21/1030. Spontaneous pyopneumopericardium. A previously healthy 42-year-old man presented to the emergency department with progressive weakness, lightheadedness, nausea, and lower extremity edema. Evaluation revealed hypotension, pulsus paradoxus, leukocytosis, hepatic and renal dysfunction, and an air-fluid level in the mediastinum. Emergency department ultrasound confirmed the presence of a large pericardial fluid collection. The patient was admitted to the medical intensive care unit with a diagnosis of pyopneumopericardium for emergent pericardiocentesis. ( info) |
22/1030. Takayasu's arteritis accompanied with massive pericardial effusion--a case report. A 40-year-old woman who had been treated for Takayasu's arteritis was admitted to the hospital with fever, fatigue, malaise, and severe chest pain. Computed tomography of the chest demonstrated massive pericardial effusion and bilateral pleural effusion. In laboratory data, the c-reactive protein was high at 22.0 mg/dL, and erythrocyte sedimentation rate was also high at 80 mm/hr. The diagnosis was pericarditis with a recurrence of the systemic inflammatory process of Takayasu's arteritis. The patient was treated with methylprednisolone pulse therapy. Her massive pericardial effusion disappeared without pericardiocentesis. ( info) |
23/1030. Video-assisted thoracoscopic pericardiectomy for severe pericardial effusions. Video-assisted thoracic surgery (VATS) has proven to be extremely useful in the diagnosis and treatment of multiple thoracic problems. We used the VATS technique to successfully treat refractory pericardial effusions associated with pericarditis by performing pericardiectomy. ( info) |
24/1030. Blunt cardiac rupture: the utility of emergency department ultrasound. BACKGROUND: rupture of the heart is usually a fatal injury in patients sustaining blunt trauma. Those arriving in the emergency department alive can be saved with prompt diagnosis and treatment. methods: We describe the cases of 4 consecutive patients with rupture of the free cardiac wall whom we treated at Grady Hospital. Two had a tear of the right ventricle, 1 had a tear of the right atrium, and 1 had two tears of the left atrium. All patients were involved in motor vehicle accidents. The diagnosis was made by ultrasound in 3 patients and during exploratory surgical intervention in the other. All tears were repaired primarily without the aid of cardiopulmonary bypass. RESULTS: Three of the patients survived, and 1 died. CONCLUSIONS: Rarely are patients with rupture of the free cardiac wall seen in an emergency department. The improvements in the prehospital care and the transportation may result in an increase in the numbers of such patients. physicians treating patients with blunt trauma must suspect the presence of cardiac rupture. Immediate use of ultrasonography will establish the diagnosis and prompt repair of the injury may improve overall survival. ( info) |
| 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. ( info) |
26/1030. 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. ( info) |
| The authors report a rare case of a malignant hemangioendothelioma (MH) originating in the pericardium. In this case, a metastatic skin lesion was found first, and subsequently the existence of a primary cardiac lesion was confirmed. Generally, primary cardiac tumors grow slowly, and the prognosis of MH is relatively good. In this case, however, the patient died suddenly during the creation of a pericardial window for drainage. An autopsy showed that the MH originated from a pericardial lesion in the right atrium. ( info) |
28/1030. Spontaneous pericardial hematoma in an infant. The finding of a pericardial hematoma is rare in the pediatric population. Its occurrence in an otherwise healthy 3-month-old infant is unprecedented in the literature. The hematoma was initially identified by echocardiography. Computerized tomography and magnetic resonance imaging did not contribute to the identification of the mass. An exploratory thoracotomy was necessary to rule out a neoplastic process. The final diagnosis of hemorrhagic pericarditis was made. ( info) |
29/1030. Combined idiopathic retroperitoneal and mediastinal fibrosis with pericardial involvement. We report the case of a 54-year-old woman with renal failure related to bilateral hydronephrosis. Clinical and radiologic findings were consistent with retroperitoneal fibrosis associated with pleuro-pericardial involvement. These features matched criteria for combined idiopathic retroperitoneal fibrosis and idiopathic mediastinal fibrosis. There are few reported cases of pericardial involvement in this combined disorder. In our observation, nuclear-magnetic resonance was the radiologic procedure of choice for aortic exploration. The responsibility of therapeutic agents (beta-adrenoreceptor-blocking drugs and ergotamine) and therapeutic options for the sclerosing disease are also discussed. Bilateral ureteral stents and corticosteroids produced favorable outcome without recurrence one year after treatment was stopped. ( info) |
30/1030. An unusual procedure for the treatment of simultaneous pericardial and pleural effusions. BACKGROUND: Symptomatic posterior pericardial effusion (PE) represents a diagnostic challenge since it is not easy to quantify by echocardiography. In addition, this type of effusion is normally treated by surgery because of the difficulty in drainage. CASE: A 59-year-old male presented a symptomatic circumferential PE following mitral valve substitution. Two days after a successful percutaneous subcostal pericardiocentesis, he reported severe dyspnea with hypotension and pulsus paradoxus. At chest x-rays, he showed a left pleural effusion; echocardiography, also performed from the left posterior axillary line, showed a large posterior PE and a large pleural effusion separated by a membrane. A needle was inserted at the fourth intercostal space 2 cm medially to the left posterior axillary line and advanced into the pleural and then into the pericardial cavity under echocardiographic guidance. Serous-hemorrhagic fluid was drained from the pericardial (800 cc) cavity and, after retraction, from the left pleural cavities (600 cc), with consequent hemodynamic improvement. CONCLUSION: Pleuro-pericardiocentesis may represent a valid alternative to surgery for the treatment of cardiac tamponade due to posterior pericardial effusions, in the peculiar situation characterized by the simultaneous presence of a left pleural effusion. This procedure should be performed by qualified physicians under echographic guidance. ( info) |