Resolution Of Pericardial Effusion Research Articles

FRI571 Maternal Graves’ Disease With Foetal Thyrotoxicosis And Goitre

Abstract Disclosure: D. Fennell: None. J. Walsh: None. M. Hatunic: None. Background: Graves’ disease (GD) is an uncommon condition affecting 0.2% of pregnancies. Foetal and neonatal thyrotoxicosis occurs in between 1-5% of pregnant patients with a history of GD, typically beyond 20 weeks gestation. Given its potential for serious morbidity and mortality, prompt recognition and treatment of the condition is essential. Clinical case: A 34-year-old female was referred at 21+2 weeks’ gestation from another hospital due to concerning cardiac findings noted on routine prenatal ultrasound (US). Her medical history was significant for GD (TRAb positive) with moderate ophthalmopathy and total thyroidectomy ten months prior, on L-thyroxine 150 mcg daily. Foetal tachycardia 170-180bpm was noted, with US showing with right ventricular hypertrophy, small pericardial effusion and a 1.9 x 2.7 x 2.8cm neck mass, suspicious for foetal goitre. Maternal laboratory studies showed TSH 2.38mIU/L (0.27-4.2), FT4 16.0pmol/L (12-22), TPO antibody negative <3.0IU/ml and TRAb markedly elevated >30IU/L (0-1.8). A diagnosis of foetal thyrotoxicosis secondary to placental passage of maternal TRAb was made. She was commenced on carbimazole 20mg twice daily at 21+6 weeks’ gestation as treatment, with the goal of normalising foetal heart rate. Careful, weekly follow-up with US scanning noted gradual improvement in the foetus’ condition, with resolution of pericardial effusion and foetal heart rate normalisation. Maternal TFTs were monitored weekly and she remained euthyroid on increased dose L-thyroxine (200 mcg daily). Multidisciplinary team consensus was to proceed with elective Caesarean section at 34 weeks’ gestation, to avoid risk of airway obstruction from foetal goitre. A healthy male infant was born with spontaneous breathing and normal heart rate at delivery. Apgar scores were 9 and 9 at 1 and 5 minutes. Maternal carbimazole was immediately discontinued post-delivery and L-thyroxine reduced to 150 mcg daily. She had an uncomplicated recovery post-Caesarean section. The infant was closely monitored in the neonatal ICU. On day five of life, he became unwell, developing a supraventricular tachycardia. Thyrotoxicosis was confirmed on laboratory studies (FT4 >100pmol/L). Carbimazole, propranolol and Lugol’s iodine were all used as treatment. Thyroid hormone levels normalised within days, with gradual clinical improvement. He was discharged home well four weeks after birth, remaining on propranolol 0.3mg four times daily and carbimazole 0.5mg twice daily, with close paediatric outpatient follow-up planned. Conclusion: Foetal thyrotoxicosis is a rare condition, but can cause serious morbidity, as demonstrated here. First trimester maternal thyroid antibody testing is recommended for all patients with a history of GD, to identify those at risk. Management of the condition is complex, requiring multidisciplinary specialist input for favourable outcome. Presentation: Friday, June 16, 2023

Abstract 15424: The Toxic Tango: Tyrosine Kinase Inhibitors (TKI) and Immune Checkpoint Inhibitors (ICI) Toxicities

Introduction: ICI and TKI have several cardiotoxicity side effects. We present a case of TKI-ICI toxicity resulting in multiorgan inflammatory syndrome with myocarditis and thrombotic STEMI that was treated with high-dose steroids and PCI. Case Presentation: 72-year-old man presented with acute SOB and inferior STEMI. He complains of severe DOE for the past 3 months, chronic diarrhea, and altered mental status. PMH of renal cell carcinoma (RCC) limited to kidney s/p nephrectomy. Follow-up CT scan with 4cm inferior left adrenal gland mass avid for FDG-PET and IR-biopsy positive for RCC. He was started on Pembrolizumab 200mg IV q3 weeks and axitinib 5mg PO q12h for the past 5 months. Investigation: LHC showed a thrombotic lesion in RCA with normal rest of coronaries without evidence of atherosclerosis or bystander plaque with successful PCI-DES. TTE with inferior wall hypokinesis and moderate pericardial effusion with organized material. Elevated CRP/ESR. Despite PCI, he is unable to walk 200ft due to DOE and needs supplemental O2. VQ scan low % for PE, PFT mild obstructive disease with severe reduction DLCO, and HRCT moderate emphysema, bronchial/ septal thickening, and normal hemodynamics in RHC. CMR demonstrated moderate pericardial effusion with internal debris, LVEF 38%, myocardial edema, and delayed gadolinium enhancement from base to apical inferior wall. Treatment: Empirical trial of IV-methylprednisolone 500mg IV q12 was started with drastic improvement of shortness of breath, resolution of AMS, ESR/CRP, and discontinuation of oxygen. Follow-up TTE with normal LVEF and resolution of pericardial effusion. Conclusions: ICI-Myocarditis is a severe irAE. The diagnosis requires clinical suspicion and exclusion of other cardiac conditions due to the high fatality rate. Early recognition and prompt treatment are needed to improve mortality. TKI-related arterial-thromboembolic events is not common but if present different therapy options should be offered.

Prognostic Value of Pericardial Effusion on Serial Echocardiograms in Pulmonary Arterial Hypertension

Pericardial effusion in pulmonary arterial hypertension (PAH) is an indicator of right heart failure and poor prognosis; its significance on serial transthoracic echocardiograms (TTE) is not clear. Baseline and follow-up TTE (1.0 ± 0.5 years), clinical parameters, and outcomes were studied (N = 200) in consecutive patients with PAH who underwent TTE at our center between October 1999 and November 2007. Study baseline TTE was 2.8 ± 4.0 years from initial PAH diagnosis. Over median follow-up of 3.6 ± 2.6 years from baseline TTE, 106 patients (53%) died. Pericardial effusion was present in 20% at baseline, and at any time during the study in 29%. Patients with any pericardial effusion during follow-up were more likely to have underlying connective tissue disease. They also had significantly higher mean right atrial pressure and pulmonary vascular resistance, had lower cardiac output by invasive hemodynamic studies, had higher serum creatinine, and were more likely to be treated with prostanoids. Patients were also significantly likely to have more echocardiographic right atrial dilation and right ventricular dilation and dysfunction, and worse tricuspid regurgitation with higher peak velocity. During follow-up, there was significantly increased use of prostanoids (58% vs. 28%) and combination therapy (8% vs. 2%) compared to baseline. Persistence of pericardial effusion on both baseline and follow-up TTE was associated with worse outcome, and an independent predictor of survival after adjusting for age, creatinine, functional class, and hemodynamics (P < 0.01). Persistence of pericardial effusion in PAH despite vasoactive therapy predicts worse outcomes; absence or resolution of pericardial effusion with therapy suggests better prognosis.

Resolution of pericardial effusion after minimally invasive surgical repair of pectus excavatum

Pektus ekskavatum, kalpte sikismaya ve buna bagli olarak perikardiyal sivi dongusunu bozarak perikardiyal efuzyona neden olabilir. Bu yazida pektus ekskavatum ve kronik tekrarlayan perikardiyal efuzyonlu 32 yasinda bir kadin olgu sunuldu. Minimal invaziv pektus ekskavatum tamiri ve perikardiyosentez sonrasinda, bir yillik takipte nuks gozlenmedi. Sternumu kaldirarak ve kalbin sikismasini rahatlatarak, minimal invaziv pektus ekskavatum tamiri perikardiyal sivi uretimi ve yeniden emilim mekanizmasinin tekrar insa edilmesine yardimci olabilir.

Cytogenetic remission with imatinib therapy in hypereosinophilic syndrome with trisomy 8 and resolution of severe cardiac dysfunction

We report a 50-year-old patient with idiopathic hypereosinophilic syndrome with trisomy 8 who experienced a complete and durable hematological and cytogenetic remission with low-dose imatinib therapy. He also had a significant reversal of cardiac dysfunction with a reduction in cardiac hypertrophy, resolution of pericardial effusion and mitral and tricuspid regurgitation. He remained in remission 3 years after therapy.

Diffuse Abdominal Uptake Mimicking Peritonitis in Gallium Inflammatory Scan: An Unusual Feature of Acute Q Fever

The clinical features in patients with acute Q fever are variable. We present a patient with fever, abdominal distension, pericardial effusion, and diffuse gallium uptake in the abdominal cavity, mimicking peritonitis or peritoneum carcinomatosis. Serologic surveys revealed acute infection by Coxiella burnetii. The patient responded poorly to doxycycline and improved with oral levofloxacin. During the afebrile period, gallium inflammatory scan showed resolution of previous diffuse uptake in the abdomen, and cardiac echo resolution of pericardial effusion, which was suggestive of peritoneal inflammation related to acute C. burnetii infection. Therefore, clinicians in Taiwan should be alert to the possibility of acute Q fever in patients with fever of unknown cause, especially with clinical evidence of peritoneal and/or pericardial inflammation.

Resolution of pericardial effusion after removal of ovarian fibroma-- a Meigs'-like syndrome

Meigs' syndrome consists of benign ovarian tumour with ascites and pleural effusion that resolve after resection of the tumour.1 A variant with pericardial effusion has not to our knowledge been reported.

Pericardial graft vs. host disease in a patient with myelodysplastic syndrome following peripheral blood stem cell transplantation

A patient with myelodysplastic syndrome developed pericardial effusion 20 month after allogenic peripheral blood stem cell transplantation. Sclerotic and erythematous skin lesions were observed over the face and extremities, and a diagnosis of chronic graft vs. host disease (GVHD) was made based on skin biopsy findings. Pericardial fluid contained numerous CD8+/HLA-DR+ lymphocytes, but no leukaemic cells. Tumour necrosis factor alpha (TNFalpha) and soluble Fas (sFas) levels were highly elevated in both the effusion and serum. The patient was treated with methylprednisolone and tacrolimus. Skin GVHD improved rapidly associated with resolution of pericardial effusion and reductions in cytokine levels. We concluded that pericardial effusion was due to pericarditis and was a manifestation of chronic GVHD in this patient, and that cytotoxic lymphocytes and specific cytokines played significant roles.

Canine cardiomyopathy after whole heart and partial lung irradiation

The late radiation response of the heart is of concern because of many reports of heart disease following radiation therapy of thoracic tumors. This study was done because of the clinical relevance of the pathophysiology of cardiopulmonary irradiation and because the heart is a good model for late effects of vasculoconnective tissue due to its lack of acutely responding parenchymal cells. Thoracic irradiation of adult beagle dogs including the heart and one third of the lung volume produced an early response in the heart at 1 and 3 months which consisted of an increase in left ventricle and septal wall thickness, decreased left ventricle ejection fraction, increased heart rates, intraventricular conduction disturbances and a high probability for pericardial effusion at 3 months. Radiation doses were 36, 44, or 52 Gy given in 4 Gy fractions in 4 weeks. Premature atrial contractions, paroxysmal atrial tachycardia, sustained atrial tachycardia and atrial fibrillation occurred at all dose levels. Evidence suggests that both early and late responses were due, at least in part, to direct injury to the cardiac microvasculature. The later effects appeared to be enhanced by injury to the lung. The early response appeared to resolve in 6 to 9 months, after which there was thinning of the myocardium at higher doses and resolution of pericardial effusions. At 12 months, elevations in right atrial pressure, but not pulmonary wedge pressure, were suggestive of right-sided congestive heart failure. Pulmonary hypertension was also present at 12 months presumably due to partial lung irradiations, and may have exacerbated right-sided congestive heart failure. The radiation injury may continue to increase with time leading to serious deficits in cardiopulmonary function. The functional studies may aid in predicting late effects and evaluating residual injury.

Diagnosis and Treatment of Pericardial Effusion Without Pericardiocentesis: Use of Steroids and Diuretics.

s1 May 1968Diagnosis and Treatment of Pericardial Effusion Without Pericardiocentesis: Use of Steroids and Diuretics.R. Bruce Logue, Dean R. Taylor, Locke Y. CarterR. Bruce LogueSearch for more papers by this author, Dean R. TaylorSearch for more papers by this author, Locke Y. CarterSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-68-5-1158_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough steroids are widely used in the control of pain, fever, and systemic symptoms due to pericarditis, then usefulness as a diagnostic and therapeutic agent in pericarditis with effusion has not been emphasized. Steroids alone may result in resolution of pericardial effusion, and when combined with diuretics, the effect may be enhanced. The combination of steroids with diuretics is useful [1] in the recognition of pericardial effusion, [2] in prevention and management of pericardial tamponade, [3] in differentiation of pericardial effusion from myocarditis and diffuse myocardial disease, [4] to prevent the need for pericardiocentesis or open drainage of the pericardium,... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Atlanta, Georgia PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1968Volume 68, Issue 5Page: 1158-1158KeywordsDiureticsFeversHyperthermiaMyocarditisPericardial diseasesPericardiumSteroids Issue Published: 1 May 1968 PDF DownloadLoading ...