Castleman's disease is an uncommon disorder characterized by benign proliferation of the lymphoid tissue that occurs most commonly in the mediastinum. Although unusual locations and manifestations have been reported, involvement of the renal parenchyma and sinus, and moreover, manifestations as cardiac tamponade are extremely rare. Here, we present a rare case of Castleman's disease in the renal parenchyma and sinus that also accompanied cardiac tamponade.
Cardiac Tamponade/*diagnosis/pathology ; Diagnosis, Differential ; Diagnostic Imaging ; Giant Lymph Node Hyperplasia/*diagnosis/pathology/surgery ; Humans ; Kidney Diseases/*diagnosis/pathology/surgery ; Male ; Middle Aged ; Nephrectomy

OBJECTIVE: To explore the cause of death, clinical manifestations and forensic pathological features of death cases caused by aortic dissection. METHODS: Sixty-three cases of aortic dissection were selected from forensic medical center, Sun Yat-sen University from 2001 to 2011 and retrospectively analyzed. RESULTS: The patients were mostly young and middle-aged male, aged from 30 to 49 years old. The DeBakey type II was the most common pathological type and the main cause of death was pericardial tamponade. The most common symptom was abdominal pain. However, the location of aorta dissection did not always correlate with the location of pain. Some cases showed no obvious clinical symptoms. The rupture was usually located in ascending aorta with atherosclerosis and pathological changes of hypertension. CONCLUSION It is significant for diagnosis and evaluation the cause of death of aortic dissection by knowing the clinical symptoms and forensic pathological features.
Adult ; Age Factors ; Aged ; Aortic Dissection/pathology* ; Aorta/pathology* ; Aortic Aneurysm/pathology* ; Aortic Rupture/pathology* ; Cardiac Tamponade/pathology* ; Death, Sudden/pathology* ; Diagnostic Errors ; Female ; Forensic Pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Young Adult

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

Endomyocardial biopsy (EMB) is one of the reliable methods for the diagnosis of various cardiac diseases. However, EMB can cause various complications. The purpose of this study is to evaluate the complication of transfemoral EMB with both fluoroscopic and two-dimensional (2-D) echocardiographic guidance. A total of 228 patients (148 men; 46.0+/-14.6 yr-old) who underwent EMB at Kyungpook National University Hospital from January 2002 to June 2012 were included. EMB was performed via the right femoral approach with the guidance of both echocardiography and fluoroscopy. Overall, EMB-related complications occurred in 21 patients (9.2%) including one case (0.4%) with cardiac tamponade requiring emergent pericardiocentesis, four cases (1.8%) with small pericardial effusion without pericardiocentesis, two cases (0.9%) with hemodynamically unstable ventricular tachycardia (VT), one case (0.4%) with nonsustained VT, one case (0.4%) with tricuspid regurgitation, twelve cases (5.3%) with right bundle branch block. There was no occurrence of either EMB-related death or cardiac surgery. Left ventricular ejection fraction was significantly lower (32.0+/-18.7% vs 42.0+/-19.1%, P=0.023) and left ventricular end-diastolic dimension was larger (60.0+/-10.0 mm vs 54.2+/-10.2 mm, P=0.013) in patients with EMB related complications than in those without. It is concluded that transfemoral EMB with fluoroscopic and 2-D echocardiographic guidance is a safe procedure with low complication rate.
Adult ; Biopsy/*adverse effects ; Cardiac Tamponade/etiology ; Echocardiography/*adverse effects ; Endocardium/*ultrasonography ; Female ; Fluoroscopy/*adverse effects ; Heart Diseases/*pathology ; Heart Ventricles/metabolism ; Humans ; Male ; Middle Aged ; Pericardial Effusion/etiology ; Tachycardia, Ventricular/etiology ; Ventricular Function

We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.
Aged ; Antifungal Agents ; Biopsy ; Bronchi ; Cardiac Tamponade ; Diabetes Mellitus ; Dyspnea ; Echocardiography ; Female ; Heart ; Heart Atria* ; Heart Neoplasms ; Humans ; Hypertension ; Hyphae ; Immunocompetence ; Invasive Pulmonary Aspergillosis* ; Mediastinal Cyst ; Mediastinal Neoplasms ; Mediastinum* ; Methenamine ; Pathology ; Thorax

We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.
Aged ; Antifungal Agents ; Biopsy ; Bronchi ; Cardiac Tamponade ; Diabetes Mellitus ; Dyspnea ; Echocardiography ; Female ; Heart ; Heart Atria* ; Heart Neoplasms ; Humans ; Hypertension ; Hyphae ; Immunocompetence ; Invasive Pulmonary Aspergillosis* ; Mediastinal Cyst ; Mediastinal Neoplasms ; Mediastinum* ; Methenamine ; Pathology ; Thorax