Pericardial Infiltration Research Articles

Unusual Presentation of a Primary Pericardial Malignant Mesothelioma: Constrictive Pericarditis A Case Report and Review of the Literature

Primary malignant pericardial mesothelioma is an extremely rare tumor with high lethality. We report the case of a 30 year-old female without medical history, who was admitted in the department of cardiology for a dyspnea and chest pain due to a large pericardial effusion. A tamponade was confirmed by echocardiography, and emergent pericardial drainage was performed. Twelve months later, the patient developed a hemodynamically relevant pericardial constriction. She underwent a partial pericardectomy. The pericardium was thick and adherent. The histological examination revealed a pericardial infiltration by malignant mesothelioma. After surgery, five cycles of chemotherapy with carboplatine were beginned. The treatment methods of primary pericardial mesothelioma are limited. Chemotherapy in addition to surgery seems to improve symptoms in case of constriction and non-response to pericardectomy.

An Unusual Case of Cardiomegaly

A 64-year-old woman presented to the emergency department because of progressive fatigue and weight loss for the previous 3 months. She had a 10 pack-year history of smoking with no other significant medical history. Physical examination was unremarkable with normal cardiac and pulmonary auscultation. Her electrocardiogram showed sinus rhythm with very low voltages in all leads (Figure 1A). A chest x-ray film showed enlargement of the cardiac silhouette with normal pulmonary vascularization (Figure 1B). A transthoracic echocardiography was performed that revealed an homogeneous mass next to the right side of the heart without clear infiltration and moderate pericardial effusion (Figure 1C; see Movies I through III in the online-only Data Supplement). A contrast-enhanced full-body computed tomography showed a 12 × 8 cm soft-tissue density mass with some necrotic areas in the anterior and medium mediastinum (Figure 1D). No clear pericardial infiltration or involvement was noted, but small pleural and pericardial effusion was present. To better characterize the tumor, a cardiac magnetic resonance was performed, showing an 11 × 8.5 cm intrapericardial mass, with well-defined borders and no signs …

Rapid response to chemotherapy in a patient with thymoma with pericardial effusion

Thymomas are rare tumors involving the anterior mediastinum. Localized thymomas can be surgically resected and have an excellent prognosis, whereas advanced thymomas are treated with induction chemotherapy followed by surgery. We report here the successful use of chemotherapy in a woman with stage IV thymoma with pericardial infiltration and effusion. Our experience suggests that aggressive chemotherapy with a cisplatinand adriamycin-based regimen can lead to rapid regression of thymoma and significant improvement in symptoms.

Massive myocardial infiltration by HIV-related non-Hodgkin lymphoma

A 23-year-old male presented with severe rest dyspnoea, engorged jugular veins, ankle oedema and heart rate 140 bpm. Computed tomography (CT) scan showed a large mediastinal mass with pericardial and atrial infiltration, pulmonary artery and superior vena cava compression. HIV infection was detected. Echocardiography showed 5 × 4 cm masses both in the right and the left atria, pericardial effusion, thickening of the right and left ventricular walls and hypokinesis; after intravenous contrast medium (SonoVue), the ventricular myocardium showed an increased, granular echogenicity, as did the mediastinal mass and pericardium. Nadroparin, bisoprolol, amiodarone and (suspecting non-Hodgkin lymphoma) steroids were started. After 3 days, at echocardiogram, the thickness of the ventricular walls was reduced and ejection fraction was improved. Mediastinal biopsy disclosed a large B-cell lymphoma. After starting systemic chemotherapy (rituximab, cyclophosphamide, vincristine, doxorubicin) and highly active antiretroviral therapy (HAART), 11 days after admission the patient was in New York Heart Association (NYHA) class 1-2, with normal jugular veins and no oedema. The echocardiogram showed no more pericardial effusion, atrial masses reduced by 50%, normal interventricular septum thickness and ejection fraction. In August 2010, after six cycles of chemotherapy followed by radiotherapy, the patient was in complete remission. This case shows both the echocardiographic findings typical of neoplastic infiltration of the myocardium and the rapid improvement observed within a few days after chemotherapy. In the HAART era patients with HIV-related lymphoma and even massive involvement of the heart may receive aggressive treatment with curative intent. Echocardiography is useful in early assessment of the response to therapy.

Cardiac tamponade and paroxysmal third-degree atrioventricular block revealing a primary cardiac non-Hodgkin large B-cell lymphoma of the right ventricle: a case report

IntroductionPrimary cardiac lymphoma is rare.Case PresentationWe report the case of a 64-year-old non-immunodeficient Caucasian man, with cardiac tamponade and paroxysmal third-degree atrioventricular block. Echocardiography revealed the presence of a large pericardial effusion with signs of tamponade and a right ventricular mass was suspected. Scanner investigations clarified the sites, extension and anatomic details of myocardial and pericardial infiltration. Surgical resection was performed due to the rapid impairment of his cardiac function. Analysis of the pericardial fluid and histology confirmed the diagnosis of non-Hodgkin large B-cell lymphoma. He was treated with chemotherapy.ConclusionThe prognosis remains poor for this type of tumor due to delays in diagnosis and the importance of the site of disease.

心嚢滲潤により心タンポナーデを起こしたが化学療法により救命し得た左肺門部T cell lymphomaの1例

心嚢滲潤により心タンポナーデを起こしたが化学療法により救命し得た左肺門部T cell lymphomaの1例

Pericarditis Heralding Erdheim-Chester Disease

A 47-year-old man with a history of gynecomastia due to prolactin-releasing pituitary microadenoma was admitted to the hospital because of persistent chest pain and fatigue. Chest x-ray showed pronounced enlargement of the cardiac profile (Figure 1), and echocardiography demonstrated a marked pericardial effusion (Figure 2). Pericardiocentesis allowed the drainage of 1800 mL of pericardial fluid whose biochemical analysis was consistent with an exudate (total protein and lactate dehydrogenase fluid-to-serum ratios of 0.9 and 2.6, respectively); cytological examination showed the presence of mesothelial cells, histiocytes, and lymphocytes. Figure 1. Chest x-ray performed at the time of admission to hospital showing marked enlargement of the cardiac profile. Figure 2. Transthoracic echocardiographic image, obtained on admission to hospital, …

Percutaneous Left Atrial Cardiac Biopsy with CT Fluoroscopy Guidance

Percutaneous computed tomographic (CT) fluoroscopy-guided biopsy was performed to evaluate an intracardiac tumor located within the left atrium of a 72-year-old woman. Postinterventional follow-up was unproblematic and free of complications. Histopathologic examination revealed a high-grade cardiac sarcoma, and the patient underwent consecutive resection and radiation therapy. In general, percutaneous puncture of the heart must be considered hazardous. Under certain conditions (eg, broad-based tumor, advanced luminal mass, myocardial and/or pericardial infiltration), however, percutaneous CT-guided biopsy may be an appropriate alternative to transluminal catheter biopsy for the minimally invasive investigation of cardiac tumors.

A New Window of Opportunity in Echocardiography

Improvements in echocardiographic technology have made technically difficult studies a rare entity. However, physical barriers such as bandages, inability for patients to turn because of intubation, arterial lines, and organ and life support machines make echocardiographic imaging challenging. We performed echocardiographic imaging from left and right posterior thoracic approach using acoustic properties of pleural fluid to assist in obtaining good imaging windows in patients who had pleural effusion (PE). In this study we describe one author's (T. Z. N.) experience with the mid to lower posterior thoracic window in 18 patients who had PE and in whom conventional transthoracic windows either provided suboptimal images or incomplete clinical information. The posterior approach allowed excellent differentiation of pericardial effusion versus PE, detection of pericardial disease and pericardial infiltration, and excellent endocardial border definition of left and right ventricle in those with poor anterior transthoracic windows. Native and prosthetic aortic valve gradients could be assessed adequately as a result of perfectly parallel Doppler alignment beam to left ventricular outflow tract and aortic valve. In addition, right posterior thoracic window provided views comparable with subcostal view and allowed visualization of inferior vena cava, right atrium, and liver. In patients with PE, imaging from low to midposterior thorax can provide additional diagnostic echocardiographic images and should be used in patients in whom conventional images are technically difficult or require additional information.

Like frogs disguised as leaves

It has long been a controversial issue whether infection by Chlamydia trachomatis directly contributes to heart disease or is a bystander simply finding a place to live on atherosclerotic plaques. Molecular mimicry is an important factor in the exacerbation of various infectious diseases, and this appears to be a possible mechanism operating in the case of the C. trachomatis–heart disease link. Kurt Bachmaier and colleagues1xChlamydia infections and heart disease linked through antigenic mimicry. Bachmaier, K. et al. Science. 1999; 283: 1335–1339Crossref | PubMed | Scopus (335)See all References1 in Toronto have discovered that a peptide extracted from mouse heart muscle has sequence homology to outer membrane proteins of several Chlamydia spp. In mice, cardiac myosin-induced myocarditis is linked to CD4+ T-cell recognition of major histocompatibility complex (MHC) class II-associated peptides derived from α-myosin heavy chain. These peptides are known to be conserved between mouse and human heart muscle. All the Chlamydia-derived mimics of these myosin peptides induce inflammatory heart disease in mice, characterized by perivascular and pericardial infiltration of mononuclear cells and fibrotic changes, which looks like human myocarditis. Inflammation is restricted to heart muscle and is not seen in skeletal muscle. The authors suggest that the presence of bacterial DNA also acts as a powerful adjuvant for autoaggressive T cells. This work has shown that Chlamydia infection, which is of high prevalence in western societies, superimposed on a permissive genetic background and combined with associated risk factors, such as smoking, high cholesterol levels, stress and obesity, can indeed be a significant threat to the precipitation of inflammatory heart disease.

Endoscopic Ultrasonography in the Preoperative Staging of Adenocarcinoma of the Distal Oesophagus and Oesophagogastric Junction

Background: Endoscopic ultrasonography is considered to be the most accurate procedure in the preoperative staging of oesophageal carcinoma. Its accuracy was evaluated in the preoperative staging of adenocarcinoma of the distal oesophagus and oesophagogastric junction. Methods: Thirty-two consecutive patients with adenocarcinoma of the distal oesophagus and oesophagogastric junction were preoperatively examined and staged by means of endoscopic ultrasonography. All patients underwent radical en bloc resection of the oesophagus and proximal stomach (or total gastrectomy) with standard lymphadenectomy including thoracic duct and mediastinal fat tissue. The postoperative histopathologic TNM stage was taken as reference. Results: An endoscopic ultrasonography examination could be completed in 26 of the patients; the other 6 had obstructive tumour. In two patients infiltration of the tumour into the vital organs (in one patient aortic infiltration and in a second patient pericardial infiltration) was incorrectly suspected. The ability to predict T stage was 65.6%. T stage was overstaged in 31.2% and understaged in 3.1% of the cases. The ability to predict N stage was 71.9%. N stage was overstaged in 25.0% and understaged 3.1% of the cases. Conclusions: In adenocarcinoma of the oesophagus and oesophagogastric junction endoscopic ultrasonography helps in predicting resectability, but the exact TN staging is not accurate. Since early detection of tumour and aggressive surgical intervention constitute the only curative treatment, caution must be exercised when judging a patient to be inoperable solely on the basis of endoscopic ultrasonography findings without proven distant metastases.

Heart involvement in lymphomas. The value of magnetic resonance imaging and two-dimensional echocardiography at disease presentation

Thirty-six patients with mediastinal lymphoma were studied with chest magnetic resonance imaging (MRI) and two-dimensional echocardiography at presentation to define the extent of the disease in the paracardiac area. Involvement of cardiac structures was present in 23 of 36 patients (64%). Pericardial contiguity was detected in 23 of 23 patients (100%) by MRI and in 18 of 23 patients (78%) by echocardiography. Pericardial effusion, present in 17 patients (74%), and pericardial infiltration, present in 7 patients (30%), were detected by both techniques in 71% and 86%, respectively. Myocardial infiltration was identified in two of two patients (100%) by MRI and in one of two patients (50%) by two-dimensional echocardiography. Extrapericardial disease was identified in 100% of patients by MRI but only in 30% of patients by echocardiography. Extracardiac and intracardiac involvement is a frequent event in mediastinal lymphomas and should be carefully evaluated with different imaging modalities, mainly MRI, for correct diagnosis and proper management.

Omental Pedicle Flap Used to Treat a Bronchopleural Fistula after Diaphragma-Pericardio-Pleuropneumonectomy

In a 47-year-old male patient a bronchopleural fistula was apparent 22 days after extended right-sided diaphragma-pericardio-pleuro-pneumonectomy for pleuramesothelioma. The thoracic cavity was infected. Rethoracotomy was performed and the fistula was closed using an omental pedicle flap. The bronchial stump became tight and the cavity fluid became sterile. No abdominal complications were seen. The patient died 8 months later from malignant pericardial infiltration. The ability of greater omentum to revascularize ischemic tissue, to absorb fluid and to resist local infection is proved and used in several subspecialities of surgery. Nevertheless the use of the greater omentum in the management of bronchopleural fistula has been rarely published. The reported case shows that the closure of a large bronchopleural fistula is possible by using the attributes of the omental tissue.

Malignant Lymphoma with Pericardial Infiltration Demonstrated Clinically

Malignant Lymphoma with Pericardial Infiltration Demonstrated Clinically

An infantile case of acute lymphatic leukemia with cardiac tamponade due to pe ricardial infiltration

An infantile case of acute lymphatic leukemia with cardiac tamponade due to pe ricardial infiltration

Experimental model of leukemic infiltrative pericarditis reflecting a human disease

In human leukemias, pericarditis may be associated with leukemic pericardial infiltration. In order to obtain more information about the pathogenesis of the leukemic involvement of the pericardium, sterile talc-induced pericarditis was produced in acute lymphoid leukemic male hybrid mice. The animals invariable showed leukemic pericardial infiltration within 14 days. In leukemic mice without any treatment or with intrapericardial physiological NaCl injection (instead of talc), leukemic involvement of the pericardium did not occur.

Metastatic Cardiac Tumor Demonstrated by 201Thallium Scan

A patient with bronchogenic carcinoma had an electrocardiogram that was initially thought to be consistent with myocardial infarction and possible left ventricular aneurysm. A heart scan with radioactive 201thallium showed an area of sharply diminished uptake ("cold spot"); however, subsequent thoracotomy showed that this was caused by local pericardial and myocardial infiltration by tumor. This suggests a role for radioactive 201thallium in the detection of cardiac metastatic tumors.

Myocardial Infarction in Acute Leukemia

ELECTROCARDIOGRAPHIC changes have frequently been reported in cases of acute leukemia, 1-6 but they have most commonly occurred as the result of myocardial or pericardial infiltration, 1-5,7,8 , bleeding into the heart itself, 1,4,9 chronic anoxia, 10 or infiltration of the conduction tissue 6 and valve leaflets. 8 Myocardial infarction is rarely mentioned as a concomitant of acute leukemia in large series of such cases. We recently treated a 33-year-old man whose second relapse of acute granulocytic leukemia was complicated by transmural inferolateral myocardial infarction from which he recovered without incident. Report of a Case The patient was a 33-year-old white man who was initially admitted to the Graduate Hospital of the University of Pennsylvania on Sept 10, 1964, because of marked elevation of his white blood cell count (WBC) and cellulitis and deep calf thrombophlebitis of the left leg. Smears of the peripheral blood and aspirated bone marrow were consistent with acute granulocytic leukemia. The cellulitis