ1-IQ3: 3.0-7.0) vs. 5.0 (IQ1-IQ3: 3.0-6.0) days; P=0.498]. The groups also demonstrated comparable complication rates, with 1 (4.2%) case of pericardial effusion and 1 (4.2%) case of residual shunt in the TEE group, and 5 (20%) cases of residual shunt, 1 (4.2%) case of pericardial effusion, 1 (4.2%) case of myocardial infarction, and 1 (4.2%) case of access-related complications in the fluoroscopic group. There were no deaths. The overall incidence rate of procedure-related complications (6.2% vs. 18.1%, P=0.153) at mean 22.2±4.5 months follow-up between the 2 groups was similar. In patients with AF of high risk for use of contrast agents, LAAC under non-fluoroscopic guidance appears feasible and safe with similar outcomes to that under fluoroscopic guidance.

Gone without a Trace: A Rare Case of Pericardial Effusion Resolving after Cardiopulmonary Resuscitation

Gone without a Trace: A Rare Case of Pericardial Effusion Resolving after Cardiopulmonary Resuscitation

P283 PULMONARY, CARDIAC AND NEUROLOGIC FOLLOW–UP AFTER SEVERE COVID–19 PNEUMONIA

Abstract Background Since December 2019 COVID–19 has been burdening all health systems worldwide. However, pulmonary and extrapulmonary sequelae of COVID–19 after recovery from the acute disease are still under study. Purpose: The aim of this study was to investigate pulmonary impairments, neurologic disorders and the prevalence of right ventricle dysfunctions in patients with severe COVID–19 pneumonia, almost six months after discharge from hospital. Material and methods: Hospitalized COVID–19 patients with severe pneumonia, requiring mechanical ventilation were included in the study and evaluated at about 6 months after hospital discharge. Pulmonary function tests, echocardiography, EMG were performed to all patients, and a sitting psychotherapy was proposed. Results A total of 56 patients (median age 64 years) with severe COVID–19 pneumonia were included in the study. The disease was complicated by pulmonary embolism in 5 patients, by cerebral stroke in 1 patient, by bacterial infections in 4 patients, by pericarditis in 1 patient, by Guillain Barrè syndrome in 2 patients. At almost 6 months after hospital discharge, 17 patients (30%) had dyspnea NYHA II, 1 was in NYHA III (1.8%), and 4 (7%) suffered from symptoms of fatigue. Pulmonary function tests did not reveal any significant limitation (FVC: 96.9% {78–101}; FEV1: 99% {72–103}; FEV1/FVC 81.3% {76–85}; except for slightly reduced DLCO (61% {69–95}). Only 3 (5%) patients developed a severe DLCO alteration, among them only one patient had acute pulmonary embolism. There were no echocardiographic impairments, in particular right chambers were normal in size and function (median TAPSE=23 mm, median S1 = 12 cm/sec) and there were no cases of pericardial effusion. From the neurological point of view, in addition to the 2 patients who have developed a Guillain Barré syndrome, the patients recovered from COVID–19 who have left the Resuscitation of our Hospital have manifested after–effects of Critical Illness Myopathy and Neuropathy (CRIMYNE), a form of neuromuscular pathology considered in all respects an "organ failure" linked to the stay in intensive care caused by inflammatory mediators. Conclusions Hospitalized patients with severe COVID–19 pneumonia, requiring mechanical ventilation, are unlikely to develop pulmonary long–term impairments or cardiac dysfunction after discharge, but frequently suffer from symptoms of fatigue and persisting dyspnea on effort, due to CRIMYNE syndrome.

Echocardiographic indicators of anthracycline cardiotoxicity in breast cancer patients with normal left ventricular ejection fraction: Experience of the first cardio-oncology unit in Morocco

Anthracycline is a mainstay in the treatment of many cancers, especially breast cancer. Anthracyclines are known for their significant cardiotoxic potential. Although the cardiotoxicity induced by anthracyclines is dose-dependent and often irreversible, it can occur very early at the start of treatment and sometimes even very late after several years from the end of treatment. The aim of this study was to assess whether echocardiographic measurements of LV function, in the case of normal LVEF, predict the development of anthracycline cardiotoxicity in patients followed for breast cancer. We conducted a longitudinal study of 2329 cancer patients including 2284 female breast cancer survivors, recruited from the cardio-oncology unit in Casablanca, who were diagnosed with primary invasive breast cancer between January 2017 and April 2022. All patients underwent pre-, per- and post-chemotherapy echocardiography. LV volumes, LVEF, MAPSE, S’LV, maximum longitudinal strain were measured. Of 2284 patients, 64% had normal resting LVEF. Mean LVEF was 56 ± 5%, global longitudinal strain (GLS) was −17.4 ± 2.2%, and LV end diastolic volume (LVEDV) was 108 ± 17 mL, MAPSE was 17 ± 5 mm and S’VG was 9+/4 cm/s. 12% percent presented with cardiotoxicity: heart failure with alteration of LVEF by more than 15% (CI) in 163 patients, 67% of whom had an altered S’LV < 8 cm/s) and an altered SGL (>−18%), arterial hypertension in 58 patients, 17 cases of pericardial effusions, 15 cases of arrhythmias, 6 cases of 3rd degree atrioventricular block and 3 cases of right ventricular dysfunction. Age, diabetes, obesity, GLS and LVEDV were all predictive of MACE (P = 0.028, 0.017, 0.041, 0.038 and 0.014 respectively). In patients treated with anthracyclines with normal pre-chemotherapy LVEF, longitudinal function (MAPSE AND S’LV) and baseline GLS predict the development of cardiotoxicity. This helps us to develop algorithms for close monitoring in this type of patient.

Cardiohemodynamic Changes and Cardiac Arrhythmias After Coronavirus Infection

Aim To study changes in cardiohemodynamic alterations of the myocardium and heart rhythm disorders at 3 and 6 months following the coronavirus infection.Material and methods EchoCG, ECG Holter monitoring, and Doppler ultrasonography of hepatolienal blood vessels were performed for 77 patients (mean age, 35.9 years) at 3 and 6 months after coronavirus infection. The patients were divided into the following groups: group 1, with injury of the upper respiratory tract; group 2, with bilateral pneumonia (CТ1, 2), and group 3, with severe pneumonia (CТ3, 4). Statistical analysis was performed with a SPSS Statistics Version 25.0 software package.Results At 6 months after the disease onset, the patients noted an improvement of their general condition. In patients with moderate pneumonia, early peak diastolic velocity (p=0.09), right ventricular isovolumic diastolic time (р=0.09), and pulmonary artery systolic pressure (р=0.005) where decreased, while tricuspid annular peak systolic velocity was, in contrast, increased (р=0.042). Both segmental systolic velocity of the LV mid-inferior segment (р=0.006) and the mitral annular Em / Am ratio were decreased. In patients with severe disease at 6 months, right atrial indexed volume was reduced (р=0.036), tricuspid annular Em / Am was decreased (р=0.046), portal and splenic vein flow velocities were decreased, and inferior vena cava diameter was reduced. Late diastolic transmitral flow velocity was increased (р=0.027), and LV basal inferolateral segmental systolic velocity was decreased (р=0.046). In all groups, the number of patients with heart rhythm disorders was decreased, and parasympathetic autonomic influences prevailed.Conclusion At 6 months after coronavirus infection, practically all patients noted improvement of their general condition; incidence rate of arrhythmia and cases of pericardial effusion were decreased; and autonomic nervous system activity recovered. In patients with moderate and severe disease, morpho-functional parameters of the right heart and the hepatolienal blood flow were normalized, however, occult disorders of LV diastolic function remained, and LV segmental systolic velocity was reduced.

Chylopericardium or contamination by injectable lipid emulsion?

Effusions can show some surprises. We document the case of a fourteen-month-old male patient with short-bowel syndrome, hospitalized in a cardiology unit, receiving a chronic parenteral nutrition by a Broviac® catheter. The patient presented several thrombosis following iterative catheter replacements. In parallel with superior vena cava plasty, a right intra-atrial Broviac® catheter was placed in the absence of other peripheral venous accesses. This device has a cutaneous exit site to allow for infusion of a hyperosmolar lipid emulsion. Seven days later, a milky liquid was secreted from pericardial/mediastinal redon. A gel lipoprotein electrophoresis of the fluid suggested a preliminary diagnosis of chylopericardium. However, biochemical testing of certain analytes evoked a parenteral nutrition-related pericardial effusion and a possible pseudochyloperitoneum caused by the shearing of a migrated Broviac® in pericardium. The patient, on a fat-free diet, was admitted to the ICU to drain the effusion and reposition the catheter, with success. In the light of new datas on the interference of parenteral lipid emulsions with the lipoproteins gel electrophoresis, we will try to determine whether the apparent presence of chylomicrons in the gel would be the sign of a lesion of the lymphatic system, or rather the result of a contamination by artificial chylomicron in the lipid emulsion, if not the sign of contaminated blood. In our article, we highlight several considerations in identifying and confirming cases of pericardial effusion, such as chylopericardium and parenteral nutrition-related one, as well as points concerning the use of lipid emulsions for pediatric patients with short-bowel syndrome.

THE ROLE OF CHEST RADIOGRAPHY TO DIAGNOSE LARGE PERICARDIAL EFFUSION IN WOMAN 66 YEARS OLD WITH MALIGNANCY : HIDING PERICARDIAL EFFUSION

Introduction: Pericardial effusion refers to an increase in fluid accumulation in the pericardial cavity. This pericardial fluid acts as a lubricant between the layers of the pericardium. We report a case of pericardial effusion, which was significant but not detectable on conventional chest radiographs.Case: A 66-year-old woman with lung adenocarcinoma accompanied by large pericardial effusion without sign of impending tamponade. The diagnosis of pericardial effusion was mainly based on echocardiography, where there is a large pericardial effusion but without signs of cardiac tamponade, and the patient then underwent pericardiocentesis. Previously, the patient had undergone two examinations with two different imaging modalities, namely CXR and chest CT scan, where on the CXR results, the patient only showed cardiomegaly.Discussion: There are four parameters suggestive for assessing a pericardial effusion, namely enlargement of the heart silhouette, pericardial fat stripe, left dominant pleural effusion, and an increase in the transverse diameter of the heart compared to the previous chest X-ray. This parameter is obtained not only based on the position of the photo taken but requires another position, whereas, in this patient, only CXR was performed with the posteroanterior position.Conclusion: When there are complaints of progressive shortness of breath in individuals with an underlying disease that may cause pericardial effusion, then the CXR examination cannot be used as a reference when there are no radiographic signs that point to pericardial effusion because CXR has a low diagnostic value in assessing the presence of pericardial effusion.

The Epidemiology and Outcome of Pericardial Effusion in Hospitalized Children: A National Database Analysis

To describe the epidemiology of pericardial effusion in hospitalized children and evaluate risk factors associated with the drainage of pericardial effusion and hospital mortality. A retrospective study of a national pediatric discharge database. We analyzed hospitalized pediatric patients from the neonatal age through 20years in the Kids' Inpatient Database 2016, extracting the cases of pericardial effusion. Of the 6 266 285 discharged patients recorded, 6417 (0.1%) were diagnosed with pericardial effusion, with the highest prevalence of 2153 patients in teens (13-20years of age). Pericardial effusion was drained in 792 (12.3%), and the adjusted risk of pericardial drainage was statistically low with rheumatologic diagnosis (OR, 0.485; 95% CI, 0.358-0.657, P<.001). The overall mortality in children with pericardial effusion was 6.8% and 10.9% of those who required pericardial effusion drainage (P<.001). The adjusted risk of mortality was statistically high with solid organ tumor (OR, 1.538; 95% CI, 1.056-2.239, P=.025) and pericardial drainage (OR, 1.430; 95% CI, 1.067-1.915, P=.017) and low in all other age groups compared with neonates, those with cardiac structural diagnosis (OR, 0.322; 95% CI, 0.212-0.489, P<.001), and those with rheumatologic diagnosis (OR, 0.531; 95% CI, 0.334-0.846, P=.008). The risk of mortality in hospitalized children with pericardial effusion was higher in younger children with solid organ tumors and those who required pericardial effusion drainage. In contrast, it was lower in older children with cardiac or rheumatologic diagnoses.

Pericardial effusion caused by viral pericarditis in a patient receiving peritoneal dialysis

BackgroundAcute pericarditis causes acute inflammation of the pericardium. Although most cases of pericarditis are idiopathic with no identifiable cause, its etiology can be infectious, such as viral, bacterial, mycotic, and tuberculous infections, or non-infectious, including post-pericardiotomy, metastatic malignant tumor, connective tissue disease, or uremia. However, there has been no report of pericarditis caused by adenoviral infection in patients undergoing peritoneal dialysis (PD). Herein, we report a case of pericarditis and pericardial effusion caused by adenoviral infection in a patient undergoing PD.Case presentationA 59-year-old man who had been undergoing PD in our department for 3 years had a bout of acute enteritis. He was later admitted to the emergency department of our hospital because of malaise and loss of consciousness due to pericardial effusion. Testing after admission revealed elevated adenovirus antibody titers. Pericardial effusion improved although no changes in his PD prescription were made. The patient was hospitalized and admitted to maintain hemodynamics and prevent hypotension. Since insufficient dialysis volume was ruled out by peritoneal equilibrium tests and dialysis volume assessment, the patient was kept under observation, and no changes were made regarding the method of dialysis. Pericardial effusion and the C-reactive protein level both gradually declined, and the patient’s weight remained steady. The adenovirus antibody titer alone increased to 1:64 at approximately 2 weeks after hospitalization. The final diagnosis was acute pericarditis due to adenoviral infection rather than uremia or dialysis-associated pericarditis.ConclusionsWe treated a patient with a rare case of pericardial effusion caused by viral (adenoviral) pericarditis in a patient undergoing PD. In addition to testing for the usual causes, uremic and dialysis-associated pericarditis must always be ruled out in patients receiving dialysis. In cases of pericarditis with a viral origin, diagnosis and treatment must be comprehensive.

Value of transesophageal echocardiography in device closure of perimembranous ventricular septal defects in children via ultra-minimal trans intercostal incision.

To investigate the value of transesophageal echocardiography (TEE) in perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children. From January 2015 to December 2020, 212 children with PmVSDs underwent device occlusion via an ultra-minimal trans intercostal incision. TEE was used throughout the perioperative period, including TEE assessment, TEE-guided localization of the puncture site, and TEE guidance. All patients were followed up using transthoracic echocardiography for more than 6 months. A total of 207 cases were successfully occluded, and the success rate was 97.64%. One hundred forty-five patients had a single orifice, and 62 patients had multiple orifices in the aneurysm of the membranous septum (AMS). During the operation, the surgeon readjusted the device or replaced it with a larger device in 17 cases. After the operation, 19 cases of a slight residual shunt, 13 cases of pericardial effusion, and 4 cases of pleural effusion were noted. All patients returned to normal during the 4-month follow-up period. Mild mitral regurgitation was present in one patient and remained the same during the follow-up period. No other complications were found. Under TEE guidance, PmVSDs were closed successfully using a concentric occluder via an ultra-minimal trans intercostal incision. TEE, which was used to assess defects and postoperative effect, effectively guide PmVSDs closure, is of great value.

ETIOLOGY AND CLINICAL PROFILE OF PERICARDIAL EFFUSION PATIENTS

Background Pericardial effusion is one of the most prevalent disorders . Pericardial effusion can create substantial symptoms and a lower quality of life, but its also linked to a higher risk of cardiopulmonary failure, mortality, and death. Pericardial effusion has a variety of causes that are related to the relative occurrence of certain diseases in different parts of the world. Methods:it was a retrospective study that includes data from all pericardial effusion cases diagnosed . Echocardiography was used to diagnose a total of 50 cases with pericardial effusion. Complete blood count with ESR, blood urea, serum creatinine, tuberculin skin test, chest X-ray, ECG, Thyroid profile, ANA, Rheumatoid factor, CT chest / MRI, and pericardiocentesis were all used to determine the source of the pericardial effusion. Cells, proteins, LDH, malignant cells, ADA, PCR (for Mycobacterium tuberculosis), gram staining, AFB staining, and cultures were all examined in the pericardial fluid. Iatrogenic (cardiac surgery, catheterization) and post-traumatic cases were excluded . Results: The majority of the patients were between the ages of 50 and 70. Thirty patients (60%) were men and 20 patients (40%) were women. Tuberculosis was the most prevalent cause of pericardial effusion, accounting for 28 % of cases, followed by Idiopathic 18%, Uremia 12 %, and Malignant 14 %. HIV infection was the least common cause of pericardial effusion, accounting for 2% of cases. Tachycardia was the most common clinical symptom, in 70% of patients, followed by Breathlessness (60%), and fever (56 %). Conclusions:Tachycardia, shortness of breath, fever, heaviness of chest, cough, chest pain, and other symptoms of pericardial effusion have been noted in this study. Tuberculosis, idiopathic/viral, uremic, neoplastic, CCF, hypothyroidism, post-MI, etc. are all major factors for the development of pericardial effusion.

A rare presentation of extragonadal germ cell tumor; massive pericardial effusion with impending tamponade

The clinical manifestations of extragonadal germ cell tumor (EGGCT) depend on its location and are often caused by compression on surrounding structures. Pericardial effusion is absolutely rare as an initial clinical manifestation for this tumor. We report a 31-year-old man presenting to the emergency department with dyspnea. Two-dimensional echocardiography revealed a massive pericardial effusion with impending tamponade. The patient was immediately transferred to the operating room where a cardiac surgeon drained bloody effusion. A mediastinal mass measuring 173×105×105 mm was accidentally noticed during COVID-19 work-up. Fine core needle biopsy of the mass led to the diagnosis of a germ cell tumor, which was treated appropriately. This study shows the importance of proper work-up in pericardial effusion cases with chest CT-scan as an important part of it.

Derrame pericárdico

Pericardial effusion refers to the accumulation of liquid or fluid in the pericardial sac or space. The pericardium is the membrane which surrounds the heart. It has two layers: an internal “visceral” layer and another external, fibrous “parietal” layer. In normal conditions, it can contain from 10 to 50ml of pericardial fluid. Cardiac tamponade is a clinical syndrome in which pericardial effusion under pressure compresses the heart and interferes with diastolic filling of the heart's chambers. In cases of sudden, rapid accumulation of fluid in the pericardial sac, small quantities of pericardial effusion can cause hemodynamic compromise.In developed countries, the majority of pericardial effusion cases have an idiopathic etiology, whereas other common causes may include cancer, infections, iatrogenic causes, and connective tissue diseases.

THE STORY OF THE HEART'S WET SUIT: A CASE OF CARDIAC TAMPONADE WITH COVID-19 IN A YOUNG FEMALE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: COVID-19 has awestruck physicians across the world with its atypical presentations. Often, pericarditis and myocarditis occur with viral infections in young adults. It is rare to see viral infections causing cardiac tamponade, which is a potentially fatal complication. Several cases of pericardial effusions and pre-tamponade physiology have been reported in elderly individuals with an extensive history of cardiac disease. Here, we describe the case of a previously healthy young adult who developed COVID-19 related cardiac tamponade without any preceding respiratory symptoms. CASE PRESENTATION: A 34-year-old female with a past medical history of hypothyroidism had tested positive for the SARS CoV-2 (Severe Acute Respiratory Distress Syndrome Coronavirus-2) one week prior to presentation. She presented with constant, central chest pain radiating to the back for 2 days. While being evaluated for hypotension, the patient broke into convulsions and was consequently intubated and mechanically ventilated. The patient's Brain natriuretic peptide (BNP) was elevated at 2,470 pg/mL (normal range: 0 – 450 pg/mL), and cardiac troponin was mildly elevated at 0.63 ng/mL. Initial electrocardiogram showed a low voltage strip with sinus tachycardia, and electrical alternans, suggestive of pericarditis(1). Computerized tomography (CT) of the chest with contrast revealed a small non-tappable pericardial effusion. CT head was negative. Over the course of a few hours, significant elevation of cardiac troponin to 5.18 ng/mL, and escalation in vasopressor requirements prompted us to obtain bedside echocardiography, which demonstrated a large pericardial effusion with pre-tamponade physiology. Emergent bedside pericardiocentesis was performed and 250cc of serous pericardial fluid was drained. A pericardial window was kept open to watch for re-accumulation. Post-procedural electrocardiogram had normal voltage, showed no electrical alternans and tachycardia had resolved. The patient was gradually weaned from vasopressor support and other supportive treatment. The pericardial drain was removed. An echocardiogram obtained at a 2-month follow-up showed a healthy heart with a normal ejection fraction. DISCUSSION: On initial evaluation, the differential diagnosis for convulsive syncope in a young patient with hypotension and COVID-19 were pulmonary embolism or a thromboembolic stroke. EKG findings and subsequent clinical course pointed towards a possible pericardial effusion. However, pericardial effusions are commonly idiopathic and only a smaller subset of cases stem from infectious disease. Viral pericarditis causes gradual accumulation of transudate leading to a pericardial effusion. Interestingly, in our patient cardiac tamponade was acute. CONCLUSIONS: This case underscores that an index of suspicion should be held for COVID-19 causing cardiac tamponade in young individuals and that prompt intervention is invaluable. REFERENCE #1: Eisenberg MJ, de Romeral LM, Heidenreich PA, Schiller NB, Evans GT Jr. The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment. Chest. 1996 Aug;110(2):318-24. doi: 10.1378/chest.110.2.318. PMID: 8697827. DISCLOSURES: No relevant relationships by Neha Panchagnula, source=Web Response