Cause Of Pericardial Effusion Research Articles

“A double twist” presentation – a case report of purulent cardiac tamponade following a rare complication of small-cell lung cancer radiotherapy

Background: Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava syndrome is present, radiation therapy–induced pericardial disease can be a potential complication. Case Report: A 55-year-old man, who recently underwent radiotherapy for stage IV small-cell lung cancer complicated by superior vena cava syndrome, presented with chest pain and dyspnea. In the emergency room, he was dyspneic, hypotensive, and tachycardic. Pulmonary auscultation revealed the absence of lung sounds on the right. The initial electrocardiogram showed ST-segment elevation in lateral leads and in lead DII, with reciprocal changes in lead DIII. A bedside transthoracic echocardiogram revealed cardiac tamponade and emergent pericardiocentesis was performed, removing 500 ml of purulent fluid, resulting in an immediate clinical improvement. Thoracentesis was also performed, showing no empyema. Large spectrum empirical antibiotic therapy was started. Cultures from the pericardial fluid and peripheral blood grew multi-sensitive Streptococcus pneumoniae. Cytological analysis of the pericardial fluid was consistent with infection. The patient improved after 2 weeks of targeted antibiotic therapy and underwent the first cycle of chemotherapy. He was discharged with an early scheduled pulmonology appointment. Conclusions: Although the most common causes of pericardial effusion in lung cancer are malignant, non-malignant etiologies should also be considered. This patient had an infectious pericardial effusion most probably due to a pericardial-mediastinal mass fistula caused by radiotherapy. This was a diagnostic challenge, both in the emergency room as well in the inpatient setting.

Cardiac Tuberculosis: A Case Series from Ethiopia, Italy, and Uganda and a Literature Review.

Extrapulmonary tuberculosis (TB) is estimated to account for up to 20% of active cases of TB disease, but its prevalence is difficult to ascertain because of the difficulty of diagnosis. Involvement of the heart is uncommon, with constrictive pericarditis being the most common cardiac manifestation. Diagnostic research for cardiac disease is frequently lacking, resulting in a high mortality rate. In addition to direct cardiac involvement, instances of cardiac events during antitubercular therapy are described. This case series describes five cases of TB affecting the heart (cardiac TB) from Italy and high-burden, low-income countries (Ethiopia and Uganda), including a case of Loeffler syndrome manifesting as myocarditis in a patient receiving antitubercular therapy. Our study emphasizes how cardiac TB, rare but important in high-burden areas, is a leading cause of pericardial effusion or pericarditis. Timely diagnosis and a comprehensive approach, including imaging and microbiological tools, are crucial. Implementing high-sensitivity methods and investigating alternative samples, such as detection of tuberculosis lipoarabinomannan or use of the GeneXpert assay with stool, is recommended in TB control programs.

Epidemiological characteristics, etiological spectrum, and outcomes of adult patients with pericardial effusion at a Teaching Hospital in Somalia.

Pericardial effusion (PE) is an abnormal fluid volume in the pericardial space and is a common clinical entity. The incidence of PE is estimated diversely and depends on risk factors, etiologies, and geographic locations. This study aimed to assess the clinical characteristics, etiologic spectrum, echocardiographic features, and outcomes among patients with different types of PE. This retrospective observational study included 93 patients with confirmed PE. Their medical records were reviewed in the hospital information system of Mogadishu Somali Turkish Training and Research Hospital between April 2022 and September 2022. Patient demographics, clinical characteristics, chest X-rays, echocardiography, laboratory findings, management approaches, and outcome reports were reviewed and recorded. Out of the 3000 participants, 3.1% (n = 93/3000) met the definition of definitive PE. In this study, we included 51 females and 42 males. Among the patients, 86% (n = 80) had at least one comorbidity, with diabetes (38.7%) and hypertension (37.6%) being the most common. The most frequently reported clinical presentation findings were shortness of breath (67.7%), chest pain (49.4%), cough (47.3%), and palpitations (47.3%). Cardiac tamponade developed in 9.7% (n = 9) of the patients. Pericardial taps were performed in 64.5% of the cases. Our analysis showed that the most common cause of PE was cardiac disease (n = 33, 35.4%), followed by tuberculosis (TB) (n = 25, 26.8%), uremic pericarditis (n = 24, 25.8%), and hypothyroidism (n = 10, 10.7%). Regarding the severity of PE based on echocardiographic findings, nearly half of the patients (n = 46, 49.4%) had mild PE, whereas 26.8% (n = 25) had moderate PE, and 23.6% (n = 22) had severe PE. Two-thirds of the cases (66.6%) were managed with furosemide, 48 (51.6%) patients were treated with an anti-inflammatory, hemodialysis was performed in 24 (25.8%) patients and antituberculous medications were administered to 7 (7.5%) patients. Out of the 93 patients, 24 (25.8%) died during the hospital stay. It was determined that the mortality risk of patients with renal failure was 7.518 times higher than those without (p = 0.004), and the risk for those with TB was 5.554 times higher than those without (p = 0.011). Other variables were not influential on mortality (p > 0.050). Our study results demonstrate the epidemiological profile of PE in Somalia. The leading causes of PE were cardiac diseases, uremic pericarditis, TB, and hypothyroidism. PE is a significant cause of morbidity and mortality in Somalia, especially in individuals with renal failure and TB infection.

Clinical Profile and Etiology of Patients with Pericardial Effusion

Background: Pericardial effusion are one of the common cardiac problems in our part of the world and is associated with high risk of morbidity and mortality if not diagnosed and treated. The aim of this study was to determine etiological spectrum and clinical presentation of moderate to large pericardial effusion.Methods: A descriptive cross-sectional study was conducted from February 2023 to July 2023 at Department of Cardiology, NMC-TH. Fifty patients were included in the study who visited to NMC-TH; OPD, ward and emergency department. Apart from routine investigations, ECG, chest X-ray and echocardiography were performed in all patients. Pericardiocentesis was done in 37 patients (74%). Specific investigations for the suspected etiological diagnosis were done. Results: A total of 50 patients (30 Male, 20 Female) were included in the study with age ranging from 11 to 76 years. The most common clinical presentations were dry cough (86%) followed by shortness of breath (70%) and fever (66%). In this study, the most common etiology of pericardial effusion was tuberculosis (n-22; 44%) followed by malignancy 6(12%), idiopathic 6(12%), and Hypothyroidism 4(8%). Among malignancies, carcinoma of lung was the commonest 3(50%). Tuberculosis was the most common cause in patients presenting with tamponade 8(61.5%) followed by malignancy 2(15.3%).Conclusion: This study shows tuberculosis is the most common cause of pericardial effusion followed by malignancy.

The advantage of point-of-care ultrasound in central venous catheterization and related pericardial effusion in infants in the NICU.

Central venous catheterization (CVC) is broadly used in neonatal intensive care units (NICUs) for efficient vascular access; however, its establishment and maintenance are associated with numerous risks and complications. Here, we focus on investigating the value of point-of-care ultrasound (POCUS) in the early diagnosis and treatment of pericardial effusion associated with CVC and compare the differences in ultrasound and radiography in CVC localization and monitoring in the NICU. Twenty-five infants with CVC-associated pericardial effusion (PCE) who were hospitalized in the NICU of Peking University Third Hospital between January 2013 and March 2023 were retrospectively selected for the study. Data concerning their catheterization characteristics, CVC tip position, clinical and imaging manifestations of PCE, treatments, and prognoses were analyzed. The mean gestational age of our cohort was 29.3 ± 3.1 weeks, and the mean birth weight was 1,211 ± 237 g. The incidence of CVC-associated PCE was 0.65%, and 80% of PCE cases occurred within 4 days of CVC. After PCE, the most common symptoms were tachypnea (44%) and tachycardia (64%). Chest radiographs revealed cardiothoracic enlargement, and only 2 cases (9.10%) showed a "flask heart". Cardiac ultrasound showed that the catheter tip extended deep into the heart in 72% of infants with PCE. Cardiac insufficiency was observed in 12 cases (48%). Overall, 8 infants (32%) had pericardial tamponade, 7 (87.5%) of whom underwent pericardiocentesis. Overall, 2 (8%) infants died, and the remaining 23 (92%) were cured. CVC-associated PCE mostly occurs in the early post-catheterization stages (within 4 days) in infants. Some cases may have critical clinical manifestations and progress rapidly, with some even developing pericardial tamponade. A CVC tip being deep into the heart cavity is an important cause of PCE. Compared with chest radiography, point-of-care ultrasound is more accurate for CVC tip positioning and can detect PCE more quickly. Furthermore, it is more advantageous for locating and monitoring CVC-associated PCE. Early identification and diagnosis can effectively reduce fatality rates and improve the prognosis of infants with CVC-associated PCE.

THU601 Massive Pericardial Effusion As Sole Symptom For Uncontrolled Hypothyroidism.

Abstract Disclosure: D.A. Lopez: None. M. Caban: None. C. Camacho: None. Y. Fuentes: None. M. Sanchez: None. K. Velez: None. Hypothyroidism is a common endocrine disorder with worldwide prevalence resulting from deficiency of thyroid hormone that can affect multiple organs. It can be asymptomatic and subclinical or symptomatic with fatal complications. Hypothyroidism can present with symptoms such as fatigue, slow movement and slow speech, cold intolerance, constipation, weight gain, and bradycardia. Hypothyroidism can be the cause of pericardial effusion due to increase membrane permeability. Massive pericardial effusion or pericardial tamponade is rare. Pericardial effusion can also be caused by autoimmune conditions, infections, uremia, medications, iatrogenic, and trauma. This is a case of 68-year-old Hispanic female with past medical history of hypothyroidism that was admitted to the hospital due to large pericardial effusion. These findings were found incidentally by her primary care physician during a preoperative evaluation for cataract surgery. Chest X-ray showed massive enlargement of the cardiac silhouette. Echocardiogram was ordered presenting large circumferential pericardial effusion with moderate diastolic right atrial collapse reason why patient was sent to the hospital. Physical examination showed distant heart sounds but absent jugular venous distention. Vital signs were within normal limits. Beck's triad was absent. Electrocardiogram showed a sinus rhythm with low QRS voltage. Patient denied any recent procedure, trauma, myocardial infarction, malignancy, or fever. Complete blood count was without leukocytosis, normal hemoglobin levels and platelet count. Basic metabolic panel presented without electrolyte disturbances and preserved renal function. Evaluation for causes of pericardial effusion was made including autoimmune conditions. Results showed negative ANA, Rheumatoid factor, Anti-dsDNA antibody, Anti-Scl-70 antibody, anti-U1-ribonucleoprotein, anti-Ro, and anti-La. Inflammatory markers were within normal limits. TSH level were in 22.5μIU/mL (0.03-5.0μIU/mL) with undetectable Free T4 pointing towards uncontrolled hypothyroidism as the cause of her large pericardial effusion. Patient denied other symptoms of hypothyroidism. She agreed not being compliant with levothyroxine. Pericardiocentesis was done and 750ml of pericardial fluid was removed. A catheter was placed and 200ml of fluid was drained on the second day. Catheter was removed and Echocardiogram showed immediate resolution of the diastolic right atrial collapse. She was sent home with adequate medical therapy and intense education of hypothyroidism. As a take home message, this unique case presents the importance of being compliant to medical therapy since the initial presentation of uncontrolled hypothyroidism could be a fatal complication as pericardial effusion. This could’ve been prevented if compliance with medications was encourage since the beginning of this disorder. Presentation: Thursday, June 15, 2023

SAT325 Recurrent Pericardial Effusion As Initial Presentation Of Primary Adrenal Insufficiency

Abstract Disclosure: S. Ward: None. A.L. Champion: None. A. Mrkaic: None. Recurrent Pericardial Effusion as Initial Presentation of Primary Adrenal Insufficiency: Background: Primary adrenal insufficiency (PAI) is a rare but serious endocrinopathy. High clinical suspicion is important to avoid delay in diagnosis and treatment. We present a rare case of recurrent pericardial effusion as initial presentation. Clinical Case: 63 year old male with hypertension and diabetes presented to ED complaining of SOB and chest pain. Workup revealed pericardial effusion causing cardiac tamponade treated with emergent pericardiocentesis. He was admitted to ICU for hypotension. He was also diagnosed with COVID-19 and acute kidney injury. Labs showed hyperkalemia ranging from 5.3 to 7.2 mmol/l (n= 3.5-5.1 mmol/l) and hyponatremia 132 mmol/L (n= 136-145 mmol/L). He was started on dexamethasone for COVID-19 infection. Etiology of pericardial effusion was unclear; infectious disease workup was unremarkable, cytology showed no malignant cells, autoimmune panel was negative. Initial echo showed EF >55%. After initiation of steroids, symptoms improved with normalization of electrolytes and improvement of hypotension, however was discharged on midodrine 2.5 mg TID. Seven days after discharge patient called 911 complaining of worsening shortness of breath. He was found to be severely hypotensive with BP 67/40. Echo showed moderate to large pericardial effusion causing tamponade. Emergent pericardial window was performed. Labs showed hyponatremia 123 mmol/L and potassium ranging from 4.9-5.4 mmol/L. Patient remained hypotensive requiring pressors despite pericardial effusion drainage. With persistent hypotension, hyperkalemia, and hyponatremia there was strong suspicion for adrenal insufficiency and workup was consistent with PAI. Labs showed 8:00 am cortisol 2.7 ug/dl (n= 3.7-19.4 ug/dl), ACTH 256.0 pg/ml (n=7.2-63.3pg/ml), aldosterone <1.0 ng/dL, renin 4.216 ng/mL/hr (n= 0.167-5.380 ng/mL/hr). Due to his critical illness patient was started on stress dose hydrocortisone 50 mg Q6 hr. With initiation of steroids, hyponatremia, hypokalemia, and hypotension resolved. Patient was weaned to physiological doses of hydrocortisone and started on fludrocortisone at time of discharge. Conclusion: Timely diagnosis of PAI is essential and can be lifesaving, if untreated it can lead to adrenal crisis with high mortality. Having a high clinical suspicion is crucial to a prompt diagnosis. Pericardial effusion should prompt clinical suspicion for PAI as multiple cases have now been reported in the literature. Our patient has multiple potential causes of pericardial effusion including PAI, acute kidney injury, and COVID-19 infection. Although we cannot show definitive causation from PAI, it most certainly contributed and prompt diagnosis and treatment may have prevented recurrence. It is important to raise awareness of PAI as a differential in pericardial effusion. Presentation: Saturday, June 17, 2023

Detection of drug-resistant Mycobacterium tuberculosis in pericardial fluid culture and its correlation with cartridge based nucleic acid amplification test and adenosine deaminase activity

BackgroundPericardial effusion is the accumulation of fluid in the pericardial cavity. In nations with high tuberculosis (TB) load, TB is the most common cause of pericardial effusion. 1–2% of patients with pulmonary TB develop Pericardial TB worldwide. Multi-drug-resistant (MDR) TB, including extrapulmonary TB (EPTB) cases, are rising in number. Adenosine Deaminase (ADA) is an enzyme in lymphocytes and myeloid cells, which has certain immune functions in the body. ADA levels are increased in inflammatory conditions, like pleural, pericardial, or joint effusions, of bacterial etiology, granulomatous conditions, neoplasms, and autoimmune pathologies. TB is the only lymphocytosis involving disease with increased ADA levels. MDR EPTB is rare, but cases are on the rise, and tuberculous pericardial effusion is one such example. Hence, it is important to know the percentage of cases detected by a culture that can be identified by cartridge-based nucleic acid amplification test (CBNAAT), their resistance patterns, and to identify potential markers like ADA, which can help in early identification of cases. The objectives of this study were to identify the Mycobacterium tuberculosis (MTB) bacilli in culture, and correlate them with cartridge-based nucleic acid amplification test (CBNAAT) results and their drug-resistance, in the Pericardial tubercular effusion, and to find if Adenosine Deaminase (ADA) levels can be used as a predictor of the presence of MTB in pericardial fluid. MethodologyWe enrolled 52 patients with moderate to large tuberculous pericardial effusion, based on pericardial fluid analysis, CBNAAT, and culture methods, between January 2021 and December 2021. ResultsThe mean age of the patients was 41.85 + 17.88 years, with a median of 38 years. Males made up 57.7% of the total patients. MTB was detected in 16 (30.8%) patients in the CBNAAT evaluations. 14 (87.5%) of the CBNAAT-positive TB patients were sensitive to Rifampicin, whereas the remaining 2 (12.5%) were resistant to Rifampicin on CBNAAT. MTB was found to be growing in 8 (15.38%) drug sensitivity test cultures. Out of these 8, 6 were sensitive to first-line drugs, whereas 2 were resistant to both Isoniazid and Rifampicin. The presence of cough was found to have a significant difference between CBNAAT-detected MTB positive and negative patients (p = 0.020), whereas an insignificant difference was found for the presence of hypertension, diabetes mellitus, obesity, dyspnea, or fever. There was also an insignificant difference between the number of patients positive for the Tuberculin skin test, between the two groups. ADA was significantly higher in the MTB-detected CBNAAT group (85.91 + 37.60U/L vs 39.78 + 24.31U/L, p = 0.005), whereas the total leukocyte count, lymphocytes, neutrophils, random blood sugar levels, and serum protein levels had no significant difference. The area under the Receiver Operator Curve (CBNAAT positive: dependent variable; ADA: test result variable) was 0.854 (null hypothesis rejected), with a standard error of 0.078. ConclusionsCulture is the gold standard method to diagnose tuberculosis. Detection of MTB on pericardial fluid culture is very uncommon, though in our study, culture came out positive in 16% of patients, and 4% were resistant to rifampicin and isoniazid. Higher ADA levels in pericardial fluid are an indicator of tuberculous pericardial effusion.

An Unusual Case of Hemorrhagic Filarial Pericardial Effusion Presenting as Cardiac Tamponade

Filariasis presenting as pericardial effusion with cardiac tamponade is rare. We report a case of 34-year-old male who presented with a short history of fever, bilateral pedal edema and left sided chest discomfort of 10 days duration. On evaluation he was found to have pericardial effusion. Extensive work up to evaluate routine causes of pericardial effusion was unremarkable. His pericardial fluid showed microfilaria, however there was no microfilariae in peripheral blood smear. He was managed with pericardiocentesis and 04 weeks of Albendazole, diethylcarbamazine to which he responded. In the tropics filarial pericardial effusion should always be considered in cases of pericardial effusion of unknown etiology.

Clinical profile of patients admitted with pericardial effusion in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

Background and Aims: Pericardial effusion is a common finding in every day clinical practice. It is caused by a range of local and systemic disorders, many of which could be idiopathic. Pericardial effusions can be acute or chronic. The etiology of pericardial effusion varies in different parts of the world and is related to the relative prevalence of different diseases.
 Methods: This is a retrospective study where data from all the cases admitted with pericardial effusion in the SGNHC from January 2021 to December 2022 were included. Altogether 218 cases diagnosed with pericardial effusion established by Echocardiograpy were included. Evaluation for the cause of pericardial effusion was done. Iatrogenic (cardiac surgery, catheterization) and post-traumatic cases and age <15 years were excluded. Demographic profile, common causes, the presentation and the clinical outcome of the patients were documented.
 Results: Majority of patients were aged between 56-75 years. Most common etiology of pericardial effusion was tuberculosis (56%) followed by heart failure (11%), Hypothyroidism (6.4%) and malignancy (5.6%). Tachycardia was the most common ECG finding in 152 (69.7%) followed by Low voltage ECG in 96 (44%). The most common clinical feature was breathlessness in 85% followed by tachycardia in 56% of the patient.
 Conclusion: Tuberculosis, Heart Failure and Hypothyroidism were the common causes of Pericardial effusion with male predominance. Breathlessness was the most common presenting symptom.

Concurrent tuberculous pericarditis and lung adenocarcinoma presenting with cardiac tamponade

Mycobacterium tuberculosis (MTB) infection and lung malignancies are both important causes of pericardial effusion (PE), particularly in developing nations such as South Africa. They are each associated with significant morbidity and mortality and pose several public health challenges for the region. This case study discussed a 58-year-old man who presented acutely with a large PE complicated by cardiac tamponade. Pericardial fluid analysis was positive for TB and further cytopathological evaluation revealed metastatic lung adenocarcinoma. Dual diagnoses are rare; however, considering the rising incidences of lung cancer and its predisposition for infectious diseases, this may be under-reported in TB endemic regions. This case highlighted the importance of considering other causes of PE that may aggravate presentation, leading to life-threatening cardiac tamponade. Further research is needed to understand the impact of rising cancer incidences and ongoing burden of infectious diseases in sub-Saharan Africa.Contribution: The insights of this case study include the paucity of data surrounding diagnosis and treatment of lung cancer in non-smokers available for South Africa. The current data that are available is for the developed world only. Some evidence incidence might be related to exposure of biofuels, which has significance for our local population and requires more exact research.

Computed tomography values of pericardial effusion may predict chylopericardium: a case report

BackgroundIdiopathic chylopericardium is a rare disease characterized by filling of the pericardial cavity with chylous fluid and has no evident cause. Secondary chylopericardium usually results from injury or damage to the thoracic duct. The most common causes of secondary chylopericardium are trauma, thoracic or cardiac surgery, and congenital lymphangiomatosis. Conservative or surgical treatment can be pursued; however, surgical treatment is required if conservative treatment is unsuccessful. Pericardiocentesis plays a crucial role in the definitive diagnosis of chylopericardium. However, although a serious complication, its occurrence is infrequent. Non-invasive methods, such as computed tomography (CT), could be useful in predicting the color or characteristics of pericardial effusion.Case presentationA 37-year-old Japanese woman presented to our hospital with a cough that persisted for 1 week. Echocardiography revealed pericardial effusion, which was diagnosed as acute pericarditis and treated with loxoprofen. However, pericardial effusion increased, and the patient presented to the emergency room with cardiac tamponade 1 month later. Pericardiocentesis was performed, which confirmed that the pericardial effusion was chylopericardium. Lymphatic scintigraphy did not show any connection between the thoracic duct and pericardial cavity, and the patient was diagnosed with idiopathic chylopericardium. The patient underwent continuous drainage for 11 days. After completion of cardiac drainage, the patient was discharged from the hospital without any exacerbation. The CT attenuation value of the pericardial fluid was 11.00 Hounsfield units (HU). Compared with the other causes of pericardial effusions encountered at our hospital, the HU on CT scan of pericardial effusion was low in our study and similar to the values on CT scan of chylous ascites reported in previous studies.ConclusionsAlthough idiopathic chylopericardium is rare, it should be considered an important cause of pericardial effusion. Pericardiocentesis is necessary for definitive diagnosis; however, the CT findings of pericardial effusion may help predict the presence of chylous fluid.

Evaluation of etiology of pericardial effusion in 81 patients who underwent pericardiostomy or pericardial window

<b>Introduction: </b>A wide variety of diseases lead to pericardial effusion including systemic inflammatory diseases, pericarditis, reduced pericardial fluid reabsorption due to increased systemic venous pressure, pneumonia, pulmonary embolism, endocrine diseases, post-cardiotomy syndrome, trauma, hypothyroidism, renal-hepatic failure, collagen-vascular diseases, infectious, and malignancy. In this study, we aimed to evaluate the underlying etiology of pericardial effusions in patients underwent surgical pericardial drainage or pericardial window and contemporary management.<br /> <b>Materials and methods: </b>Between January 2006 and January 2018, a total of 81 patients (49 males, 32 females; mean 52.9±10.6 years; range 5 to 84 years) who underwent subxiphoid pericardiostomy, pericardial window procedure with left anterior thoracotomy or subxiphoid approach, due to moderate or severe pericardial effusion and cardiac tamponade, were retrospectively analyzed.<br /> <b>Results: </b>Malignancy was diagnosed either with histopathological examination of the pericardial biopsy and/or fluid in 17 (80.9%) of 21 patients had a previous history of malignancy. Of the 21 patients diagnosed with malignancy, six patients (7.5%) had leukemia/lymphoma, and six patients (7.5%) had thyroid papillary cancer. Mycobacterium tuberculosis was identified in only one (1.2%) patient’s culture of the pericardial fluid. No etiology was found in the remaining 38 patients (46.9%); thus, they were considered as idiopathic pericarditis.<br /> <b>Conclusion: </b>Tuberculosis is no longer the leading cause of pericarditis. Idiopathic pericarditis is the leading cause of pericardial effusion and malignancy is the next most common cause of pericardial effusion in our region.

A case report of late onset systemic lupus erythematous presenting with large pericardial effusion

Background: Systemic lupus erythematosus (SLE) is a multi-systemic autoimmune disease that affects multiple organ systems. Age at onset has become recognized as having a mediating effect on the clinical manifestation of SLE, late-onset presentations in individuals 50 years of age and older may represent a unique subtype of SLE. Case Presentation: A 75-year-old Saudi female patient known case of diabetes mellitus, hypertension, osteoarthritis, and morbid obesity. She was presented to the emergency department with a history of shortness of breath and dysuria for 1 week. The patient was admitted to the regular ward and in the following day the patient was developed tachycardia and hypotension and increased serum creatinine 2.59 mg/dl. Then she was shifted to intensive care unit (ICU). In ICU, she was seen by cardiology and electrocardiogram showed atrial fibrillation and T-wave inversion in Lead ll, lll, AVF, and the transthoracic echocardiogram done showed ejection fraction 68% with large effusion around lateral and posterior wall 22 mm and mild effusion around right ventricle. Becks triad was excluded. There was no obvious cause for pericardial effusion at that time, autoimmune disease was suspected, and we consulted the rheumatology department. She was seen by rheumatologist and blood test of autoimmune antibody showed antinuclear antibody positive, anti-dsDNA positive, at that time confirmed diagnosis of SLE. Clinical Discussion: Serositis is defined as pleural and pericardial effusions, up to 50% of SLE patients pericardial effusion may be seen, it is often minor and asymptomatic and it is more uncommon as an initial symptom. Conclusion: We report a rare case of late onset of SLE presenting with large pericardiac effusion, which should be considered one of the rare first signs of SLE in older patient.

Факторы риска возникновения и развития перикардиальных выпотов у собак

Pericardial effusion is an accumulation of fluid in the pericardial cavity, which can lead to cardiac tamponade – a life–threatening condition of the animal. In cardiac tamponade, the intrapericardial pressure exceeds the diastolic filling pressure of the right ventricle. This, in turn, leads to compression of the right chambers of the heart during diastole, which prevents normal systemic venous return. The consequence is a decrease in the stroke volume of the heart and a violation of cardiac output. According to available literature data, the most common causes of pericardial effusion in dogs are cardiac neoplasia, more rare are chronic heart failure, less often pericarditis, systemic inflammatory processes in the body, rupture of the left atrium, idiopathic pericardial effusion is also found. The objectives of this work are to determine the frequency of occurrence of pericardial effusions and to identify risk factors for their occurrence and development. All animals were examined according to a procedure that includes anamnesis collection, clinical examination, echocardiography, electrocardiography, chest X-ray, chest and abdominal ultrasonography for the presence of effusion (if necessary), cytology of effusion, histology of pathological material obtained intraoperatively (if necessary). The prevalence of pericardial effusions among the examined dogs in the period from 2019 to 2022 was 2,05 % (55 animals out of 2688). The risk factors for pericardial effusions were associated with age and breed, the most common causes the development of pericardial effusions were heart/pericardial neoplasms (52,5 %), idiopathic pericardial effusion (22,5 %) and congestive heart failure (12,5 %).

274 A FLOATING HEART IN AN EXCAVATED CHEST

Abstract Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease. The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. Etiology is one of the main factors determining patient's prognosis. However, in most cases the pericardial effusion, even if large, remains of unknown origin. Pectus excavatum (PEX) is a common deformity of the chest wall in which the inferior part of the sternum and the cartilage are displaced posteriorly. PEX is present within the first year of life in most affected children, more frequently in boys than girls. The chest deformity in PEX may lead to compression of the right-sided cavities between the sternum and the vertebral column impacting right ventricular anatomy and rendering cardiac assessment by echocardiography very difficult. The diagnosis of pericardial effusion is generally confirmed by echocardiography but determining its etiology may be difficult. Although many cases are idiopathic, a careful review of the patient's medical history, physical examination, and laboratory tests can reveal the etiology in most patients. The most common causes of pericardial effusion are infections, malignant tumors, connective tissue diseases, pericardial injury syndrome, myocardial pericardial disease, uremia. In the last years, an association between idiopathic pericardial effusion and PEX has been hypnotized. We report the cases of 2 athletes, 15 and 18 years old, who came to our attention for post COVID19 infection evaluation as indicated by ministerial "Return to Play" protocol. Physical examination was negative for any signs/symptoms. Resting ECG showed normal sinus rhythm. Stress test was performed and resulted negative for signs and symptoms of reduced coronary reserve and arrhythmias. The echocardiographic evaluation showed moderate-severe pericardial effusion, 20 mm and 18 mm, in the absence of hemodynamic alteration. Blood tests were performed (including CRP, ESR, blood count, D-Dimer, IL-6, uricemia) and resulted normal. CardioRM confirmed the presence of severe effusion without signs of hemodynamic impairment/instability. Holter-ECG, performed during training session, resulted negative for arrhythmic events. Athletes were followed up with six-monthly echocardiographic, HolterECG and stress test evaluations, with unchanged entity of the pericardial effusion and any arrythmia or symptoms at serial controls. Chronic pericardial effusion without active pericardial inflammation may represent a diagnostic and therapeutic challenge, especially in the later years as COVID-19 disease and vaccination may be associated with pericardial injury. In the last years, PEX has been associated with the finding of pericardial effusion. Although of interest, caution should be used before labeling indiscriminately a pericardial effusion as due to PEX, especially when clinical insights suggesting alternative diagnosis are present, such as neoplasm or tuberculosis, or when any signs of hemodynamic instability are present. On the contrary, when an otherwise idiopathic pericardial effusion is occasionally identified in a patient with PEX, both the patient and the referring physician may be reassured of the benign association of these two clinical entities, in the proper clinical setting.

Multicolor flow cytometry on pericardial effusion for a prompt diagnosis and treatment of hematological malignancies with heart involvement.

Malignancies represent 15-50% of total causes of pericardial effusions (PE). Routine analyses recommended to be performed on pericardial fluid include general chemistry, cytology, polymerase chain reaction, and microbiological cultures. Multicolor flow cytometry (FC) is a laboratory test that already proved to be useful in the detection of lymphoproliferative and metastatic malignancies in pleural and peritoneal effusions, but current guidelines do not mention its use on PE to reach a diagnosis. Our institutional protocol foresees to routinely perform a multicolor FC analysis on pericardial fluid samples obtained by pericardiocentesis, in addition to other guidelines-recommended analyses. A sample of 15-30 ml is analyzed using a lyse and wash staining method using combination panels of antibodies, allowing to detect specific cellular subpopulations, analyzing tens to hundreds of thousands of cells in few seconds. The present manuscript aims to report our single-center experience with this diagnostic tool in patients presenting with PE requiring pericardiocentesis. Routine use of multicolor FC on pericardial fluid samples in our institution allowed to reach a definite diagnosis of cardiac lymphomas in two patients presenting with otherwise unexplained severe PE. This resulted in immediate start of combined immunotherapy, with patients' clinical improvement. At 6 months follow-up both patients are alive and presented a complete disease regression. Preliminary evidence from routine use of multicolor FC on PE support that this is a promising tool to reach a rapid diagnosis of hematological malignancies with heart involvement, leading to a prompt initiation of targeted therapies.

ODP504 PERICARDIAL EFFUSION AS A LIKELY CONSEQUENCE OF NON-COMPLIANT MANAGEMENT OF HYPOTHYROIDISM

Abstract Hypothyroidism is a well-known cause of pericardial effusion with an incidence of about 3-27%. If not diagnosed in time it can lead to potentially serious complications, such as cardiac tamponade leading to hemodynamic instability. It should be considered as a causative or exacerbating agent in any patient presenting with pericardial effusion and known, suspected or laboratory evidence of hypothyroidism, e. g., elevated TSH or reduced serum free T4. We present a case of a 50-year-old woman with a Past Medical Hx of hypertension, intermittently insulin-treated type 2 diabetes for 20 years, coronary artery disease, and hypothyroidism with medical non-compliance, and s/p right BKA. She initially presented to an outside hospital for altered mental status (specifically, inability to follow simple commands and orientation only to self). She was transferred to this facility for evaluation of limb ischemia. She was agoitrous with no reported palpable thyroid abnormalities. Her admission chest x-ray exhibitedan enlarged cardiac silhouette. Her initial serology was significant for a serum TSH of 178 uIU/mL (NL: 0.45-5.33 uIU/mL), FreeT4 <0.25 ng/dl (NL: 0.58-1.64 ng/dl),Free T3 1.65 pg/mL (NL: 2.5-3.9 pg/mL), andhighly elevated anti-thyroglobulin and anti-peroxidase antibodies. She was diagnosed as having primary hypothyroidism secondary to Hashimoto's thyroiditis. She was re-started on levothyroxine (L-T4) at a dose of 150 mcg on day 1, which was reduced to 100 mcg daily on days 2-4 but readjusted to 125 mcg daily on days 5-8 and 150 mcg daily thereafter. During the 25 th day of admission in the Rehabilitation unither serum TSH showed a gradual decline from 178 to 22 prior to discharge. Her Free T4 increased to 1.18 and her Free T3 increased to 2.24 by discharge. Her pericardial effusion was managed by placement of a pericardial window. Pericardiocentesis yielded over 600 ml of clear serous fluid (protein content 5.1 gm/dl) without evidence of malignancy, infection or inflammation. This case highlights the importance of not only recognizing the diagnosis of hypothyroidism but of assessing the duration and adequacy of its management. Likewise, an enlarged cardiac silhouette in this setting should be considered as possibly representing a pericardial effusion and impending source of a cardiac tamponade. Presentation: No date and time listed

Unveiling the causes of pericardial effusion in a contemporary case series of pericardiocentesis in Latin America

Pericardial effusions requiring pericardiocentesis have multiple causes that vary among geographical regions and health contexts. This procedure can be performed for diagnostic or therapeutic indications. The purpose of this study was to identify the principal causes of pericardial effusions and indications for pericardiocentesis, exploring differences among groups. This was a retrospective case series of patients who underwent pericardiocentesis for pericardial effusion in a single center in Latin America. Demographic, clinical, echocardiographic, and procedural variables were recorded and analyzed. The primary outcome was to determine the causes of pericardial effusions in these patients and the indication (diagnostic, therapeutic, or both). The results are presented in two groups (inflammatory and noninflammatory) according to the cause of the pericardial effusion. One hundred sixteen patients with pericardial effusion underwent pericardiocentesis. The median age was 58 years (IQR 46.2–70.7), and 50% were male. In the noninflammatory pericardial effusion group, there were 61 cases (53%), among which neoplastic pericardial effusion was the most frequent cause (n = 25, 40.9%). In the inflammatory group, there were 55 cases (47%), and the main cause was postpericardiectomy syndrome after cardiac surgery (n = 31, 56.4%). The principal indication for pericardiocentesis was therapeutic (n = 66, 56.8%). Large pericardial effusion without hemodynamic effect of cardiac tamponade was significantly more frequent in the inflammatory group (p = 0.03). In conclusion, the principal cause of pericardial effusion in patients who underwent pericardiocentesis was postpericardiectomy syndrome after cardiac surgery, followed by neoplastic pericardial effusion. Pericardiocentesis is mainly a therapeutic procedure.

Malignant pericardial effusions: A retrospective look at etiology and prognosis in a tertiary oncological center.

Cancer and the associated treatments are important causes of pericardial effusion. However, the natural history of malignant pericardial effusion is largely unknown, especially in the context of newer cancer treatments. We investigated the causes of pericardial effusions in a tertiary oncology center, with particular focus on the prognosis of malignant effusions in the era of contemporary oncological therapies. We obtained data from electronic medical records. Survival analyses were performed utilizing the Kaplan-Meier method. We performed Cox regression to explore the potential clinical factors associated with survival. Forty-four patients had pericardial effusion treated with pericardiocentesis during the study period. The mean age was 62-years, and 55% were female. Sixty-eight percent of these patients also had cancer, with approximately half (47%) receiving prior chemotherapy, and a quarter (27%) having had chest radiotherapy. Seventy percent of the patients with active cancer had malignant cells on cytology of pericardial fluid. The median survival of the cohort was 227 days, with malignant effusions having a median survival of 62-days compared to nonmalignant effusions with 1408 days (Logrank statistic 7.4, p-value .007). Malignant cytology was significantly associated with mortality on univariable analysis (HR 2.5, 95% CI 1.2-5.3). Complication rates were low, with no deaths as a direct complication of pericardiocentesis. Malignancy is the most common cause of pericardial effusion in this tertiary medical and oncological center. Abnormal cytology with malignant cells has a poor median survival, despite advances in oncological treatment over the last decade. Pericardiocentesis is a safe procedure for these patients.