Cardiac tamponade due to pneumopericardium.

Pneumopericardium is rare in acute asthma and cardiac tamponade has not been reported. The case is reported of a 20 year old asthmatic patient in whom assisted ventilation and high airway pressures resulted in tension pneumopericardium with clinical signs of cardiac tamponade that were relieved by pericardial aspiration.     

Cardiac tamponade due to leukaemic pericardial effusion

Chia, B. L., Da Costa, J. L., and Ransome, G. A. (1973).Thorax, 28, 657-659. Cardiac tamponade due to leukaemic pericardial effusion. A 19-year-old Chinese woman was admitted to hospital with cardiac tamponade. Pericardial fluid analysis and other investigations failed to reveal a cause of the pericardial effusion and she was treated as for tuberculous pericarditis. Subsequently haematological investigations showed that she was suffering from an acute lymphoblastic leukaemia.     

Cardiac tamponade due to coronary artery erosion

This report describes two patients with cardiac tamponade secondary to bleeding from a coronary artery, which had been eroded by a foreign body. In one patient the foreign body had been ingested and in the other patient, the cause was iatrogenic. This report highlights varied and unusual causes of cardiac tamponade.     

Cardiac tamponade due to intrapericardial rupture of an amebic liver abscess

Pericardial abscess is rare in healthy individuals, especially the amebic type. We report a case of pericardial abscess and cardiac tamponade due to intrapericardial rupture of an amebic liver abscess. A 31-year old Japanese male complained of fever to a local hospital. A liver mass was discovered in his left hepatic lobe by an abdominal echogram. He was referred to the internal department of our hospital and was treated with quinolone antibiotics. Two weeks after medication, he suddenly complained of epigastralgia and severe orthopnea and was admitted. Abdominal computed tomographic scan showed an enlarged liver mass, and massive pericardial effusion suggested cardiac tamponade. He underwent an emergency subxiphoid partial pericardiectomy under local anesthesia. 1,000 ml of light brownish fluid was removed and his condition improved. Although no ameba was cultivated from the pus, the amebic serological test was positive. Metronidazole was administered and the patients was discharged 31 days after surgery.     

Cardiac tamponade and pulmonary compression due to volvulus of oesophageal coloplasty

We describe an unusual case of cardiac tamponade and pulmonary compression due to acute volvulus of colon interposition occuring late after oesophagectomy. Clinical signs were suggestive of cardiac tamponade but there was no evidence of pericardial effusion by transthoracic echocardiography. Thoracic-CT provided the diagnostic clue in revealing the extrapericardial nature (a major dilatation of the colonic transplant) of the tamponade. This diagnosis should be considered in case of acute cardiopulmonary distress occuring early or late after oesophagectomy.     

Cardiac tamponade caused by aortic pseudoaneurysm with fistula in the right ventricle

A 69-year-old woman, with an aortic replacement valve for rheumatic aortic insufficiency suffered a sudden cardiac tamponade caused by a ruptured pseudoaneurysm of the ascending aorta which had its origin in the suture of the aorta performed 10 years earlier. The cardiac tamponade presented as syncope, absent central pulse, and respiratory failure. Hemodynamic variables recovered with early detection and start of cardiopulmonary resuscitation maneuvers. After fluids were replaced and following catecholamine treatment, a transesophageal echocardiogram revealed a pseudoaneurysm and continuous flow between the aorta and the right ventricle. The aneurysm and an unusual right ventricular fistula were repaired surgically through an emergency exploratory sternotomy. Cardiovascular recovery was satisfactory although hospital discharge was delayed because of pulmonary complications leading to severe hypoxia, pleural effusion, and pneumonia, with tracheal aspirate and bronchoalveolar lavage cultures positive for Pseudomonas aeruginosa, Acinetobacter spp, and Aspergillus flavus. We stress that immediate start of cardiopulmonary resuscitation prevented multiorgan failure and allowed for satisfactory recovery from surgery in spite of the presence of risk factors for mortality.     

Cardiac tamponade due to a ruptured aneurysm of the sinus of valsalva

BACKGROUND AND AIM: A sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly. Rupture of a SVA often causes hemodynamic instability due to intracardiac shunting or cardiac tamponade, therefore immediate diagnosis and urgent treatment are required. METHODS: We report an 18-year-old female with cardiac tamponade due to rupture of a localized aneurysm of the right coronary sinus of Valsalva. No other congenital or acquired cardiac anomalies were found. Neurological observation precluded urgent surgery with heparinization and extracorporeal circulation. RESULTS: Semi-urgently the SVA was successfully resected. CONCLUSIONS: Semi-urgent surgery for a ruptured aneurysm of the Sinus of Valsalva was successful. In selected cases off pump surgery can be contemplated.     

Cardiac tamponade as a presentation of COVID-19 after cardiac surgery

We present two patients who turned positive for coronavirus disease 2019 (COVID-19) after elective cardiac surgery, developing postoperative pericardial effusion with tamponade. One of the patients who presented with tamponade had no other symptoms of COVID-19 infection. COVID-19 can rarely present with cardiac manifestations including pericardial effusion and tamponade. In the post cardiac surgery setting, this effect of the virus may be accentuated. Hence, a high index of suspicion and prompt management are the keys for a successful outcome.     

Cardiac tamponade due to advanced gastric cancer: case report and review

Introduction and importancePericardial involvement due to gastric cancer is uncommon, especially when it is secondary to direct tumor infiltration. Its manifestation as cardiac tamponade is an exceptional situation that represents a challenge for the treating medical team.Case presentationa case of a patient with advanced gastric cancer with cardiopericardial infiltration, complicated with cardiac tamponade is reported. A narrative review of the diagnostic and therapeutic management was performed.Clinical discussionThere are no well-established diagnostic and therapeutic algorithms.ConclusionsIt is such an exceptional entity that most of the available bibliography is based on case reports or expert opinions. It is a situation with a very bad prognosis.     

Cardiac tamponade due to a ruptured solitary mediastinal varix: a case report

Mediastinal varix is rare. Some reports have noted that the mediastinal vein can become varicose in cases of portal hypertension or obstruction of the vena cava. However, solitary mediastinal varices without portal hypertension or obstruction of the vena cava are very rare. Mediastinal varicose veins have been problematic as pseudotumors, as no symptoms have been described in the literature. We encountered a case of cardiac tamponade due to a ruptured solitary mediastinal varicose vein. To the best of our knowledge, this is the first report of sustained symptomatic mediastinal varicose vein.     

Endovascular stenting of a leaking thoracic aortic pseudoaneurysm

Rupture of an aortic aneurysm is a major cause of early mortality during the course of disease. A less invasive approach with fewer complications is sought. A case of leaking thoracic aortic aneurysm is presented, where endovascular approach was adapted owing to ongoing sepsis. This report indicates prospects for employment of endovascular stenting as a suitable alternative to surgery in a growing variety of settings.     

Cardiac tamponade due to ruptured intramural hematoma of the ascending aorta: a case report

A 72-year-old man with a history of hypertension for 20 years was admitted with symptoms of acute aortic dissection. Computed tomography showed a crescentic thickening of the ascending aortic wall, suggesting an intramural hematoma. Sixteen hours after admission, he underwent urgent repair of the ascending aorta because of cardiac tamponade. We inspected the inside of the aorta from the aortic valve to the arch. Subadventitial hematoma due to hemorrhage from the outer media was confirmed. Rupture of the vasa vasorum was thought to be an initiating mechanism. The affected aortic wall was simply resutured and was not replaced with a graft because the intima was intact and the media was not dissected and the aortic wall was considered to be tolerable to normal blood pressure. The patient continues to do well 18 months following operation. An intramural hematoma of the ascending aorta should be regarded as a precursor of imminent rupture or classic dissection.     

Hypotension due to unexpected cardiac tamponade

We report a case of profound hypotension, after induction of general anaesthesia, that resulted from unexpected cardiac tamponade. The differential diagnosis was complicated by the absence of any evidence to indicate that there was significant direct chest injury. Many of the recognised clinical signs of cardiac tamponade were absent, in particular, there was no compensatory tachycardia, and heart rate remained stable despite severe hypotension before surgical drainage of the pericardium. The possible aetiology and pathophysiology is discussed. It is suggested that after major trauma, cardiac tamponade should be considered as a possibility even in the absence of significantly abnormal cardiovascular signs, evidence of direct chest injury, or an abnormal chest X ray.