1.Rare
Nicholas W S CHEW ; Raymond C WONG ; William W F KONG ; Adrian LOW ; Huay Cheem TAN
Annals of the Academy of Medicine, Singapore 2021;50(8):655-656
2.Tuberculous Pericarditis Presenting as Multiple Free Floating Masses in Pericardial Effusion.
Shin Ae YOON ; Youn Soo HAHN ; Jong Myeon HONG ; Ok Jun LEE ; Heon Seok HAN
Journal of Korean Medical Science 2012;27(3):325-328
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
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Cardiac Tamponade/etiology
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Echocardiography
;
Humans
;
Male
;
Pericardial Effusion/*diagnosis/etiology/surgery/ultrasonography
;
Pericardiectomy
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Pericarditis, Tuberculous/complications/*diagnosis/ultrasonography
3.Cardiac Tamponade Complicated by Acupuncture: Hemopericardium due to Shredded Coronary Artery Injury.
Ae Young HER ; Yong Hoon KIM ; Se Min RYU ; Jun Hwi CHO
Yonsei Medical Journal 2013;54(3):788-790
We report a case of 62-year-old man with cardiac tamponade due to coronary artery injury after acupuncture into the substernum. After resuscitation of cardiac arrest, we performed emergent pericardiocentesis. Nevertheless, the cardiac arrest recurred, and the emergent operation on cardiopulmonary bypass was performed. We identified hemopericardium due to shredded acute marginal branch of right coronary artery, and it was ligated leading to termination of bleeding. The patient was discharged without any other complications.
Acupuncture Therapy/*adverse effects
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Cardiac Tamponade/*diagnosis/etiology
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Coronary Vessels/*injuries
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Humans
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Male
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Middle Aged
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Pericardial Effusion/*diagnosis/etiology
4.A Case of Behcet's Disease with Pericarditis, Thrombotic Thrombocytopenic Purpura, Deep Vein Thrombosis and Coronary Artery Pseudo Aneurysm.
Chang Mo KWON ; Seung Hyun LEE ; Jin Ho KIM ; Kyu Hyung LEE ; Hyun Do KIM ; Yeong Hoon HONG ; Choong Ki LEE
The Korean Journal of Internal Medicine 2006;21(1):50-56
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
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Purpura, Thrombotic Thrombocytopenic/diagnosis/*etiology
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Pericarditis/diagnosis/*etiology
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Humans
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Female
;
Echocardiography
;
Coronary Vessels/*physiopathology
;
Coronary Stenosis/diagnosis/*etiology
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Cardiac Tamponade/diagnosis/*etiology
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Behcet Syndrome/*complications/diagnosis
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Aneurysm, False/diagnosis/*etiology
;
Adult
5.ECGs with small QRS voltages.
Ting Ting LOW ; Voon Shiong Ronnie TAN ; Swee-Guan TEO ; Kian-Keong POH
Singapore medical journal 2012;53(5):299-quiz 304
The causes of low voltage complexes on the electrocardiogram (ECG) are variable; however, they are not commonly discussed. An ECG with small QRS amplitudes may initially look unremarkable to the unwary, but some of the underlying conditions may be critical. Although imperfect, the ECG is still a useful, noninvasive and readily available tool for the screening of these underlying conditions. We present two cases with low voltage complexes in the ECG. The first case highlights how the findings on ECG and subsequent echocardiogram led to the diagnosis of a rare case of cardiac amyloidosis. In the second case, a screening electrocardiogram alerted the physicians to a life-threatening condition, that of a large pericardial effusion with cardiac tamponade.
Aged
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Cardiac Tamponade
;
diagnosis
;
etiology
;
physiopathology
;
Diagnosis, Differential
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Electrocardiography
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Female
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Heart Conduction System
;
physiopathology
;
Humans
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Male
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Middle Aged
;
Pericardial Effusion
;
diagnosis
;
physiopathology
6.Tension Pneumopericardium after Pericardiocentesis.
Jinhyuck LEE ; Bo Seung KANG ; Changsun KIM ; Hyuk Joong CHOI
Journal of Korean Medical Science 2016;31(3):470-472
Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.
Aged
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Cardiac Tamponade/etiology
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Drainage
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Dyspnea/diagnosis
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Emergency Medical Services
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Heart Ventricles/physiopathology
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Humans
;
Male
;
Medical Errors
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Pericardial Effusion/diagnostic imaging/*therapy
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*Pericardiocentesis
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Pneumopericardium/*diagnosis/therapy
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Tomography, X-Ray Computed
7.Fever in a Patient with a Previous Gastrectomy.
Debra Gf SEOW ; Po Fun CHAN ; Boon Lock CHIA ; Joshua Py LOH
Annals of the Academy of Medicine, Singapore 2016;45(3):117-120
Adenocarcinoma
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surgery
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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
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etiology
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Stomach Neoplasms
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surgery
;
Streptococcal Infections
;
etiology
;
Tomography, X-Ray Computed
8.Pleural and pericardial empyema in a patient with continuous ambulatory peritoneal dialysis peritonitis.
Jong Hoon LEE ; Young Sun NOH ; Youn Hee LEE ; In Ae JANG ; Ho Chul SONG ; Euy Jin CHOI ; Yong Kyun KIM
The Korean Journal of Internal Medicine 2013;28(5):626-627
No abstract available.
Anti-Bacterial Agents/therapeutic use
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Cardiac Tamponade/etiology
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Drainage
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Empyema, Pleural/diagnosis/*etiology/microbiology/therapy
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Heart Diseases/diagnosis/*etiology/microbiology/therapy
;
Humans
;
Kidney Failure, Chronic/*therapy
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Male
;
Methicillin-Resistant Staphylococcus aureus/isolation & purification
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Middle Aged
;
Pericardial Effusion/etiology
;
Pericardial Window Techniques
;
Pericardiocentesis
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Peritoneal Dialysis, Continuous Ambulatory/*adverse effects
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Peritonitis/diagnosis/drug therapy/*etiology/microbiology
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Pleural Effusion/etiology
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Staphylococcal Infections/diagnosis/drug therapy/*etiology/microbiology
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Tomography, X-Ray Computed
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Treatment Outcome
9.N-terminal pro-B-type natriuretic peptide as a marker of disease severity in patients with pericardial effusions.
Shin Jae KIM ; Eun Seok SHIN ; Sang Gon LEE
The Korean Journal of Internal Medicine 2008;23(2):78-86
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
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Adult
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Aged
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Aged, 80 and over
;
Biological Markers/blood
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Cardiac Tamponade/blood/etiology
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Diastole
;
Disease Progression
;
Female
;
Humans
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Male
;
Middle Aged
;
Natriuretic Peptide, Brain/*blood
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Peptide Fragments/*blood
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Pericardial Effusion/*blood/complications/*diagnosis/physiopathology/ultrasonography
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Predictive Value of Tests
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Prognosis
;
Prospective Studies
;
Severity of Illness Index
;
Systole
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Ventricular Function, Left