Pleuropericardial Effusion Research Articles

A Novel Non-Sense Mutation in a Senegalese Patient with Hermansky-Pudlak Type 1 Syndrome

Hermansky-Pudlak syndrome (HPS) is a rare inherited multisystem disorder characterized by oculocutaneous albinism and diathesis, and in some patients with pulmonary fibrosis. It is caused by defective biogenesis and trafficking of lysosome-related organelles. Genetically HPS is heterogeneous, and ten loci have been identified as causative genes. The majority of these genes encode subunits of multi-protein complexes named biogenesis of lysosomes-related organelles complex. Mutations within HPS1 and HPS4 genes lead to pulmonary fibrosis in HPS type1 and type 4 patients respectively and are the leading cause of mortality. A 14 years Senegalese boy who was initially diagnosed with oculocutaneous albinism was recruited with his father after informed consent for genetic analysis. In his clinical history, there was no bleeding tendency or clinical episodes of hemorrhagic diathesis. One of his sisters had albinism and died from lung complications at the age of 15 years. The patient was referred to the pneumology department of Fann Hospital in Dakar for further explorations. The high-resolution computed tomography (HRCT) scans of the lungs revealed no evidence of diffuse interstitial lung disease, pleuropericardial effusion, bronchiectasis, pulmonary hypertension, intra pulmonary/mediastinal mass or lymphadenopathy. Mutation screening by Albinism NGS panel identified a homozygous mutation located in exon 6 of the HPS1 gene, c.421C>T (p.Gln141*), in the Proband while his father showed heterozygosity for this mutation. The parents of the proband are not consanguineous and this may suggest a common allele of HPS1 among Senegalese people. Patients with oculocutaneous albinism should therefore be evaluated for Hermansky-Pudlak syndrome by mutational screening within the ten HPS genes.

Corrigendum to “Pericardial Tamponade: An Uncommon Clinical Presentation in cANCA Related Vasculitis and Glomerulonephritis in Association with Very High Titres of ANA”

[This corrects the article DOI: 10.1155/2019/4983139.].

A Diagnostic Conundrum in a Newly Diagnosed Ulcerative Colitis Patient Who Presented with Pleuropericardial Effusion

Ulcerative colitis is a chronic inflammatory disease affecting mainly the colon and presenting with diarrhea, bloody defecation andabdominal pain. Although cardiac and/or pulmonary involvement has been reported in patients with ulcerative colitis, it rarelyinvolves both the pleura and pericardium at the same time. Also, it is difficult to determine whether pulmonary or cardiac diseaseis secondary to the ulcerative colitis drugs or to the underlying disease process. Here we present a rare case of pleuropericardialeffusion in a patient newly diagnosed with ulcerative colitis. In ulcerative colitis, the simultaneous involvement of the respiratoryand cardiovascular systems is uncommon yet potentially dangerous.

Influenza B virus infection complicated by life-threatening pericarditis: a unique case-report and literature review

BackgroundAcute pericarditis may occur frequently after viral infections. To our knowledge, influenza B virus infection complicated by pericarditis without myocardial involvement has never been reported. We report the first case of life-threatening pericarditis caused by influenza B virus infection.Case presentationA 48-years-old woman with trisomy 21 and ostium primum atrial septal defect was transferred from Cardiology to our Internal Medicine Department for severe pericardial effusion unresponsive to ibuprofen and colchicine. Based on the recent patient history of flu-like syndrome, and presence of pleuro-pericardial effusion, a viral etiology was suspected. Laboratory evaluation and molecular assay of tracheal aspirate identified influenza B virus. Therefore, the ongoing metilprednisolone and colchicine therapy was implemented with oseltamivir with progressive patient improvement and no evidence of pericardial effusion recurrence during follow-up.ConclusionsEspecially in autumn and winter periods, clinicians should include Influenza B virus infection on differential diagnosis of pericarditis with large pericardial effusion.

Incidence of Differentiation Syndrome with Ivosidenib (IVO) and Enasidenib (ENA) for Treatment of Patients with Relapsed or Refractory (R/R) Isocitrate Dehydrogenase (IDH)1- or IDH2-Mutated Acute Myeloid Leukemia (AML): A Systematic Analysis By the U.S. Food and Drug Administration (FDA)

▪Background: IVO (Agios Pharmaceuticals, Inc.) and ENA (Celgene) are small molecules approved by the FDA for treatment of adults with R/R AML with an IDH1 or IDH2 mutation, respectively. Gain-of-function mutations in IDH1 and IDH2 alter normal DNA methylation and impair differentiation (Im et al, Leukemia 2014). IVO and ENA inhibit IDH1 and IDH2 gain-of-function mutant enzymes, respectively, with the intent of restoring differentiation. IVO and ENA carry boxed warnings for differentiation syndrome (DS), a clinical syndrome that can be fatal if not treated. Montesinos et al (Blood 2009) proposed diagnostic criteria for DS based on at least 2 of the following signs and symptoms: 1) dyspnea, 2) unexplained fever, 3) weight gain, 4) unexplained hypotension, 5) acute kidney injury, and 6) pulmonary infiltrates or pleuropericardial effusion. Patients with 2 or 3 criteria were classified as having moderate and patients with at least 4 criteria were classified as having severe DS. DS was excluded in cases with an alternative explanation (e.g. septic shock). The incidence of DS in patients treated with IVO (DiNardo et al. NEJM 2018) and ENA (Fathi et al. JAMA Oncol 2018) has been reported based on investigator and review committee determination. FDA sought to perform a systematic analysis of DS cases in patients treated with IVO or ENA based on adverse event (AE) preferred terms (PTs) and laboratory test results grouped per the Montesinos criteria. We hypothesized that using an algorithmic approach would uncover a higher incidence of DS than reported initially.Methods: We searched for cases of DS in Study AG120-C-001 for IVO and Study AG221-C-001 for ENA using PTs and laboratory data within the first 90 days of treatment, grouped per the Montesinos criteria. Patients were included in the analysis if they had been treated for R/R AML using the approved dose of IVO (n=179) or ENA (n=214). We reviewed case narratives and laboratory data for algorithmically-identified cases of DS to adjudicate whether cases were DS or unlikely DS, due to an alternative explanation (e.g., infection, disease progression). An additional query for the DS cases was performed for concomitant leukocytosis, defined using PTs Leukocytosis, Hyperleukocytosis, or White blood cell count increased, or laboratory results showing leukocyte count > 10Gi/L within 7 days of clinical signs/symptoms.Results: The algorithm identified 72/179 (40%) cases of potential DS for IVO and 86/214 (40%) for ENA. FDA reviewer adjudication revealed that roughly half of the cases identified by the algorithm were DS for IVO (34/179, 19%) and ENA (41/214, 19%). This contrasts with the DS incidence of 11% (19/179) for IVO (DiNardo et al. NEJM 2018) and 12% (26/214) for ENA (Fathi et al. JAMA Oncol 2018) reported by investigators and review committee determination, respectively. Characteristics of FDA-identified DS cases in patients treated with IVO and ENA and FDA-adjudicated complete remission (CR) + CR with partial hematologic recovery (CRh) responses to the respective drugs in patients with DS are presented in the Table. For both IVO and ENA, CR+CRh rate in patients with DS was numerically lower than that for patients without DS (IVO: 18% [95% CI 7-35%] vs. 36% [95% CI 28-45%]; ENA: 18% [95% CI 7-33%] vs. 25% [95% CI 18-32%]). Age, demographics, and cytogenetic risk of patients with FDA-identified DS were similar to those of patients without DS.Conclusions: An algorithmic analysis of AEs and laboratory tests using the Montesinos criteria led to recognition of additional cases of DS not identified by investigators for patients treated with IDH inhibitors IVO and ENA. DS occurred in roughly one in five patients treated with both drugs and grade 3 or higher adverse reactions were present in over half of cases. Leukocytosis was not always present. Patients with DS had numerically lower response rates, but firm conclusions regarding the impact on response cannot be inferred based on this post-hoc subgroup analysis. Increased recognition of signs and symptoms of DS through the framework of the Montesinos criteria may lead to earlier diagnosis and treatment, which may decrease severe complications and mortality. Furthermore, integration of the algorithmic approach into clinical trials of differentiating therapies may help to prospectively monitor the incidence and severity of DS. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Ruptured Amoebic Liver Abscess with Pleuro Pericardial Effusion – A Case Report

Ruptured Amoebic Liver Abscess with Pleuro Pericardial Effusion – A Case Report

Abstract 2652: Favorable outcome of primary mediastinal large B-cell lymphoma treated by Dose Adjusted EPOCH-Rituximab regimen

Abstract Background Primary Mediastinal Large B-Cell Lymphoma (PMLBCL) is a unique type of B-cell lymphoma probably arising from a putative thymic medulla B-cell. One to 2% of NHL, 7% of all diffuse large B-cell lymphomas (DLBCL), occurring more often in young females. Often presents with superior vena cava syndrome and airway compromise. Treatment is with chemotherapy combined with Rituximab, followed by involved field radiation therapy to mediastinum. PMLBCL has better outcome than others DLBCL. We aimed to develop a more dose-dense/intense regimens that improves the rate of cure with an attempt to avoid mediastinal radiation. Patients and methods A prospective study was conducted in our department from January to December 2015, in 6 patients with untreated primary mediastinal B-cell lymphoma. An infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) has been administred according to the protocol Day 1 : Rituximab 375 mg/m2 IV Day 1-4 : Etoposide 50 mg/m2 IV, Doxorubicin 10 mg/m2 AND Vincristine 0.4 mg/m2 Day 5 : Cyclophosphamide 750 mg/m2 Days 1-5 : Prednisone 60 mg/m2 PO BID. Administer G-CSF 5 mcg/kg SQ on day 6 until ANC exceeds nadir Cycles were repeated every 3 weeks for a toal of 6 cycles Results The median age of the patients was 32 years, the male to female ratio : 2:4. Systemic symptoms mainly fever and weight loss, were present in all cases; increased LDH levels were also observed in 50% of cases. Majority of the patients (83%) presented with stage I/II disease, bulky mass with a median tumor diameter 15 cm. Most had features of local extension like pleuro-pericardial effusion. Absence of infradiaphragmatic lymph nodes and no bone marrow involvement at presentation. All patients required biopsy from the mediastinal mass by image guided core biopsy. The patients were treated by RDA-EPOCH, they received 4 to 6 courses, without involved field radiotherapy (only one patient underwent radiotherapy for residual mass). No late morbidity or cardiac toxic effects were found in any patients. After 24 months of follow-up, one patient still received treatment and was not evaluable. 5 patients achieved complete remission and were disease-free at the last visit. Conclusion PMBCL is a specific lymphoma entity seen in the young with good survival. It has a distinct clinical behavior and prognosis, and therefore require a different therapeutic approach. The R/DA-EPOCH regimen need to be confirmed in further prospective study for a large cohort. Note: This abstract was not presented at the meeting. Citation Format: Fatiha Grifi, Soraya Bougherira. Favorable outcome of primary mediastinal large B-cell lymphoma treated by Dose Adjusted EPOCH-Rituximab regimen [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2652. doi:10.1158/1538-7445.AM2017-2652

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) as a first presentation of systemic lupus erythematosus

Peripheral nervous system involvement frequently occurs in systemic lupus erythematosus (SLE) patients. However, chronic inflammatory demyelinating polyneuropathy (CIDP) is an unusual presentation that can develop before, after, or simultaneously with the onset of SLE. This paper reports the case of a 20-year-old man with diabetes mellitus (DM) and CIDP accompanied by SLE. The patient complained of progressive weakness in the bilateral upper and lower extremities that had begun 2 months prior to this visit. He was diagnosed with CIDP and treated with intravenous immunoglobulin (IVIG), but had little improvement. A plasma exchange was then scheduled, but it was not helpful either. The patient developed polyarthritis, oral ulcer, and a worsening of his muscle weakness two weeks later. A neurologic examination revealed 3/5 muscle strength in the upper and lower extremities, absent deep tendon reflex (DTR), and impaired position sense. The patient was diagnosed with SLE because of pancytopenia, lymphopenia, pleuropericardial effusion, proteinuria, high titer anti-nuclear antibody (ANA), and anti-dsDNA. A kidney biopsy revealed stage IV lupus nephritis. The patient received 3 pulses of methyl prednisolone, 6 months of cyclophosphamide, and a high daily dose of prednisolone. His proteinuria improved, and he regained the ability to ambulate with a normal gait after about 2.5 months. To the best of the authors’ knowledge, the concurrency of CIDP with SLE and DM has not been previously reported.

Clinical study of infective endocarditis in children: a 3 years experience from MGM Hospital, Warrangal

Background: The impact of endocarditis in childhood accompanies many cardio-vascular disorders. Infective endocarditis (IE) is the most frequently occurring form of endocardium inflammation. Prevailing among the agents are Str. Viridans, Str. Haemoliticus, Staph. Aureus, Staph Epidermidis, Enterococcus, etc. Objective: This study will explore the outcome of children diagnosed with infective endocarditis for a better guidance in management. Methods: This was a prospective study from warrangal from January 2013 to December 2015. 50 patients with definite IE based on modified Duke’s criteria were recruited into the study. Clinical presentation, risk factors, echocardiography and outcome were obtained. Results: A total of 50 IE patients were included within the study. The mean age was 6 ± 5.45. Most patients (80.39%) were diagnosed within the first week of admission. Staphylococcus aureas was the most common pathogen (38%) and the mitral valve was predominantly affected (68%). Complication were common and in hospital mortality remains high (27.3%). Conclusions: Mortality remains relatively high in children with infective endocarditis. The most common complication is cardiac deficiency (70%), and pleuropericardial effusions and lung embolism

A rare case of cardiac tamponade due to tuberculosis

Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased intrapericardial pressure which can negatively affect heart function. A pericardial effusion with enough pressure to adversely affect heart function is called cardiac tamponade. Pericardial effusion usually results from a disturbed equilibrium between the production and re-absorption of pericardial fluid, or from a structural abnormality that allows fluid to enter the pericardial cavity. Tuberculosis involvement of the pericardium is well-known and can result in pericardial tamponade apart from other sequelae like constrictive pericarditis. Here we report a case of 60 years old female of pleuropericardial effusion presented with acute onset breathlessness, palpitation, tachypnea. Urgent echocardiography shows cardiac tamponade. Pericardiocentesis was performed immediately and more than one litre hemorrhagic fluid drained. Patient was put on anti-tubercular treatment with oral steroid after adenosine deaminase positivity in exudative pericardial fluid. Patient is doing well in follw-up visit.

Tuberculous Pleuro-Pericardial Effusion with Adenitis

Background: Hydra-headed clinical presentations of tuberculosis could be confusing even in immunocompetent, for example pleuro-pericardial effusion with adenitis. From our literature search, this is rare. Case presentation: A 61-year-old clergyman presented with a 3-week history of cough, fever and a 5-day history of progressive dyspnoea. There was associated anaemia, weight loss but no history of drenching night sweat, hemoptysis, exposure to tuberculosis, diabetes or other suggestion of immunosuppression. Examination revealed multiple matted left axillary lymph nodes. Erythrocyte sedimentation rate (ESR) was 70 mm/hr; and negative for Hepatitis B, C and HIV. Chest X-ray showed left lower lung zone homogenous opacity with obliteration of the left cardiac border. Lymph node aspirate and pleural fluid analyses confirmed a tuberculous aetiology. Conclusion: Tuberculous pleuro-pericardial effusion with adenitis occurs in immunocompetent. High index of suspicion in endemic areas as well as early anti-tubercular treatment could be life-saving.

Antisynthetase syndrome: An under-recognized cause of interstitial lung disease.

Background:Antisynthetase syndrome (AS) is an uncommon and under-recognised connective tissue disease characterized by the presence of antibodies to anti-aminoacyl t-RNA synthetase along with features of interstitial lung disease (ILD), myositis and arthritis. The aim of the current study is to describe our experience with management of AS.Materials and Methods:This was a 2-year (2013-2014) retrospective analysis of patients diagnosed with anti-Jo-1-related AS. The presence of anti-Jo-1 antibody was tested by the immunoblot assay. All patients underwent high-resolution computed tomography of the chest, transthoracic echocardiography and evaluation for inflammatory myositis. Transbronchial lung biopsies and muscle biopsies were obtained when clinically indicated.Results:Nine patients (mean age: 43.8 years) were diagnosed with anti-Jo-1-related AS. The median duration of symptoms before diagnosis of AS was 6 months. All patients were negative for antinuclear antibodies by indirect immunofluorescence. The prevalence of ILD, myositis and arthritis at presentation was 100%, 77.8% and 55.6%, respectively. The most common ILD pattern was non-specific interstitial pneumonia (n = 6) followed by organizing pneumonia (n = 2) and usual interstitial pneumonia (n = 1). ILD was the sole manifestation in two patients and was subclinical in two patients. Six patients had pleuropericardial effusions, three patients had pulmonary artery hypertension and two patients had venous thromboembolism. Eight of the nine patients improved after treatment with steroids and other immunosuppressants.Conclusion:Antisynthetase syndrome is an important and a treatable cause of ILD. Strong clinical suspicion is needed to achieve an early diagnosis.

Post-transplant Lymphoproliferative Disorders: A Rare Case of Primary Pericardial Involvement Epstein-Barr Virus-Correlated in Heart Transplantation

Post-transplant lymphoproliferative disorders (PTLDs) are considered a fatal consequence of immunosuppression. We report a case of a 52-year-old patient, who underwent a cardiac transplantation and presented undefined recurrent episodes of pleuropericardial effusions without lymphoadenomegaly at chest radiographs and computed tomography. Histopathological analysis of the bioptic pericardium showed a specific chronic inflammation. Monitoring endomyocardial biopsies (EMBs) showed only 1 episodes of greater than grade 2R acute cellular rejection requiring immunosuppressive treatment, mild vasculitis in 2 subsequently EMBs while constantly negative for antibody-mediated rejection or infection. Only a post-mortem examination demonstrated the presence of an aggressive acute non–Epstein-Barr virus (EBV)-related proliferative disorder with unusual primitive localization into the pericardium and with coronary epicardial and intramyocardial necrotizing vasculitis and superimposed occlusive and subocclusive thrombosis. Recurrence of unexplained early pleuropericardial effusion and mild intramyocardial vasculitis should raise the suspicion of PTLD requiring reduction of immunosuppression, even in the setting of negative intramyocardial cellular infiltrate and tissue EBV-negative molecular assessment.

A sanguineous pleuro pericardial effusion in a patient recently treated with Dabigatran

Dabigatran, a direct thrombin inhibitor, is one of the new oral anticoagulants. As more patients receive treatment with Dabigatran, and as the clinical indications for Dabigatran use expand, reporting serious adverse effects is fundamental to future safety assessment. Although patients taking Dabigatran had fewer life-threatening bleeds when compared to Coumadin, those events continue to be reported. We describe, in the same patient, a sanguineous pleuro pericardial effusion that was diagnosed incidentally on a pre-ablation cardiac CT angiography. The diagnosis was made approximately two months after initiating Dabigatran treatment for non-valvular atrial fibrillation in a 63-year-old patient.

Pulmonary manifestations in systemic lupus erythematosus: association with disease activity.

Background and objectiveAlthough systemic lupus erythematosus (SLE) is the most common connective tissue disease affecting the lung, few studies have assessed risk factors that predict pulmonary manifestations. The objectives of the present study were to determine the prevalence of lung manifestations in SLE patients from Western Saudi Arabia by analysing results from high-resolution computed tomography (HRCT) scans and to identify independent risk factors for lung involvement.MethodsThis was a 10-year retrospective study involving 184 SLE patients. We examined all HRCT lung abnormalities and determined whether findings were associated with the presence of lupus nephritis (LN), SLE disease activity (as defined by SLE Disease Activity Index 2000 item scores ≥4 for any and all items) or levels of complement and anti-double-stranded DNA (anti-dsDNA).ResultsWe identified 61 patients (33%) with pulmonary involvement, and 52 (85%) of these subjects showed HRCT abnormalities. The most common HRCT findings were pleural effusion, consolidation and atelectasis (58%, 42% and 42%, respectively). There was a significant association between abnormal HRCT results and hypocomplementemia, high levels of anti-dsDNA and disease activity (P < 0.05), particularly with regard to pleuropericardial effusion and consolidation. Pulmonary abnormalities were significantly higher within the first five years after SLE diagnosis (P < 0.001). However, neither disease duration nor LN was associated with increased risk.ConclusionsLung manifestations were frequent in SLE patients from Saudi Arabia, with pleural effusion, consolidation and atelectasis being the most common. Low complement levels, high anti-dsDNA levels and disease activity were significantly associated with abnormal HRCT findings (all P < 0.001).

How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia

AbstractDifferentiation syndrome (DS), formerly known as retinoic acid syndrome, is a relatively common and potentially severe complication seen in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and/or arsenic trioxide. The full-blown syndrome consists of unexplained fever, weight gain, dyspnea with pulmonary infiltrates, pleuropericardial effusion, hypotension, and renal failure. Most measures currently used for management of DS have very little evidence-based support, and therefore, many remain controversial. Despite the lack of evidence supporting DS prophylaxis, several groups have adopted a preventive strategy with corticosteroids, especially for patients with leukocyte levels higher than from 5 to 10 × 109/L. DS diagnosis should be suspected in the presence of any of the above-mentioned signs and symptoms, and preemptive treatment with dexamethasone should be started immediately. Other supportive measures can also be crucial for the correct management of DS, especially in those patients with life-threatening complications. Temporary discontinuation of all-trans retinoic acid or arsenic trioxide is indicated only for patients in very poor clinical condition or with severe renal or pulmonary dysfunction, sometimes requiring admission to the intensive care unit. Recognition of specific biomarkers and a better understanding of DS pathogenesis can be helpful for the development of specific therapies to counteract DS in a timely manner.

A Unique Case of Malignant Pleuropericardial Effusion: HHV-8-Unrelated PEL-Like Lymphoma—A Case Report and Review of the Literature

Primary effusion lymphoma (PEL) or body cavity lymphoma is a rare type of extra nodal lymphoma of B-cell origin that presents as lymphomatous effusion(s) without any nodal enlargement or tumor masses. It belongs to the group of AIDS related non-Hodgkin's lymphomas. First described in 1996 in HIV infected individuals who were coinfected with Kaposi's sarcoma-associated herpesvirus (KSHV) or HHV-8 virus, it was included as a separate entity in WHO classification of tumors of hematopoietic and lymphoid tissue in the year 2001. The definition included association with HHV-8 virus as a mandatory diagnostic criterion. However, cases were later reported where PEL-like disease process was diagnosed in HHV-8 negative patients. This was eventually recognized as a rare but distinct entity termed as “HHV-8-unrelated PEL-like lymphoma”. Herein, we are reporting a case of an elderly patient who presented with a large pleuropericardial effusion and was eventually diagnosed with this entity. Till date, only around 50 cases of HHV-8-unrelated PEL-like lymphoma have been reported and our case being EBV, HIV, and Hepatitis C negative makes it very unique and rare occurrence. We are also presenting a review of relevant literature focused mainly on comparing outcomes in patients treated with and without chemotherapy.

A rare cause of pleuropericardial effusion in the elderly — Case report

A rare cause of pleuropericardial effusion in the elderly — Case report

An unusual case of pleuropericardial neutrophilic effusion associated with valproate

Valproate is used in the treatment of patients with epilepsy, focal fits, bipolar disorder, mood swings, and bipolar disorder. Common adverse effects of valproate contain headache, somnolence, insomnia, alopecia, nausea, vomiting, diarrhea, abdominal pain, dyspepsia, thrombocytopenia, and tremor. Herein, we describe a patient who developed pleuropericardial effusion associated with the use of valproate. A 42-year-old woman was admitted to the internal medicine department of our hospital due to dyspnea and cough during the past 10 days. Her symptoms began 10 days prior to admission. Detailed medical history showed that she had epilepsy that was treated for 2 years with valproate 1250 mg/day for 6 years. Physical examination of the chest revealed decreased breath sounds at the middle and lower part of the left hemithorax. Standard laboratory studies demonstrated mild anemia (hemoglobin, 10.3 g/L), increased C-reactive protein (CRP, 5.1 mg/L), and erythrocyte sedimentation rate (ESR, 77). Leukocytosis (10,000/mm) and thrombocytosis (690,000/ mm) were observed. Further laboratory investigation,

Pleuropericardial effusion: a diagnostic conundrum

Pleuropericardial effusion as a presenting feature raises the possibility of infectious, neoplastic and connective tissue disorders.1 However, unusual pathophysiological mechanisms may sometimes pose a diagnostic conundrum in certain clinical contexts....