1/16. Unclassified connective tissue disease presenting as cardiac tamponade: a case report.This report describes a case of cardiac tamponade as the initial manifestation of unclassified connective tissue disease (UCTD). A 68-year-old Japanese woman was admitted to hospital because of dyspnea and edema. She had undergone a radical left mastectomy for the treatment of breast cancer 18 years before. On admission, bilateral leg edema, hepatomegaly, and a paradoxical pulse were noted on physical examination. The erythrocyte sedimentation rate was elevated and the c-reactive protein was 2.8 mg/dl. Antinuclear antibodies and anti-SS-A/Ro antibodies were present. The scl-70 and anticentromere antibodies were elevated. Chest radiography showed cardiomegaly. echocardiography revealed a large pericardial effusion, but the pericardial fluid did not contain malignant cells or bacteria. She did not meet the diagnostic criteria for any known connective tissue diseases, so was diagnosed with cardiac tamponade due to UCTD. prednisolone (30 mg/day) was administered, which resulted in a gradual resolution of the pericardial effusion. Although connective tissue diseases are known to cause pericardial effusion, cardiac tamponade as the initial manifestation of the disease in the absence of other symptoms is quite rare.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/16. bacteroides pericardial effusion and cardiac tamponade in a patient with chronic renal failure.A 31-year-old woman with chronic renal insufficiency and recurrent pericarditis developed an enlarging cardiac silhouette and physical signs of cardiac tamponade. cardiac catheterization demonstrated pericardial effusion with hemodynamic evidence of cardiac compression. At pericardial exploration, 1.5 L. of foul-smelling purulent material was removed from a distended pericardial sac. Cultures of both the exudate and pericardium revealed pure growth of bacteroides fragiles. The patient was subsequently treated with intravenous chloramphenicol and has had an uncomplicated clinical course since that time. This represents the first reported case of cardiac tamponade secondary to culturally proved bacteroides pericarditis in the setting of chronic renal insufficiency.- - - - - - - - - - ranking = 0.090453979615239keywords = physical (Clic here for more details about this article) |
3/16. Idiopathic chylopericardium: 131-I-triolein scan for noninvasive diagnosis.We report idiopathic chylopericardium in a physically active, asymptomatic 29-year-old man. Preoperative diagnosis was made by external cardiac imaging after oral administration of 131-I-labeled triolein. To our knowledge this is the first report of preoperative noninvasive diagnosis of chylopericardium. After open drainage and pericardial biopsy, the patient is asymptomatic without recurrence after 8 months.- - - - - - - - - - ranking = 0.090453979615239keywords = physical (Clic here for more details about this article) |
4/16. A rare case of massive pericardial effusion secondary to hypothyroidism.Massive pericardial effusions secondary to hypothyroidism are rarely seen in the emergency department (ED). The case of a patient presenting with a relatively asymptomatic massive pericardial effusion due to hypothyroidism is described. The patient had a history of laryngeal carcinoma post-total laryngectomy and adjuvant radiotherapy 12 years previous. Although underlying malignancy was in the differential diagnosis, hypothyroidism was diagnosed through a detailed history and physical examination, thereby avoiding the need for pericardiocentesis. Thyroid replacement alone is sufficient for resolution of these effusions, although it may take many months. pericardiocentesis is indicated only if cardiac tamponade develops. This rare but significant condition should be considered, especially when it occurs after acute cold exposure.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/16. Pericardial conditions: signs, symptoms and electrocardiogram changes.This article describes the anatomy and physiology of the pericardium and the signs and symptoms of acute pericarditis, pericardial effusion and cardiac tamponade. It illustrates the likely electrocardiogram findings in each of these conditions and discusses how the results, combined with patient history and physical examination, can help emergency nurses make accurate diagnoses.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/16. A patient with pulseless extremities: an unusual manifestation of cardiac tamponade.We describe a 51-year-old man who came to our institution with cold cyanotic extremities. He was receiving radiation therapy for adenocarcinoma of the lung and superior vena cava syndrome. Findings on initial physical examination were notable for absent peripheral pulses and increased jugular venous pulsations. Shortly after admission, the patient experienced severe dyspnea and tachypnea. Arterial blood gas studies revealed mild metabolic acidosis. A chest roentgenogram showed an enlarged cardiac silhouette and the known mass in the right upper lobe of the lung. An electrocardiogram demonstrated no evidence of ischemia but low-voltage QRS complexes. An emergency echocardiogram disclosed a large pericardial effusion and evidence of hemodynamic compromise. With use of echocardiographic-guided pericardiocentesis, 600 ml of bloody fluid was removed; the pulses were immediately palpable in the patient's extremities. Although symptoms associated with the extremities are unusual as the initial complaint of patients with cardiac tamponade, we illustrate several key physical findings and abnormal results of laboratory test characteristic of this disorder. In addition, we underscore the importance of considering this diagnosis, especially in patients with a malignant tumor, and we describe the prompt response to therapy.- - - - - - - - - - ranking = 1.0904539796152keywords = physical examination, physical (Clic here for more details about this article) |
7/16. Massive primary chylopericardium: a case report.A large pericardial effusion was discovered in an asymptomatic 12-year-old boy admitted for an elective orthopedic procedure. On physical examination, heart rate was 96 and blood pressure was 130/70 without paradox. The neck veins were not distended, but heart tones were distant. Chest roentgenogram (CXR) showed an enlarged cardiac silhouette. Echocardiogram showed a massive pericardial effusion compressing the right atrium, with depressed ventricular contractility. pericardiocentesis yielded 450 mL of chylous fluid. A percutaneous pericardial drain was placed and drained another 400 mL of chyle. Pericardial fluid reaccumulated even though the patient was on a low-fat diet, and 1 week after admission left thoracotomy was performed with partial pericardiectomy and pericardial window. There was 1 L of chyle in the pericardial sac; frozen section of the pericardium showed lymphangiectasia. Chest tube drainage diminished rapidly and the patient was discharged. Follow-up CXR at 1 week showed fluid in both pleural spaces requiring bilateral tube thoracostomies again draining chyle. Even with total parenteral nutrition (TPN), 500 mL/d of chyle drained from the pleural tubes. Right thoracotomy with ligation of the thoracic duct was performed after 1 week of TPN. Pleural drainage abruptly dropped, and there has been no reaccumulation in either the pleural spaces or pericardium at 6-month follow-up. This case dramatically supports early thoracic duct ligation and partial pericardiectomy as the treatment of choice for primary massive chylopericardium.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/16. pericardial effusion in dengue haemorrhagic fever.Acute shock in severe dengue haemorrhagic fever (DHF) may occur concurrently with accumulation of fluid in serous body spaces such as pleural, peritoneal and pericardial cavities. echocardiography is a non-invasive diagnostic procedure which is sensitive to detect even a small quantity of pericardial effusion. The chest radiogram in two reported cases of DHF associated with severe shock revealed that almost half of the pleural cavity was filled with fluid. Although no signs of pericardial effusion could be determined on physical examination, ECG and radiological procedures, a small amount of fluid was clearly seen on echocardiogram.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/16. Cardiac injuries caused by blunt chest trauma in children.Two illustrative cases with different features of cardiac injury caused by blunt chest trauma are described. The first patient had mild and obscure symptoms, detected on physical examination, and required observation only. The second patient had acute pericardial tamponade, necessitating surgical treatment. We present the different medical procedures that should be taken into consideration in management of such cases, although continuous monitoring, repeated physical examination, electrocardiograms, chest x-rays, and echocardiography proved sufficient in managing our two children. It is important that physicians who provide care to children suffering from blunt chest trauma have increased awareness of possible cardiac injuries.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
10/16. Primary chylopericardium recovered without surgical treatment.--Report of a case and review of the literature.A case of 7-year-old girl who had recurrent chylopericardium is presented. She was asymptomatic and physical examination disclosed only enlarged cardiac dullness on percussion and distant cardiac sound on auscultation. In despite of numerous pericardiocentesis, institution of medium-chain triglyceride diet and corticosteroid therapy, chylous pericardial effusion persisted. Four years later the amount of pericardial effusion began to decrease and 5 years later it disappeared completely. Her cardiac size became normal on the chest X-ray. She remained totally asymptomatic throughout the course of this disease. If the patient is asymptomatic and can well tolerate daily life, surgery is not necessarily indicated, and the patients should be treated medically as long as possible. A review of previously reported cases are given.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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