1/41. Squamous cell metastasis from the tongue to the myocardium presenting as pericardial effusion.Cardiac metastasis from head and neck cancer is rarely encountered. We present a base-of-tongue squamous cell carcinoma with metastasis to the heart that was diagnosed antemortem. autopsy series indicate that tongue cancer may metastasize more frequently to the heart than from other head and neck sites. However, none of these studies was controlled. Most importantly, cardiac metastasis should be suspected in any patient with cancer in whom new cardiac symptoms develop. The diagnosis is best confirmed with two-dimensional echocardiography or cardiac MRI. A myocardial or endocardial biopsy specimen can be obtained with angiographic guidance. Despite the improvement in diagnostic capability, available treatments are only palliative. All patients eventually die of their metastatic disease.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/41. Recurrent pericardial effusion: the value of polymerase chain reaction in the diagnosis of tuberculosis.A 23 year old army man presented with progressive dyspnoea and was found to have a massive pericardial effusion. Despite extensive investigations the cause remained elusive, until samples were sent for polymerase chain reaction (PCR). This case was unusual for several reasons and is a reminder of the atypical way in which tuberculosis infection can present and how a high index of suspicion should be maintained. It shows the importance of molecular biological advances in providing simple and rapid methods for arriving at the correct diagnosis, by way of nucleic acid probes and polymerase chain reaction.- - - - - - - - - - ranking = 2.5351256535672keywords = sample (Clic here for more details about this article) |
3/41. Cardiac injury from an air gun pellet: a case report.air guns are tools which each day become more powerful serious or even fatal accidents are caused by them. We report the clinical case of a 10-year old patient who received an accidental shot puncturing the right auricle, with generation of an important hemopericardium. A favorable evolution followed conservative treatment. However, we want to emphasize the potential gravity of injuries caused by this type of weapon.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
4/41. Primary cardiac angiosarcoma associated with cardiac tamponade: case report.A 57-year-old male with primary cardiac angiosarcoma was initially admitted for cardiac tamponade. pericardiocentesis was performed twice preoperatively, but the bloody pericardial fluid was cytologically negative for malignant cells. The tumor in the right atrium was resected during cardiopulmonary bypass. The resected tumor was 5.5x4.5x3.0cm in size and the diagnosis of cardiac angiosarcoma was made histologically. There were no tumor cells in the surgical margin. Unfortunately the patient died 3.5 months after surgery due to multiple recurrence in the pericardium. A suitable therapy for cardiac angiosarcoma is still controversial, but early antemortem diagnosis and more aggressive combined treatment should be considered.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
5/41. Slowly progressive heart failure due to subepicardial myocardial fibrosis in a patient with chronic pericardial effusion.A 65-year-old woman was admitted to hospital because of orthopnea. She had been followed-up for chronic pericardial effusion detected by echocardiography 10 years previously. Initial echocardiography showed that the left ventricular diastolic diameter (LVDd) was 39 mm and percent fractional shortening (%FS) was 33.3%. Neither fluid samples nor a pericardial biopsy specimen identified the etiology. cardiac tamponade was not evident, and c-reactive protein and creatine-kinase values were within normal limits. During follow-up, the %FS decreased gradually, but the LVDd remained unchanged. On admission, echocardiography showed that the %FS was 12.5% and LVDd was 40 mm. She developed intractable hyponatremic heart failure with bilateral pleural effusion. autopsy findings revealed that infiltration of small lymphocytes in the epicardium had penetrated into the subepicardial myocardium. The subepicardial myocardium and the interventricular septal myocardium were diffusely replaced by fibrosis, which could have induced restrictive diastolic heart failure and reduced left ventricular contractility. The fibrosis was not detected in the epicardium itself nor the subendocardial myocardium. This is the first report describing diffuse subepicardial myocardial fibrosis in a patient with chronic pericardial effusion and progressive heart failure.- - - - - - - - - - ranking = 2.5351256535672keywords = sample (Clic here for more details about this article) |
6/41. nocardia asteroides pericarditis in association with hiv.This case report describes Nocardia pericarditis in a newly diagnosed human immunodeficiency virus (hiv) patient as an initial manifestation. Previously, two cases of Nocardia pericarditis were reported in patients with established hiv infection. To our knowledge this is the first case of Nocardia pericarditis as an initial manifestation of hiv infection. This case substantiates and emphasizes the importance of identifying Nocardia as an infectious cause of pericarditis in patients with acquired immunodeficiency. Long-term survival may be achieved with a combined medical and surgical approach.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
7/41. Benign lipid envelope of the heart simulating a pericardial hematoma.The hallmark of diagnosing a pericardial effusion by echocardiography is the presence of relatively sonolucent space outside of the cardiac structures. The location, size, mobility, and consistency of the pericardial space determined by echocardiography are considered to be reliable markers for defining pericardial processes. In certain clinical scenarios, however, it may be difficult to differentiate fluid from other pericardial processes, notably subepicardial adipose tissue. This case of a 76-year-old woman, who presented with possible cardiac tamponade after permanent pacemaker implantation, demonstrates some of the potential pitfalls in the diagnosis of pericardial space abnormalities.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
8/41. Perforation complications of percutaneous central venous catheters in very low birthweight infants.OBJECTIVE: To prospectively survey perforation complications of consecutively inserted percutaneous central venous catheters (PCVC) in very low birthweight (VLBW) infants over a 2 year period. METHODOLOGY AND RESULTS: Three serious perforation complications were encountered in a series of 100 consecutive PCVC. One infant (birthweight 685 g) developed pericardial effusion and fatal cardiac tamponade during the use of a polyurethane PCVC. At autopsy, the pericardial sac contained 8 mL fluid with a glucose concentration of 109 mmol/L and the catheter tip was embedded in the right ventricular wall. The second infant (birthweight 1380 g) showed pleural effusion and transient immobility of the right diaphragmatic leaf after perforation of a similar PCVC into the right pleural cavity. The third perforation, causing subcutaneous oedema, occurred in a 655 g infant who had a silastic PCVC. CONCLUSIONS: The data suggest a 3% incidence for PCVC-associated symptomatic perforation complications and a 1% incidence for fatal perforations, despite a policy of careful placement. The data also indicate that perforation complications occur regardless of the size or material of the PCVC. Proper visualization of the PCVC and vigilant attention to its location is required to prevent these rare but potentially fatal complications.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/41. Hemopericardium after superior vena cava stenting for malignant SVC obstruction: the importance of contrast-enhanced CT in the assessment of postprocedural collapse.We report the complication of hemopericardium following superior vena cava (SVC) stenting with an uncovered Wallstent in a patient with malignant SVC obstruction. The patient collapsed acutely 15 min following stent placement with hypoxemia and hypotension. A CT scan demonstrated a hemopericardium which was successfully treated with a pericardial drain. The possible complications of SVC stenting, including hemopericardium, pulmonary embolism, mediastinal hematoma, and pulmonary edema from increased venous return resulting from improved hemodynamics, ensure a wide differential diagnosis in the postprocedural collapsed patient and this case emphasizes the important role of contrast-enhanced CT in the peri-resuscitation assessment of these patients.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/41. Fatal inhalational anthrax with unknown source of exposure in a 61-year-old woman in new york city.A 61-year-old woman who was a new york city hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. blood cultures, as well as dna amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.- - - - - - - - - - ranking = 2.5351256535672keywords = sample (Clic here for more details about this article) |
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