1.A "Vanishing", Tuberculous, Pericardial Effusion.
Jacques LIEBENBERG ; Pieter VAN DER BIJL
Korean Circulation Journal 2016;46(6):879-881
We present an iatrogenic, pleuro-pericardial connection resulting from pericardiocentesis of a large, tuberculous, pericardial effusion. Recognition of this situation is paramount when one is unable to aspirate pericardial fluid after a successful, initial puncture. Such knowledge will help prevent myocardial or coronary artery injury with further attempts at aspiration.
Coronary Vessels
;
Echocardiography
;
Pericardial Effusion*
;
Pericardial Fluid
;
Pericardiocentesis
;
Pleural Cavity
;
Punctures
;
Tuberculosis
2.Early Detection of Hidden Adenocarcinoma through the Prompt Pericardiocentesis in Patient with Small Pericardial Effusion.
Batzaya SHINEBAYAR ; Se Yong GILL ; Haemin JEONG ; Kyung Chan CHOI ; Junshik HONG ; Sang Min PARK
The Ewha Medical Journal 2017;40(2):91-93
Pericardial drainage is an important diagnostic and therapeutic option in the symptomatic patient with large amount of pericardial effusion (PE). However, when the amount of PE is relatively small, physicians are often reluctant to perform the invasive drainage of the fluid due to the increased risk of causing myocardial injury during the procedure. Even in some cases of suspected pericarditis with small amount PE, an initial empirical anti-inflammatory therapy is often recommended. A 65-year-old woman presented with mild dyspnea for two weeks. The echocardiography revealed small amount of PE. A careful fluoroscopy-guided pericardiocentesis, subsequent pericardial fluid cytology, and thorough whole body check-up demonstrated adenocarcinoma with no proven primary site. After the palliative chemotherapy, she had survived for 15 months until her death due to asphyxia. Although pericardiocentesis is considered dangerous in small amount of PE, a prompt and careful drainage may provide early detection of hidden malignancy and better survival outcome.
Adenocarcinoma*
;
Aged
;
Asphyxia
;
Drainage
;
Drug Therapy
;
Dyspnea
;
Echocardiography
;
Female
;
Humans
;
Pericardial Effusion*
;
Pericardial Fluid
;
Pericardiocentesis*
;
Pericarditis
3.Bacteria as Normal Flora in Postmortem Body Fluid Samples.
Joo Young NA ; Ji Hye PARK ; Soo Hyun KIM ; Jong Tae PARK
Korean Journal of Legal Medicine 2017;41(4):87-93
Bacterial culture and identification are both useful in the clinical and forensic fields, although the postmortem changes in human microbiology are poorly understood. This study aimed to identify bacteria that were considered normal flora in postmortem body fluid samples. Bacterial culture and identification testing were performed for 336 body fluid samples (e.g., cardiac blood, peripheral blood, pericardial fluid, pleural fluid, peritoneal fluid, cerebrospinal fluid, and urine) from 129 forensic autopsy cases. Bacteria were identified using both genetic and biochemical methods, and testing for C-reactive protein (CRP) was used to identify the presence of antemortem inflammation. Among the 129 autopsy cases, 79 cases (69.3%) were negative for CRP, and bacterial culture and identification testing were performed for 185 samples from those 79 cases. Bacteria that were considered both normal flora and pathogens were identified in the CRP-negative cases. Therefore, the results from postmortem bacterial culture and identification testing should be interpreted in the context of other postmortem examination, including CRP testing. Furthermore, case selection, postmortem testing, and interpretations of the results should be performed by both clinical bacteriologists and forensic pathologists. To best of our knowledge, this is the first study to examine normal flora in various postmortem body fluid samples form Korean autopsy cases.
Ascitic Fluid
;
Autopsy
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Bacteria*
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Body Fluids*
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C-Reactive Protein
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Cerebrospinal Fluid
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Humans
;
Inflammation
;
Pericardial Fluid
;
Postmortem Changes
4.Bronchogenic cyst masquerading as malignant pericardial effusion with tamponade.
Kang Un CHOI ; Byung Jun KIM ; Hong Ju KIM ; Jang Won SON ; Jong Seon PARK ; Dong Gu SHIN ; Young Jo KIM
Yeungnam University Journal of Medicine 2017;34(1):91-95
We report on a rare case involving a 23-year-old female patient with mediastinal cystic mass complicated with acute pericarditis and cardiac tamponade. Pericardial fluid demonstrated lymphocyte-predominant exudate and the level of carcinoembryonic antigen (CEA) was unexpectedly elevated. Successive aspiration of mediastinal cystic mass revealed a very high level of CEA (>100,000 U/mL) and carbohydrate antigen 19-9 (>15,000 ng/mL). This patient was clinically diagnosed as an infected bronchogenic cyst complicated with pericarditis and cardiac tamponade. The treatment resulted in alleviation of her symptoms.
Bronchogenic Cyst*
;
Carcinoembryonic Antigen
;
Cardiac Tamponade
;
Exudates and Transudates
;
Female
;
Humans
;
Mediastinal Cyst
;
Pericardial Effusion*
;
Pericardial Fluid
;
Pericarditis
;
Young Adult
5.Disappearance of pericardial effusion by suspected pericardial-pleural fistulain a Miniature Schnauzer dog
Hakhyun KIM ; Ji Houn KANG ; Dongwoo CHANG
Korean Journal of Veterinary Research 2018;58(2):115-118
A 13-year-old spayed female Miniature Schnauzer was presented with complaints of intermittent syncope. Pericardial effusion was confirmed based on the physical examination, thoracic radiographs and echocardiography. Subsequently, prompt pericardiocentesis was performed. Clinical abnormalities were immediately improved after pericardiocentesis. However, the clinical signs associated with acute collapse recurred. After the second pericardiocentesis, thoracic radiographs revealed pleural effusion, and the clinical signs resolved rapidly. The dog underwent pleural aspiration. Analysis of pleural fluid revealed almost similar features as the previous pericardial fluid. It was possible that a pericardial-pleural fistula was created during the pericardiocentesis. The pericardial and pleural effusion disappeared after the procedures.
Adolescent
;
Animals
;
Cardiac Tamponade
;
Dogs
;
Echocardiography
;
Female
;
Fistula
;
Humans
;
Pericardial Effusion
;
Pericardial Fluid
;
Pericardiocentesis
;
Physical Examination
;
Pleural Effusion
;
Syncope
;
Thoracentesis
6.Bronchogenic cyst masquerading as malignant pericardial effusion with tamponade
Kang Un CHOI ; Byung Jun KIM ; Hong Ju KIM ; Jang Won SON ; Jong Seon PARK ; Dong Gu SHIN ; Young Jo KIM
Yeungnam University Journal of Medicine 2017;34(1):91-95
We report on a rare case involving a 23-year-old female patient with mediastinal cystic mass complicated with acute pericarditis and cardiac tamponade. Pericardial fluid demonstrated lymphocyte-predominant exudate and the level of carcinoembryonic antigen (CEA) was unexpectedly elevated. Successive aspiration of mediastinal cystic mass revealed a very high level of CEA (>100,000 U/mL) and carbohydrate antigen 19-9 (>15,000 ng/mL). This patient was clinically diagnosed as an infected bronchogenic cyst complicated with pericarditis and cardiac tamponade. The treatment resulted in alleviation of her symptoms.
Bronchogenic Cyst
;
Carcinoembryonic Antigen
;
Cardiac Tamponade
;
Exudates and Transudates
;
Female
;
Humans
;
Mediastinal Cyst
;
Pericardial Effusion
;
Pericardial Fluid
;
Pericarditis
;
Young Adult
7.Undiagnosed Traumatic Tricuspid Regurgitation Identified by Intraoperative Transesophageal Echocardiography.
Yun Yong JEONG ; Jonghwan MOON ; Sang Hyun LIM ; Yeo Jin KIM ; Hyoeun AHN ; Sung Yong PARK
Journal of Acute Care Surgery 2016;6(2):68-70
In the critically injuried and hemodynamically unstable patient, extended focused assessment with sonography for trauma (E-FAST) examination can be performed for a rapid assessment of peritoneal and/or pericardial fluid. We report a case of traumatic tricuspid regurgitation that was missed in the emergency department by E-FAST and identified by intraoperative transesophageal echocardiography.
Echocardiography
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Echocardiography, Transesophageal*
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Emergency Service, Hospital
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Humans
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Pericardial Fluid
;
Thoracic Injuries
;
Tricuspid Valve
;
Tricuspid Valve Insufficiency*
8.Emergency department point-of-care ultrasonography improves time to pericardiocentesis for clinically significant effusions.
Evan Avraham ALPERT ; Uri AMIT ; Larisa GURANDA ; Rafea MAHAGNA ; Shamai A GROSSMAN ; Ariel BENTANCUR
Clinical and Experimental Emergency Medicine 2017;4(3):128-132
OBJECTIVE: Our objective was to determine the utility of point-of-care ultrasound (POCUS) to identify and guide treatment of tamponade or clinically significant pericardial effusions in the emergency department (ED). METHODS: This was a retrospective cohort study of non-trauma patients who were diagnosed with large pericardial effusions or tamponade by the ED physician using POCUS. The control group was composed of those patients later diagnosed on the medical wards or incidentally in the ED by other means such as a computed tomography. The following data were abstracted from the patient’s file: demographics, medical background, electrocardiogram results, chest radiograph readings, echocardiogram results, and patient outcomes. RESULTS: There were 18 patients in the POCUS arm and 55 in the control group. The POCUS arm had a decreased time to pericardiocentesis (11.3 vs. 70.2 hours, P=0.055) as well as a shorter length of stay (5.1 vs. 7.0 days, P=0.222). A decreased volume of pericardial fluid was drained (661 vs. 826 mL, P=0.139) in the group diagnosed by POCUS. CONCLUSION: This study suggests that POCUS may effectively identify pericardial effusions and guide appropriate treatment, leading to a decreased time to pericardiocentesis and decreased length of hospital stay. Pericardial tamponade or a large pericardial effusion should be considered in all patients presenting to the ED with clinical, radiographic, or electrocardiographic signs of cardiovascular compromise.
Arm
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Cardiac Tamponade
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Cohort Studies
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Demography
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Electrocardiography
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Emergencies*
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Emergency Service, Hospital*
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Humans
;
Length of Stay
;
Pericardial Effusion
;
Pericardial Fluid
;
Pericardiocentesis*
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Point-of-Care Systems*
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Radiography, Thoracic
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Reading
;
Retrospective Studies
;
Ultrasonography*
9.Cardiac tamponade as a rare manifestation of systemic lupus erythematosus: A report on four cases in the Philippine General Hospital.
Aherrera Jaime Alfonso M. ; Manapat-Reyes Bernadette Heizel D. ; Lantion-Ang Frances Lina ; Manguba Alexander ; Salido Evelyn O. ; Punzalan Felix Eduardo ; Corpuz Allan D. ; Magallanes Jonray
Philippine Journal of Internal Medicine 2015;53(2):1-8
SYNOPSIS: Cardiac tamponade among systemic lupus erythematosus (SLE) patients is an unusual event. The pericardial effusion may be a consequence of uremia, infections in the pericardium, or the lupus pericarditis itself. We present four atypical cases of cardiac tamponade from pericarditis of connective tissue disease (CTD), all of which were treated with drainage and immunosuppressants. Due to the rarity of this combination, management was a challenge.
CLINICAL PRESENTATION: Four females each sought consult for dyspnea associated with typical manifestations of connective tissue disease such as arthritis, characteristic rashes, serositis, typical laboratory features, and a positive ANA and/or anti-dsDNA. The first three cases fulfilled the criteria for SLE, while the fourth fulfilled the criteria for SLE-dermatomyositis overlap syndrome. Echocardiography was done due to suspicion of pericardial involvement and revealed massive pericardial effusion in tamponade physiology in all cases.
DIAGNOSIS: Cardiac tamponade from serositis due to connective tissue disease [SLE (case 1 to 3) or SLE-dermatomyositis overlap (case 4). Other common etiologies of tamponade such as bacterial, tuberculous, malignant, and uremic pericardial effusion were ruled out by clinical and laboratory tools, including Gram stain and culture, cytology, PCR, and biochemical testing. The pericardial fluid of the first case tested positive for lupus erythematosus (LE) cells, indicative of lupus serositis.
TREATMENT AND OUTCOME: All patients underwent pericardial drainage via tube pericardiostomy. They received high dose glucocorticoids after infectious etiologies for the pericardial effusion were ruled out. The fourth case with the overlap syndrome, however, required more immunosuppressants using azathioprine and methotrexate. Resolution of pericardial effusion was noted with this approach. Three of four were discharged improved, however, the third case suffered from worsening nephritis and pulmonary hemorrhage leading to her demise.
SIGNIFICANCE AND RECOMMENDATIONS: Four cases of cardiac tamponade as a manifestation of connective tissue disease were presented. Literature underlines the rarity of this condition anytime during the course of SLE. Despite this, SLE should be considered as one of the differential diagnosis of cardiac tamponade, especially in patients who manifest with multi-systemic findings. Likewise, massive pericardial effusion should be considered in patients with a connective tissue disease presenting with subtle evidence of pericardial involvement. It requires timely identification and treatment with high dose steroids, after other causes such as infections have been excluded. Immediate drainage through pericardiocentesis or pericardiostomy in combination with immunosuppressants may be life-saving.
Human ; Female ; Adult ; Adolescent ; Pericardiocentesis ; Pericardial Effusion ; Azathioprine ; Cardiac Tamponade ; Methotrexate ; Glucocorticoids ; Serositis ; Dermatomyositis ; Immunosuppressive Agents ; Pericardial Fluid ; Neutrophils ; Lupus Erythematosus, Systemic ;
10.Hypothyroidism with Suspected Ovarian Malignancy: A Case Report.
You Jeong KIM ; Seong Man KIM ; Min Gu CHON ; Joon Hyung JHI ; Dong Jun KIM ; Yeo Jeong SONG ; Tae Ik KIM
Korean Journal of Medicine 2011;81(5):641-646
We report a 44-year-old woman with massive ascites, elevated serum carbohydrate antigen 125 (CA 125) concentrations, pericardial effusion, and junctional bradycardia. Ascites caused by hypothyroidism are rare, and the pathogenesis is unclear. The ascitic fluid showed elevated total protein concentrations and a high serum-ascites albumin gradient. The massive ascites and increased serum, ascitic, and pericardial CA 125 concentrations led us to make an incorrect presumptive diagnosis of an ovarian malignancy with metastasis. However, there was no evidence of malignancy except the elevated CA 125 level. Similar to ascites, also junctional escape rhythm with marked bradycardia is a very rare feature of hypothyroidism. Following thyroid hormone replacement, the ascites and serum CA 125 gradually decreased, and the heart rhythm returned to sinus bradycardia. We report this case with a brief review of the literature.
Adult
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Ascites
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Ascitic Fluid
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Bradycardia
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CA-125 Antigen
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Female
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Heart
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Humans
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Hypothyroidism
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Neoplasm Metastasis
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Pericardial Effusion
;
Thyroid Gland
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United Nations