Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.
Adhesives ; Adult ; Dyspnea ; Echocardiography ; Female ; Humans ; Inflammation ; Necrosis ; Pathology ; Pericardial Effusion ; Pericarditis, Constrictive ; Pericarditis, Tuberculous* ; Pulmonary Artery* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Pleural

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.
Adhesives ; Adult ; Dyspnea ; Echocardiography ; Female ; Humans ; Inflammation ; Necrosis ; Pathology ; Pericardial Effusion ; Pericarditis, Constrictive ; Pericarditis, Tuberculous* ; Pulmonary Artery* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Pleural

OBJECTIVETo summarize the clinical and pathological characteristics of constrictive pericarditis in China.

METHODData from 150 patients with constrictive pericarditis who admitted to our hospital from 2000 to 2007 were retrospectively analyzed.

RESULTSConstriction pericarditis was detected by echocardiography in 149 out of 150 patients. Pericardial effusion was evidenced in 59.3% patients (89/150). The diagnostic accuracy rate for identifying constrictive pericarditis by echocardiography (98.7%, 107/109) was comparable to that of surgical diagnosis (100%, 109/109). Tuberculosis was the main cause of constrictive pericarditis in this cohort (78.7%, 118/150) including 25 (16.7%) cases with pathological or etiological evidences of tubercular pericarditis, 8 (5.3%) cases with pathologically active tuberculous focus elsewhere in the body, 66 (44.0%) cases with typical clinical tuberculosis manifestation and responded to anti-tubercular therapy and 19 (12.7%) cases with a diagnosis of suspicious tuberculosis. Pericardiectomy was performed in 108 cases and pericardial biopsy and surgical drainage was performed in 1 patient. In hospital death rate was 8.7% (13/150, 4 tubercular patients and 9 non-tubercular).

CONCLUSIONTuberculosis is the leading cause of constrictive pericarditis in this cohort and the best diagnosis tool is echocardiography other than pathological and etiological findings in pericardium.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Mycobacterium tuberculosis ; Pericarditis, Constrictive ; diagnosis ; etiology ; microbiology ; pathology ; Pericarditis, Tuberculous ; complications ; diagnosis ; pathology ; Retrospective Studies ; Young Adult

Bite wounds are often mistakenly considered innocuous. However, they are frequently complicated by infection which may be serious. We describe a case of Pasteurella multocida septicaemia with myopericarditis following a dog bite. Treatment of the infection as well as active support of myocardial function led to a successful outcome.
Adult ; Animals ; Bites and Stings ; microbiology ; Dogs ; Hand Injuries ; microbiology ; Humans ; Male ; Pasteurella Infections ; pathology ; Pasteurella multocida ; Pericardial Effusion ; microbiology ; Pericarditis ; microbiology ; Sepsis ; pathology ; Wound Infection ; pathology

OBJECTIVESTo study the pathologic feature of sudden cardiac death in Yunnan province and to investigate the role of myocarditis.

METHODSDuring the period from 1991 to 2006, there were 29 cases of sudden cardiac death with autopsy performed. Fourteen of these cases were diagnosed to have myocarditis based on Dallas criteria and World Heart Federation's consensus. The clinical and pathologic findings were reviewed. The cardiac conduction system was examined in details by serial sectioning in 3 cases.

RESULTSFourteen cases suffered with myocarditis, which accounted for 48% of all cases of sudden cardiac death studied. The age of the deceased ranged from 8 to 68 years (mean = 30 years), with male-to-female ratio equaled to 9:5. Lymphocytic myocarditis and neutrophil myocarditis were the two major types, affecting 11 and 3 cases, respectively. The inflammatory infiltrates were often patchy rather than diffuse. The inflammatory foci were detected only in 8% to 42% (average = 20%) of the paraffin sections of the heart tissue. These lesions were usually located in the lateral wall of left ventricle and occasionally in interventricular septum and right ventricular wall. Myocardial injury was mild in most cases while patchy myocytolysis or coagulation necrosis was observed only in a few cases. Most of the lesions were relatively new and histologic evidence of myocardial repairing sometimes coexisted. Pericarditis and subacute endocarditis were also identified in 4 and 1 cases, respectively. Atrioventricular node was involved by myocarditis in 1 of the 3 cases examined for cardiac conduction system. Two cases showed gross evidence of cardiac dilatation (either left ventricle or biventricular). Respiratory tract and pulmonary infection was present in 5 cases.

CONCLUSIONSMyocarditis represents one of the major pathologic changes of sudden cardiac death occurring in Yunnan province. The inflammation is usually focal. Further studies are required for delineation of possible etiologies which may include virus, bacteria or exogenous toxin.

Adolescent ; Adult ; Aged ; Atrioventricular Node ; pathology ; Child ; China ; epidemiology ; Death, Sudden, Cardiac ; epidemiology ; pathology ; Dilatation, Pathologic ; pathology ; Endocarditis ; pathology ; Female ; Humans ; Inflammation ; pathology ; Lymphocytes ; pathology ; Male ; Middle Aged ; Myocarditis ; diagnosis ; epidemiology ; mortality ; pathology ; Myocardium ; pathology ; Pericarditis ; pathology

We report a case of early non-invasive diagnosis of acute eosinophilic myopericarditis (AEM) by cardiovascular magnetic resonance (CMR) before cardiac biopsy. A 35-yr-old woman presented with a flu-like illness, followed by pleuritic chest pain and shortness of breath. Transthoracic echocardiography revealed mild left ventricular (LV) systolic dysfunction with borderline LV wall thickness and moderate pericardial effusion. The patient had peripheral eosinophilia and CMR was performed immediately at first day of visit before cardiac biopsy. CMR showed diffuse subepicardial high T2 signals and diffuse late gadolinium enhancement in LV. Steroid therapy was immediately initiated and patient's symptom was rapidly improved. Endomyocardial biopsy at hospital day 3 reported multifocal mild infiltration of eosinophils and lymphocytes. The patient was finally confirmed as acute eosinophilic myopericarditis. This presentation emphasizes on the role of CMR which enables early non-invasive diagnosis of AEM and visualize the extent of the myocarditis.
Adult ; Early Diagnosis ; Echocardiography ; Eosinophilia/*diagnosis ; Female ; Gadolinium/diagnostic use ; Humans ; Magnetic Resonance Imaging ; Pericarditis/*diagnosis/*drug therapy/pathology ; Ventricular Dysfunction, Left/diagnosis/drug therapy/pathology

To recognize the hemodynamic change in the constrictive pericarditis, we have reviewed the Doppler echocardiography, cardiac catheterization, and pathology of 6 patients who were admitted to Pusan National University Hospital due to right-side heart failure, diagnosed as constrictive pericarditis and were undertaken pericardiectomy. Doppler echocardiographic findings showed that acceleration and deceleration of early diastolic rapid filling were increased, followed by shortening of duration but there was a tendency to decrease in velocity-time integral of early diastolic rapid filling compared to that of atrial contraction filling in the left ventricle. On the contrary, there was decrease in acceleration of rapid filling in right ventricle, but other indices were comparable to that of left ventricle. The integral of D wave increased relatively compared to that of S wave in superior vena canal flow. Also, there was decrease in peak flow velocity, acceleration and velocity-time integral of aortic and pulmonary arterial flow velocity. One patient who had increased fraction of integral of early diastolic rapid filling compared to that of atrial contraction filling in right ventricle showed that he had higher central venous pressure and D wave was dominant in superior vena caval flow. In conclusion, Doppler flow patterns showed characteristic diastolic filling inpairment and systolic dysfunction in constrictive pericarditis, so that Doppler echocardiography is believed to be a useful method of noninvasive diagnosis and follow-up of hemodynamic change in constrictive pericarditis.
Acceleration ; Busan ; Cardiac Catheterization ; Cardiac Catheters ; Central Venous Pressure ; Deceleration ; Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Pathology ; Pericardiectomy ; Pericarditis, Constrictive*

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

Atrial Ca²⁺ handling abnormalities, mainly involving the dysfunction of ryanodine receptor (RyR) and sarcoplasmic reticulum Ca²⁺-ATPase (SERCA), play a role in the pathogenesis of atrial fibrillation (AF). Previously, we found that the expression and function of transient receptor potential vanilloid subtype 4 (TRPV4) are upregulated in a sterile pericarditis (SP) rat model of AF, and oral administration of TRPV4 inhibitor GSK2193874 alleviates AF in this animal model. The aim of this study was to investigate whether oral administration of GSK2193874 could alleviate atrial Ca²⁺ handling abnormalities in SP rats. A SP rat model of AF was established by daubing sterile talcum powder on both atria of Sprague-Dawley (SD) rats after a pericardiotomy, to simulate the pathogenesis of postoperative atrial fibrillation (POAF). On the 3rd postoperative day, Ca²⁺ signals of atria were collected in isolated perfused hearts by optical mapping. Ca²⁺ transient duration (CaD), alternan, and the recovery properties of Ca²⁺ transient (CaT) were quantified and analyzed. GSK2193874 treatment reversed the abnormal prolongation of time to peak (determined mainly by RyR activity) and CaD (determined mainly by SERCA activity), as well as the regional heterogeneity of CaD in SP rats. Furthermore, GSK2193874 treatment relieved alternan in SP rats, and reduced its incidence of discordant alternan (DIS-ALT). More importantly, GSK2193874 treatment prevented the reduction of the S2/S1 CaT ratio (determined mainly by RyR refractoriness) in SP rats, and decreased its regional heterogeneity. Taken together, oral administration of TRPV4 inhibitor alleviates Ca²⁺ handling abnormalities in SP rats primarily by blocking the TRPV4-Ca²⁺-RyR pathway, and thus exerts therapeutic effect on POAF.
Administration, Oral ; Animals ; Atrial Fibrillation/etiology* ; Calcium/metabolism* ; Myocytes, Cardiac/metabolism* ; Pericarditis/pathology* ; Rats ; Rats, Sprague-Dawley ; Ryanodine Receptor Calcium Release Channel/pharmacology* ; Sarcoplasmic Reticulum/pathology* ; TRPV Cation Channels