Infectious Pericarditis Research Articles

Constrictive Pericarditis and Protein-Losing Enteropathies: Exploring the Heart-Gut Axis.

Background/Objectives: Constrictive pericarditis very rarely causes protein-losing enteropathy (PLE) induced by secondary intestinal lymphangiectasia. This study thoroughly reviewed the literature to shed light on the clinical management of PLE provoked by intestinal lymphangiectasia following constrictive pericarditis. Methods: We performed a PubMed search using the keywords enteropathy, protein-losing enteropathy, pericarditis, acute pericarditis, pericardial effusion, recurrent pericarditis, constrictive pericarditis, noninfectious pericarditis, idiopathic pericarditis, and infective pericarditis, with only English-language publications included. Results: Although constrictive pericarditis is primarily idiopathic, less common causes include infectious etiologies, connective/autoimmune tissue disorders, previous cardiac surgery, congenital syndromes, and cancer. On the one hand, PLE secondary to intestinal lymphangiectasia may cause a severe cellular immune deficiency that could raise infection hazards due to lymphocytopenia and hypogammaglobulinemia. On the other hand, lymphocytopenia may cause anergy and mask an underlying tuberculous etiology of constrictive pericarditis. Cardiac catheterization is the most useful diagnostic tool for constrictive pericarditis, though it may be misdiagnosed in rare cases. The videocapsule endoscopy and double-balloon enteroscopy techniques can detect small bowel lymphangiectasias distal to the Treitz ligament. MRI or a CT scan helps confirm constrictive pericarditis, visualize lymphangiectasias, and reveal features specific to the underlying etiology of PLE. Radioisotopic techniques may ensure PLE diagnosis in challenging cases, whereas fecal alpha1-antitrypsin can estimate gastrointestinal protein loss. Conclusions: Constrictive pericarditis is rarely associated with PLE. The cardio-intestinal abnormalities of PLE caused by constrictive pericarditis are frequently reversed following a complete pericardiectomy, though its ability to invert severe hypoalbuminemia is currently unknown.

Atypical loculated pericardial effusion with infectious pericarditis mimicking a cardiac mass in a dog: a case report

Atypical loculated pericardial effusion with infectious pericarditis mimicking a cardiac mass in a dog: a case report

ПЕРИКАРДИТ, АССОЦИИРОВАННЫЙ С ВИЧ-ИНФЕКЦИЕЙ И ТУБЕРКУЛЕЗОМ

Introduction. HIV infection, despite the measures taken, continues to spread throughout the world. Unfavorable course of diseases is often determined by some concomitant pathologies. Among HIV-infected patients, tuberculosis is the most common disease forming the comorbid condition named “TB/HIV” that reaches more than a half of all the cases of newly diagnosed tuberculosis in some regions of Russia. In recent years, due to the increase in the HIV- infected patients’ life expectancy based on antiretroviral therapy, cardiovascular diseases, such as primarily infectious pericarditis, are gradually beginning to hold a significant place. Aim: To select and analyze publications dealing with HIV- and tuberculosis-associated infectious pericarditis. Materials and Methods. A systematic search was conducted for publications that examined possible associations between pericardial damage, HIV infection and tuberculosis. A search of publications was carried out in the electronic databases PubMed, www.pubmed.gov; MEDLINE, www.ncbi. nlm.nih.gov; and Russian scientific database eLibrary, https://www.elibrary.ru. Preference was given to meta-analyses or systematic reviews, and studies with duplicate materials were excluded from the analysis. Results and Discussion. Publications on the epidemiology of infectious pericarditis associated with HIV infection and tuberculosis in the world and Russia are presented by authors from different countries; both the human immunodeficiency virus and mycobacterium tuberculosis are important for the development of pericarditis. Tuberculous pericarditis, being a rare manifestation of tuberculosis, usually reflects the severity of the disease and an unfavorable prognosis. In cases of unexplained pericardial effusion, it is advisable to include testing for HIV infection in the differential diagnosis plan. Conclusions. Diagnosis of pericarditis requires a multidisciplinary approach; late diagnosis has an unfavorable prognosis.

Cardiac Diagnoses in Obstetric Patients: An Observational Trimester-Based Analysis from Patients Undergoing Cardiology Consultations.

The aim of this study is to evaluate the frequency of cardiac complaints and diagnosed cardiovascular diseases across trimesters in pregnant women referred for cardiology consultations. This retrospective observational study was conducted at a second-level state hospital. Pregnant women referred to the cardiology clinic between September 2020 and March 2022 were included. Data collected included demographic information, clinical presentations, trimester of pregnancy, blood pressure, heart rate, anemia status, electrocardiography (ECG), and echocardiographic findings. Cardiac diagnoses were based on clinical evaluation, ECG, and echocardiographic findings. A total of 658 pregnant women were included, with a mean age of 28.18 (± 4.28) years. Most consultations occurred in the third trimester (49.1%). Primary reasons for consultation were palpitations (48%), chest pain (21.3%), leg edema (13.1%), and high blood pressure (11.6%). Anemia was present in 28.7% of the women, and 20.2% had hypertension (HT). Significant differences across trimesters included higher rates of chest pain and presyncope/syncope in the first trimester, and higher rates of palpitations and anemia in the second and third trimesters. The most common cardiac diagnoses were arrhythmias (16.6%), high blood pressure (15.2%), and mitral regurgitation (MR) (12.5%). Hypertension was most frequently diagnosed in the second trimester (P = 0.04). Infective endocarditis, myocarditis, and pericarditis were more common in the third trimester. Cardiac consultations are most frequent in the third trimester, with palpitations, chest pain, and high blood pressure being the most common complaints. Hypertension and MR are the most common cardiac diagnoses. Early and ongoing cardiologic assessment during pregnancy is crucial for managing cardiovascular risks.

Abstract 14902: Prevalence and Characteristics of Myocarditis-Related Sudden Death in the General Population

Introduction: Myocarditis is a frequent cause of sudden cardiac death (SCD) in young individuals (<35 years), but the frequency of myocarditis in middle-aged (35-65 years) and older SCD victims (>65 years) is unclear. Objective: We aimed to investigate the prevalence and characteristics of myocarditis-related sudden death in the general population. Methods: Our study population is drawn from the Fingesture study, which has prospectively collected all out-of-hospital SCD cases from Northern Finland (population ~700,000) since 1998. As required by Finnish law, all sudden deaths undergo a medicolegal autopsy. All out-of-hospital sudden death cases in the community with a verified cardiac cause of death at autopsy are included in the Fingesture study. By 2017, the Fingesture study had collected data on 5,869 SCD victims. Results: In total, 60 SCD victims had evidence of acute myocarditis at autopsy (1.0% of all SCD cases). The mean age of SCD victims with myocarditis was 55.9±18.2, which was significantly lower than among the rest SCD victims (65.0±12.3; p<0.001). Myocarditis cases were also more often female in comparison to the rest SCD cases (33.3% vs. 21.0%; p=0.02). The proportion of myocarditis was highest among young (<35 years) SCD cases (n=6/73; 8.2%), and the proportion decreased in middle aged (35-65 years) (n=34/2,948; 1.2%) and older (>65 years) SCD cases (n=20/2,848; 0.7%) (p<0.001), although the absolute number was higher. The most common diagnosis was undetermined acute myocarditis (n=42/60; 70%) followed by infective myocarditis (n=10/60; 16.7%) and pericarditis (n=5/60; 8.3%). In addition, two SCD cases had sarcoidosis and one had giant cell myocarditis. Five SCD cases due to myocarditis (8.3%) occurred during physical exercise. Conclusions: Myocarditis is a rare cause of SCD in the general population. Although the relative proportion of myocarditis was highest among young SCD victims, the absolute number was highest among middle-aged SCD victims.

Pericardial Tamponade in Infant with upper Respiratory Tract Infection

Infectious pericarditis is a rare phenomenon in the era of antibiotics and vaccines. The number of patients with Haemophilus influenzae are rising (in rare cases) and commonly affect the adult population. Haemophilus influenzae is rarely seen in children due the advancement of vaccination. We describe a case where a 1 year infant suffering from cardiogenic shock, its management in the emergency room.

Diagnosing and treating pericardial disease in dogs and cats

Background: Pericardial disease accounts for approximately 10 per cent of all cardiac referrals. It is seen in all species, but is most commonly diagnosed in dogs and occasionally in cats. Pericardial disease comprises both acquired and congenital conditions, of which pericardial effusion (PE) associated with acquired disease is most common. PEs are most frequently either idiopathic or secondary to neoplasia, although other causes such as left atrial tear (secondary to myxomatous valvular disease), infectious pericarditis, an extension of congestive heart failure (CHF) and secondary to trauma are all possible causes. Congenital pericardial disease is rare, but includes peritoneopericardial diaphragmatic hernia, benign intrapericardial cysts and pericardial defects. This rare and small group of congenital conditions are important, as prompt recognition and management usually infers an excellent prognosis. Where there is sufficient volume within the pericardial sac, intrapericardial pressure can rise, leading to cardiac tamponade and signs of right‐sided CHF (R‐CHF) and low cardiac output. Importantly, management of R‐CHF in cases of pericardial disease requires a completely different approach to other diseases causing R‐CHF.Aim of the article: This article reviews the most common conditions that cause PE, common clinical signs and appropriate management strategies.

Acinetobacter Lwofii, an unusual cause of infectious pericarditis complicated with cardiac tamponade: a case report

Bacterial pericarditis can be considered a rare pathology, usually associated with cardiac procedures and, to a lesser extent, with immunosuppression and chronic diseases. The importance of its knowledge lies in the fact that mortality can reach up to 100% in untreated patients. Once diagnosed, pericardiocentesis and administration of intravenous antimicrobial therapy are mandatory for the prevention of its complications, which include cardiac tamponade and sepsis. Here we present an exceptional case of infectious pericarditis due to Acinetobacter Lwoffii in an older adult, which was complicated by pericardial effusion and cardiac tamponade.

Longitudinal study on background lesions in broiler breeder flocks and their progeny, and genomic characterisation of Escherichia coli

In broiler breeders, background mortality is rarely addressed, however, it represents the death of a vast number of birds, a constant productivity loss, welfare concerns and it might affect chick quality. The study aimed to unveil lesions leading to mortality in a study population perceived as healthy, combined with whole-genome sequencing (WGS) of Escherichia coli, a well-known contributor to disease problems in poultry. Broiler breeders (n = 340) originating from three distinct, putative healthy flocks and their progeny (n = 154) were subjected to a comprehensive post-mortem examination, bacteriological sampling, and sequencing of 77 E. coli isolates. Productivity data confirmed an exemplary health status of the enrolled flocks, and post-mortem examination further verified the absence of general disease problems. Among the submitted broiler breeders, exudative peritonitis (31.2%) was the most frequent lesion linked to infectious disease, whereas airsacculitis, pericarditis, perihepatitis, and salpingitis occurred in 18.5%, 3.5%, 3.8% and 17%, respectively. Yolksacculitis occurred in 15.6% of the broilers, whilst pericarditis, perihepatitis and peritonitis were diagnosed in 9.7%, 7.1% and 9.1%, respectively. WGS revealed a diverse population where ST95 dominated the population retrieved from broiler breeders, whereas ST10 was highly prevalent among broilers. Both lineages could be isolated from extraintestinal sites of birds without lesions indicative of infection. In general, the genetic diversity within flocks was comparable to the diversity between farms, and the overall occurrence of resistance markers was low. In conclusion, a comprehensive insight into lesions associated with background mortality is presented, together with a vast diversity of E. coli isolated from extraintestinal sites during a non-outbreak situation.

Efficacy and safety of decamethoxin in complex treatment of patients with group III viral-bacterial community-acquired pneumonia

BACKGROUND. There are many unsolved medical problems and, of course, pneumonia is one of them. Communityacquired pneumonia (CAP) is a multifactorial disease, but the role of viruses as causative agents is constantly growing. Specific antiviral therapy for CAP is limited. Therefore, the search for drugs with virucidal activity remains relevant. An antimicrobial agent with a broad spectrum of action – decamethoxin – is successfully used today for treatment of patients with infectious exacerbations of bronchial asthma and chronic bronchitis. At the same time efficacy of decamethoxin in CAP patients was not studied. OBJECTIVE. To evaluate the effectiveness and safety of the inhaled antimicrobial drug decamethoxin in the complex treatment of patients with group III viral-bacterial CAP. MATERIALS AND METHODS. There was enrolled 62 patients with group III viral-bacterial CAP. All patients received the same sequential antibiotic therapy: protected aminopenicillin with macrolide or III generation cephalosporin with macrolide. Patients of the main group were prescribed inhalations through a nebulizer of the antiseptic drug decamethoxin in addition to antibacterial therapy from the first day of treatment for 5-7 days. RESULTS AND DISCUSSION. No adverse events were detected in any of the patients during treatment. In all cases, recovery was diagnosed. At the same time, the term of achieving positive results in the main group was 12.2±0.7 days, and in the control – 17.2±0.7 (р <0,05). The average duration of antibiotic use was different in main and control groups: respectively 9.4±0.4 and 10.7±0.4 days (р <0,05). There were no infectious complications in the patients of the main group, while 24 (72 %) patients of the control group were diagnosed with acute rhinopharyngitis (47.0 % of cases), lateral pharyngitis (13 %) and sinusitis (9 %), other complications (otitis, infectious exudative pericarditis). In 22 (66 %) cases there was one complication and in 2 (6 %) cases there were two complications. CONCLUSIONS. For patients with group III viral-bacterial CAP additional inclusion in the empirical sequential antibiotic therapy of inhaled decamethoxin can significantly reduce the frequency of infectious complications, duration of antibiotic therapy, as well as the duration of positive treatment results.

Pericarditis in contemporary therapeutic clinic: nosological spectrum, approaches to diagnosis and treatment

To analyze the register of pericarditis in a therapeutic clinic, to evaluate their nosological spectrum, to optimize approaches to diagnosis and treatment. For the period 20072018, the register includes 76 patients with the diagnosis of pericarditis (average age 53.115.7 years, 2085 years, 46 female). Patients with hydropericardium were not included in the register. Diagnostic puncture of pericardium was carried out in 5 patients, pleural puncture in 11 patients. Morphological diagnostics included endomyocardial/ intraoperative biopsy of myocardium (n=4/2), thoracoscopic/intraoperative biopsy of pericardium (n=1/6), pleural puncture (n=5), transbronchial (n=1), thoracoscopic biopsy of intrathoracic lymph nodes (n=2), lung (n=1), supraclavicular lymph node biopsy (n=1), salivary gland (n=1), subcutaneous fat and rectum biopsy per amyloid (n=6/1). The genome of cardiotropic viruses, level of anti-heart antibodies, C-reactive protein, antinuclear factor, rheumatoid factor (antibodies to cyclic citrullinized peptide), antibodies to neutrophil cytoplasm were determined, extractable nuclear antigens (ENA), protein immunoelectrophoresis, diaskin test, computed tomography of lungs and heart, cardiac magnetic resonance imaging, oncologic search. The following forms of pericarditis were verified: tuberculosis (14%, including in combination with hypertrophic cardiomyopathy HCM), acute / chronic viral (8%) and infectious immune (38%), including perimyocarditis in 77%, pericarditis associated with mediastinum lymphoma/sarcoma (4%), sarcoidosis (3%), diffuse diseases of connective tissue and vasculitis (systemic lupus erythematosus, rheumatoid arthritis, diseases of Horton, Takayasu, Shegren, Wegener, 12%), leukoclastic vasculitis, Loefflers endomyocarditis, AL-amyloidosis, thrombotic microangiopathy (1% each), HCM (8%), coronary heart disease (constriction after repeated punctures and suppuration; postinfection and immune, 4%), after radiofrequency catheter ablation and valve prosthetics (2%). Tuberculosis was the main causes of constrictive pericarditis (36%). Treatment included steroids (n=39), also in combination with cytostatics (n=12), anti-tuberculosis drugs (n=9), acyclovir/ganclovir (n=14), hydroxychloroquine (n=23), colchicine (n=13), non-steroidal anti-inflammatory drugs (n=21), L-tyroxine (n=5), chemotherapy (n=1). In 36 patients different types of therapy were combined. Treatment results observed in 55 patients. Excellent and stable results were achieved in 82% of them. Pericardiectomy/pericardial resection was successfully performed in 8 patients. Lethality was 13.2% (10 patients) with an average follow-up 9 [2; 29.5] months (up to 10 years). Causes of death were chronic heart failure, surgery for HCM, pulmonary embolism, tumor. During a special examination, the nature of pericarditis was established in 97% of patients. Morphological and cytological diagnostics methods play the leading role. Tuberculosis pericarditis, infectious-immune and pericarditis in systemic diseases prevailed. Infectious immune pericarditis is characterized by small and medium exudate without restriction and accompanying myocarditis. Steroids remain the first line of therapy in most cases. Hydroxychloroquine as well as colchicine can be successfully used in moderate / low activity of immune pericarditis and as a long-term maintenance therapy after steroid stop.

Abstract 15132: Inpatient Outcome of Infective Pericarditis in the United States: An Analysis From National Inpatient Sample 2016-2017

Introduction: Infective pericarditis is a relatively uncommon condition in the modern antibiotic era, has a high mortality rate (20-30%) and is associated with immunosuppression, alcohol use, illicit drug use, thoracic surgery. Outcomes data in the current era is unknown. We aim to analyze the baseline characteristics and outcomes of patients admitted in the hospital with infective pericarditis. Methods: We conducted a retrospective study using National Inpatient Sample (NIS) database from 2016 to 2017. Hospital visits with a primary diagnosis of infective pericarditis (ICD10, I30.1) during which a pericardial procedure was performed were identified using ICD-10-CM and ICD-10-PCS Codes. Our primary outcome was basic characteristics and in-hospital all-cause mortality. Multivariate regression model was used to adjust for the pericardial procedure approach, age, and cardiac tamponade. R (Version 3.6.1) was utilized for the analysis. Results: A total of 1010 weighted hospitalizations in adult patients with infective pericarditis were identified. The mean age was 56.7±1.1 years (woman - 41.4%). The baseline characteristics and comorbidities are described in table 1 and table 2. 60.5% of the patients underwent percutaneous pericardial drainage, 36.4% had open surgery, and 3.2% had VATs. The mean time from admission to a pericardial procedure is 1.7±0.2 days. In-hospital all-cause mortality was 2.27%. The mean length of stay was 7.59±0.43 days. The mean total cost was 22530±1193 US dollars. Among all hospitalizations, 61.8% of them were complicated by hemodynamic instability and 56.8% had cardiac tamponade. Compared to pericardiocentesis, patients who underwent pericardiotomy had a higher mortality (5% vs 0.8%, adjusted OR 8.03, P = 0.043). Conclusions: Our study demonstrates relatively low inpatient mortality with infective pericarditis compared to older studies. Around half of the patients had cardiac tamponade.

Mitochondrial disease, hypertrophic cardiomyopathy and cutaneous lupus in an infant with food hypersensitivity

This paper describes a 4 month-old-girl with food allergies, mitochondrial disease, cutaneous lupus, and hypertrophic cardiomyopathy. She suffered from infectious pericarditis due to Coxsakie virus as a complication.

Pericardite – apresentação e características numa população pediátrica

IntroductionPericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow‐up of children diagnosed with pericarditis at our center. MethodsWe performed a retrospective analysis of all children admitted to our pediatric cardiology unit with pericarditis between 2003 and 2015. Patient characteristics were summarized using frequencies and percentages for categorical variables and medians with percentiles for continuous variables. ResultsFifty patients were analyzed (40 male, 10 female) with a median age of 14 years. The most common diagnosis was acute pericarditis (80%). Thirty‐five patients (70%) presented with chest pain and 26% reported fever. Cardiomegaly was identified on chest X‐ray in 11 patients (22%), 30 patients (60%) had an abnormal ECG and 44 patients (80%) had alterations on the transthoracic echocardiogram. In 17 cases (34%) there was myocardial involvement. Forty‐eight percent of patients presented with infectious pericarditis and the pathologic agent was identified in half of them. Postpericardiotomy syndrome was diagnosed in five cases. The first‐line therapy was aspirin in 50% of cases. Pericardiocentesis was performed in 12 patients. The median length of stay was nine days. There was symptom recurrence in seven children. ConclusionsIn this study, acute infectious pericarditis was the most common presentation and about one third of patients also had myocarditis. The symptom recurrence rate was not negligible and is probably related to the type of therapy employed.

Pericarditis – clinical presentation and characteristics of a pediatric population

Abstract Introduction Pericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow-up of children diagnosed with pericarditis at our center. Methods We performed a retrospective analysis of all children admitted to our pediatric cardiology unit with pericarditis between 2003 and 2015. Patient characteristics were summarized using frequencies and percentages for categorical variables and medians with percentiles for continuous variables. Results Fifty patients were analyzed (40 male, 10 female) with a median age of 14 years. The most common diagnosis was acute pericarditis (80%). Thirty-five patients (70%) presented with chest pain and 26% reported fever. Cardiomegaly was identified on chest X-ray in 11 patients (22%), 30 patients (60%) had an abnormal ECG and 44 patients (80%) had alterations on the transthoracic echocardiogram. In 17 cases (34%) there was myocardial involvement. Forty-eight percent of patients presented with infectious pericarditis and the pathologic agent was identified in half of them. Postpericardiotomy syndrome was diagnosed in five cases. The first-line therapy was aspirin in 50% of cases. Pericardiocentesis was performed in 12 patients. The median length of stay was nine days. There was symptom recurrence in seven children. Conclusions In this study, acute infectious pericarditis was the most common presentation and about one third of patients also had myocarditis. The symptom recurrence rate was not negligible and is probably related to the type of therapy employed.

Propionibacterium acnes Septic Pericarditis in a Patient With Sarcoidosis and Acne

Abstract Propionibacterium acnes has been recently recognized as a common cause of pericarditis in both immunocompetent and immunocompromised hosts. It is frequently missed on routine cultures because of its slow growth. We present the first case of infective pericarditis caused by P. acnes in a man with acne and severe sarcoidosis. This case emphasizes the importance of considering this microorganism as a causative agent of pericarditis in this setting.

Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis

Pericardial effusion is associated with high mortality in oncology. The etiology of infectious pericarditis and iatrogenic effects of previous radio-/chemotherapy may be always suspected, especially when a subsequent episode is observed. The study included 17 hemodynamically-unstable patients with cancer due to recurrent pericardial bloody effusion after previous pericardiocentesis and analyzed survival determinants after intrapericardial chemotherapy with cisplatin. The mortality rate was not significantly associated with the level of N-terminal pro-B type natriuretic peptide, low hemoglobin (<12 g/dl), elevated white blood cell account (>104/μl), large volume (>1500 ml) and long duration (>8 days) of pericardial drainage, cardiac arrhythmias, positive culture test results nor fever occurring during cisplatin administration. Subsequent systemic anticancer therapy was the strongest factor determining a longer survival (hazard ratio(HR)=0.31, 95% confidence interval(CI)=0.11-0.9; p=0.03). Efficacy of rescue intrapericardial chemotherapy with cisplatin is independent of parameters of hemodynamic instability and levels of inflammatory markers in recurrent pericardial effusion.

Pleural Effusions and Pneumothoraces.

1. Katherine Cashen, DO* 2. Tara L. Petersen, MD† 1. *Department of Pediatrics, Children's Hospital of Michigan/Wayne State University School of Medicine, Detroit, MI 2. †Division of Critical Care, Department of Pediatrics, The Children’s Hospital of Wisconsin/The Medical College of Wisconsin, Milwaukee, WI * Abbreviations: BTS: : British Thoracic Society CHF: : congestive heart failure CT: : computed tomography VATS: : video-assisted thoracoscopic surgery 1. Clinicians should be aware of the causes and clinical presentation of pleural effusions and pneumothoraces. 2. Clinicians should understand the current role of diagnostic tests, imaging modalities, and timing of minimally invasive treatments. After completing this article, readers should be able to: 1. Describe the pathogenesis of pleural fluid accumulation. 2. Identify the most likely causes of pleural effusion and pneumothorax. 3. Understand the basic clinical presentation, diagnostic tests, and management of pleural effusions and pneumothoraces. 4. Differentiate between transudative and exudative pleural effusions. 5. Understand the natural history of spontaneous pneumothorax. The pleural space is created by the parietal and visceral pleura that line the chest wall and the lung surface, respectively. Normally, only a small amount (0.3 mL/kg) of hypotonic fluid is present within the pleural space due to homeostatic balances in physiologic fluid production and absorption. Various infectious and noninfectious processes can lead to pathologic filling of the pleural space with fluid (effusion) or air (pneumothorax). Such pathologic changes create a true space that can interfere with normal lung mechanics and, in severe cases, cardiac function. Although much less common in pediatric than adult populations, pleural effusions and pneumothoraces in both groups can lead to substantial complications, resulting in significant morbidity and mortality if unrecognized or untreated. Overall, the cause of pleural effusions and pneumothoraces differs in children compared to adults. In adults, congestive heart failure (CHF) and malignancy account for a substantial number of pleural effusions, but these are uncommon causes in children. Infectious pleural effusions in the setting of pneumonia (parapneumonic effusions) remain the most common cause of effusions in both children and adults. Unlike the adult population, children experience spontaneous …

Atypical Presentation of Bacterial Infective Pericarditis in a Sixteen-Year-Old Male

Atypical Presentation of Bacterial Infective Pericarditis in a Sixteen-Year-Old Male

Pericardiocentesis guided by echocardiography performed in echocardiography laboratory – Safety profile of the single center prospective registry

IntroductionPericardiocentesis is an invasive procedure for treatment of large pericardial effusion or cardiac tamponade and for diagnostics of pericardial effusion of unknown origin. Fluoroscopy navigation has been the preferred method during the past decades. Nevertheless, new imaging methods such as echocardiography emerged as an alternative guiding method for pericardiocentesis. These methods may improve safety of the procedure. MethodsAll consecutive pericardiocenteses performed in noninvasive cardiology department of a tertiary cardiovascular center during the period between 1998 and 2012 were prospectively recorded. We focused on the procedural safety and procedural success rate. ResultsDuring a 15-year period, 253 pericardiocenteses were performed in 185 patients. Most of the procedures (240 cases) were performed under echocardiographic control in our noninvasive cardiology laboratory under strictly sterile conditions and with equipment for cardiopulmonary resuscitation on site. Etiology of effusion was heart transplantation in 38 patients (25%), postoperative in 20 patients (14%), infective pericarditis in 25 patients (16%), malignancy in 18 patients (12%), and invasive procedures in 19 patients (8%). Apical approach was the most frequent in 218 patients (92%), parasternal in 13 patients (5%) and subxiphoideal in 7 patients (3%). The procedural success rate was 97% overall, with a total complication rate of 3% (2 major complications (0.3%); 7 minor complications (2.7%)). Minor complications included 2 cases of small pneumothorax, 2 cases of pericardial fluid drainage into pleural space, 2 cases of transient right chamber entries, and in 1 case the procedure was complicated by hemopericardium without the need for surgical management. Major complications included 2 cases due to ventricular perforation, one with left ventricule wall laceration in a loculated effusion and one complication due to right ventricular laceration, both resulting in hemopericardium and requiring emergency surgical repair. ConclusionEchocardiography-guided pericardiocentesis performed by echocardiologists in noninvasive cardiology department under strictly sterile conditions and with equipment for cardiopulmonary resuscitation is a safe procedure with infrequent complications. Apical entry site is safe and the dominant approach for pericardiocentesis under echocardiographic navigation.