31/1030. chylothorax, chylopericardium and lymphoedema--the presenting features of signet-ring cell carcinoma. This report describes a patient with chylous pleural and pericardial effusions in conjunction with severe lymphoedema resembling elephantiasis. The chylous effusions and generalized lymphoedema were associated with a signet-ring cell carcinoma. ( info) |
32/1030. Loculated pericardial effusion due to congestive heart failure: an unusual case of vanishing tumor--a case report. Loculation of a pleural effusion within an interlobar fissure as a result of congestive heart failure is a well-known entity. It has been termed "vanishing" or "phantom" tumor because its roentgenographic appearance simulates a pulmonary tumor and resolves with treatment of the congestive heart failure. The authors describe an 89-year-old man with a loculated pericardial effusion on the left cardiac border on chest roentgenogram. This was initially thought to represent an occult metastatic malignancy; however, its etiology became obvious when it disappeared with therapy of heart failure. Loculated pericardial effusion should be included in the differential diagnosis of roentgenographic densities in the chest when seen on the left cardiac border. ( info) |
| OBJECTIVES: To review the oncologic emergency of cardiac tamponade through a case study presentation/analysis and a discussion of the pathophysiology, diagnosis, treatment, and nursing management. DATA SOURCES: research studies, review articles, book chapters, abstracts, and clinical practice. CONCLUSIONS: cardiac tamponade is a potentially life-threatening condition that is not uncommon in the oncology setting. It can result directly from the malignant or metastatic process or from the treatment of the malignancy. observation and prompt intervention are mandatory to deal effectively with cardiac tamponade. IMPLICATIONS FOR nursing PRACTICE: Oncology nurses play important roles in identifying patients at risk for cardiac tamponade and in recognizing signs and symptoms of cardiac tamponade early so this life-threatening emergency can be treated promptly. ( info) |
| We describe a case of visceral larva migrans syndrome complicated by liver abscess, pericardial effusion and ascites. To our knowledge, these findings have not been reported previously. The structural and immunological alterations caused by visceral larva migrans are thought to lead to the development of visceral abscesses. ( info) |
35/1030. Primary cardiac angiosarcoma with right coronary artery-to-pericardial fistula--a case report. Primary cardiac sarcoma is a rare tumor that is difficult to diagnose preoperatively. Hemopericardium and coronary artery fistula are rare complications of primary cardiac sarcoma. The authors report a case of primary cardiac angiosarcoma presenting with hemopericardium, secondary to right coronary artery-to-pericardial fistula, with a review of the literature. ( info) |
36/1030. An autopsy case of a malignant pericardial mesothelioma in a Japanese young man. An autopsy case of a malignant pericardial mesothelioma in a 27-year-old man with no history of exposure to asbestos is reported. He was admitted for heart failure due to pericardial effusion of unknown origin and surgically drained, but later died. The diagnosis of a malignant pericardial mesothelioma was made on the basis of histologic, immunohistochemical and ultrastructural findings. The tumor was located on the pericardium, but autopsy revealed that it had spread extensively in the mediastinum and the lungs. Microscopically, the tumor cells were epithelial like and contained histochemically demonstrable glycogen and hyaluronic acid. Immunohistochemical studies of the tumor demonstrated positive immunoreactivity for cytokeratin 19, muscle actin HHF35, epithelial membrane antigen, CA125, p53 and p21WAF1/CIP1 whereas the tumor was negative for cytokeratins 10 and 17, carcinoembryonic antigen, vimentin, epithelial antigen BerEP4, S-100, c-erbB2 and bcl-2. A high MIB-1 labeling index was noted. Under the electron microscope the tumor cells exhibited long, thin villi. The operation and autopsy findings thus revealed this to be a very rare case of malignant pericardial mesothelioma in a young man. ( info) |
37/1030. Constrictive pericarditis following hemopericardium due to ascending aortic dissection: A case report. A 79-year-old woman, who had had no history of trauma, tuberculosis, or collagen diseases, was referred for examination of general fatigue and shortness of breath on exertion. physical examination revealed engorged neck veins, hepatomegaly, and ascites with abdominal distention. On chest x-ray the cardiac shadow was slightly enlarged and bilateral pleural effusion was present. An electrocardiogram showed low voltage of the QRS complex. Computed tomographic scans revealed two lumens in the remarkably dilated ascending aorta and the severely thickened pericardium. cardiac catheterization showed elevated right atrial pressure and elevated right and left ventricular end-diastolic pressures, in addition to a pressure record of early diastolic dip and end-systolic plateau in the right ventricle. aortography demonstrated aortic dissection localized to the ascending aorta. On the basis of these findings, the diagnosis of chronic ascending aortic dissection complicated with constrictive pericarditis was made. After subtotal pericardiectomy, graft replacement of the ascending aorta and proximal aortic arch was performed with successful results. Her postoperative recovery was uneventful. Histological studies of the pericardium showed fibrosis and marked infiltration of the inflammatory cells. No findings of specific pericarditis such as tuberculosis or collagen diseases were detected. ( info) |
38/1030. A minimally invasive approach to chylopericardium after coronary artery surgery. We report a case of chylopericardium and chylothorax after coronary artery bypass grafting, which presented as delayed cardiac tamponade. We describe the minimally invasive management of a condition that can be associated with a protracted surgical course. ( info) |
39/1030. Fine needle aspiration biopsy of mastitis secondary to empyema necessitatis. A report of two cases. BACKGROUND: empyema necessitatis is a relatively rare entity. Two instances of mastitis secondary to empyema necessitatis, diagnosed by fine needle aspiration biopsy are reported. CASES: One case was tuberculous in etiology and was initially recognized by cytologic findings of epithelioid and granulomatous cellular reactions and the presence of acid-fast bacilli, which were subsequently cultured and speciated as mycobacterium tuberculosis. The other case was due to coexisting actinomyces and actinobacillus. These organisms were cytologically suggested by "sulfur" granules of filamentous, gram-positive bacilli, admixed gram-negative coccobacilli and Splendore-Hoeppli phenomenon in an exudative cell background and were confirmed by microbiologic culture as actinomyces israelii and Astinomyces actinomycetemcomitans, respectively. CONCLUSION: The usefulness of fine needle aspiration cytology in the diagnosis of empyema necessitatis, supported by ancillary microbial culture, histochemistry, and radiographic imaging, is well illustrated by these two cases. ( info) |
| We report a case of IgA-kappa multiple myeloma in a 68-year-old woman that was revealed by concomitant pleural and pericardial effusion. These effusions were found to be caused by myeloma and were verified by cytological examination of the pleural fluid and pericardial biopsy. The patient had neither osteolytic lesions nor Bence-Jones proteinuria. After a pericardiocentesis, her condition improved with a melphalan and prednisolone treatment. As far as we know, such a phenomenon is rare and has never been reported yet as a way of diagnosing multiple myeloma. ( info) |