Pericarditis is a rare manifestation of tuberculosis (Tb) in children. A 14-yr-old Korean boy presented with cardiac tamponade during treatment of pulmonary tuberculosis. He developed worsening anemia and persistent fever in spite of anti-tuberculosis medications. Echocardiography found free floating multiple discoid masses in the pericardial effusion. The masses and exudates were removed by pericardiostomy. The masses were composed of pink, amorphous meshwork of threads admixed with degenerated red blood cells and leukocytes with numerous acid-fast bacilli, which were confirmed as Mycobacterium species by polymerase chain reaction. The persistent fever and anemia were controlled after pericardiostomy. This is the report of a unique manifestation of Tb pericarditis as free floating masses in the effusion with impending tamponade.
Adolescent ; Cardiac Tamponade/etiology ; Echocardiography ; Humans ; Male ; Pericardial Effusion/*diagnosis/etiology/surgery/ultrasonography ; Pericardiectomy ; Pericarditis, Tuberculous/complications/*diagnosis/ultrasonography

This paper presents a case of cardiac tamponade with idiopathic hemorrhagic pericarditis as the initial symptom of human immunodeficiency virus (HIV) infection. A 29-year-old male came to the emergency room with a sudden onset of dizziness. Upon arrival, he was hypotensive although not tachycardic, and his jugular venous pressure was not elevated. His chest X-rays revealed a mild cardiomegaly. Transthoracic echocardiography revealed a large amount of pericardial effusion with a diastolic collapse of the right ventricle, a dilated inferior vena cava with little change in respiration, and exaggerated respiratory variation of mitral inflow velocities, representing echocardiographic evidence of cardiac tamponade. After pericardiocentesis, his blood pressure improved to 110/70 mmHg without inotropics support. Serial 12-lead electrocardiograms during hospitalization revealed upwardly concave diffuse ST-segment elevation followed by a T-wave inversion suggestive of acute pericarditis. Pericardial fluid cytology and cultures for bacteria, mycobacteria, adenovirus, and fungus were all negative. HIV enzyme-linked immunosorbent assay (ELISA) was positive and confirmed by Western blot. The CD4 cell count was 168/mm3. Finally, the diagnosis of cardiac tamponade due to HIV-associated hemorrhagic pericarditis was made. It was concluded that HIV infection should be considered in the diagnosis of unexplained pericardial effusion or cardiac tamponade in Korea.
Acquired Immunodeficiency Syndrome/*diagnosis/*pathology ; Acute Disease ; Adult ; Cardiac Tamponade/*complications/*diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Male ; Pericarditis/*complications/*diagnosis

Behcet's disease with concomitant thrombotic thrombocytopenic purpura (TTP), coronary artery stenosis and coronary artery pseudo aneurysm is rare. Here we report a case of Behcet's disease with several cardiovascular complications, namely: pericarditis, deep vein thrombosis (DVT), TTP, coronary artery stenosis, and a coronary artery pseudo aneurysm. A 37-year-old female presented with sudden dyspnea and syncope at our emergency room and underwent pericardiectomy and pericardial window formation for the diagnosis of cardiac tamponade with acute hemorrhagic pericarditis. Thereafter, TTP and DVT complicated her illness. After confirmation of Behcet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. However, whilst maintaining anticoagulation therapy, a newly developed pericardial aneurysmal dilatation was noted on follow-up radiologic evaluation. Further evaluation revealed right coronary artery stenosis and a left coronary artery pseudo aneurysm; these additional problems were treated with the nonsurgical insertion of an endovascular graft stent . At the time of writing three months later after stent insertion, the aneurysm has continued to regress and no additional complications have intervened with combined immunosuppressive therapy.
Venous Thrombosis/diagnosis/*etiology ; Purpura, Thrombotic Thrombocytopenic/diagnosis/*etiology ; Pericarditis/diagnosis/*etiology ; Humans ; Female ; Echocardiography ; Coronary Vessels/*physiopathology ; Coronary Stenosis/diagnosis/*etiology ; Cardiac Tamponade/diagnosis/*etiology ; Behcet Syndrome/*complications/diagnosis ; Aneurysm, False/diagnosis/*etiology ; Adult

Adenocarcinoma ; surgery ; Candidiasis ; etiology ; Cardiac Tamponade ; diagnosis ; etiology ; Echocardiography ; Electrocardiography ; Esophageal Fistula ; complications ; diagnostic imaging ; Fever ; etiology ; Gastrectomy ; Haemophilus Infections ; etiology ; Heart Diseases ; complications ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Pericardial Effusion ; diagnostic imaging ; etiology ; Pericarditis ; diagnostic imaging ; etiology ; Postoperative Complications ; diagnostic imaging ; Staphylococcal Infections ; etiology ; Stomach Neoplasms ; surgery ; Streptococcal Infections ; etiology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has recently been introduced as a useful marker in diagnosing underlying disease in patients with dyspnea and for determining the prognosis of patients with heart failure. The purpose of this study was to evaluate the value of the NT-proBNP as a marker of disease severity in patients with pericardial effusions. METHODS: We enrolled 69 consecutive patients who showed moderate or large pericardial effusion with preserved left ventricular (LV) systolic function; 42 patients finally participated in the study, and 13 (31.0%) of them showed cardiac tamponade. We analyzed the etiologies, the clinical and echocardiographic variables, and the serum NT-proBNP levels in these patients. RESULTS: The mean NT-proBNP level was 751+/-1002 ng/L (range 5 to 5289), and the median level was 385 ng/L (interquartile range 152 to 844). The NT-proBNP levels were higher in those patients with jugular venous distension (p=0.002), pulsus paradoxus (p=0.016), heart rate > or =100/min (p=0.006), cardiac tamponade (p=0.001), large pericardial effusion (p=0.029), exaggerated respiratory variation of the transmitral inflow (p=0.006), or plethora of the inferior vena cava (p=0.01). The NT-proBNP levels showed significant correlation with heart rate (r=0.517, p<0.001) and the diameter of the inferior vena cava (r=0.329, p=0.03). CONCLUSIONS: NT-proBNP may be useful as a marker of disease severity in patients suffering from pericardial effusion, but further prospective studies with more patients will be needed.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Cardiac Tamponade/blood/etiology ; Diastole ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood ; Peptide Fragments/*blood ; Pericardial Effusion/*blood/complications/*diagnosis/physiopathology/ultrasonography ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Severity of Illness Index ; Systole ; Ventricular Function, Left