A case report: suppurative pericardial effusion

We present the case of a 67 year old woman who was resuscitated due to cardiac tamponade. Examination of the pus fluid showed a bacterial infection with streptococcus milleri. Four days before resuscitation the patient experienced weakness, dyspnoea, increased temperature (39 degrees C), swelling of the neck, and pain on swallowing. Using computed tomography, examination revealed an infection extending from the right tonsil to the mediastinum and into the pericardium. After surgery to remove the retropharyngeal abscess, the patient healed well. Therefore, on presentation of a cardiac tamponade, possible hematogenous or lymphogenous causes or per continuitatem infections should always be considered. In this case the germs in the fluid and the typical patient history indicated an oropharyngeal reason.     

心脏扩大、心包积液、水肿一例

<正>1病例资料患者女,61岁。因"活动后气促9个月,水肿4个月"于2012年9月7日入院。患者9个月前开始于活动后出现气短,休息后可缓解,无胸痛、心悸不适。4个月前患者因气促伴颜面及双下肢重度水肿就诊山东某院,诊断为"冠心病、心力衰竭",经"强心、利尿"等对症治疗后症状好转出院。此后患者仍间断发作活动后气短,休息即可缓解,夜间平卧后     

Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature

BACKGROUND: Human immunodeficiency virus (HIV)-associated pericardial effusion is common. We present its clinical features, cause, and prognosis on the basis of a review of 40 cases at a single public hospital. METHODS: A retrospective study was conducted of 122 patients with pericardial effusion (of which 40 were HIV associated) admitted to Queens Hospital Center from January 1988 to April 1997. A review of the literature is also presented. RESULTS: Forty patients with HIV-associated pericardial effusion represent 33% of the 122 patients with pericardial effusion admitted during that period. The most common symptom of the 40 patients was dyspnea (75%). Echocardiogram detected small effusions in 18 (45%), moderate effusions in 10 (25%), and large effusions in 12 (30%). Sixteen (40%) patients had cardiac tamponade, in 15 of whom pericardiocentesis or pericardiostomy was performed. Causes of cardiac tamponade were Mycobacterium species in 3 (19%), Streptococcus pneumoniae in 1 (6%), Staphylococcus aureus in 1 (6%), Kaposi's sarcoma in 1 (6%), and unknown in 10 (63%). In comparison, causes of cardiac tamponade in 74 cases of acquired immunodeficiency syndrome in the literature were 45% idiopathic, 20% mycobacteria, 19% bacteria, 7% lymphoma, 5% Kaposi's sarcoma, 3% viruses, and 1% fungus. Thirteen of the 40 patients were lost to follow-up. Among the other 27, 11 (41%) were alive at 3 months and 5 (19%) at 1 year. Ten of the 27 patients had cardiac tamponade, of whom 5 (50%) were alive at 3 months and 3 (30%) at 1 year. CONCLUSIONS: HIV-associated pericardial effusion is the most common type of pericardial effusion in our inner city hospital. Causes are diverse. The development of pericardial effusion predicts a poor prognosis in HIV infection.     

Primary pericardial mesothelioma presenting as constrictive pericarditis: a case report

Primary malignant pericardial mesothelioma is a rare tumor and the case reported here presented as constrictive pericarditis. The patient's symptoms progressed day by day despite treatment with digitalis, diuretics and catecholamines. Although a computed tomographic scan of the chest, echocardiography and pericardiocentesis were performed, a preoperative definitive diagnosis could not be obtained. Emergency pericardiectomy and partial resection of the tumor were carried out with the aid of a percutaneous cardiopulmonary supporting system, but the patient died of cardiac failure on postoperative day 3. The tumor appeared to be the biphasic type of diffuse malignant mesothelioma. The prognosis for pericardial mesothelioma is extremely poor due to its late presentation and difficulty in completely removing it surgically and, unfortunately, there still is not a radical therapy for this tumor.     

Gonococcal arthritis complicated by acute pericarditis and pericardial effusion

A woman of 23 presented with a painful, swollen left knee. A thick yellow fluid aspirated from the joint cavity grew Neisseria gonorrhoeae. Central pleuritic chest pain and ST segment elevation developed 48 hours after presentation. These signs and symptoms of pericarditis had settled two months after the acute illness.     

Benign pericardial schwannoma with massive pericardial effusion in a Chinese man: A case report

Primary cardiac neoplasms are rare, and the pericardial schwannoma has an even lower occurrence. We report a case of pericardial schwannoma in China, which is the eighth reported case adding to the existing literature on pericardial schwannoma, and this is the first case reported complicated with massive pericardial effusion. Pericardial schwannomas are usually benign, but they can sometimes have a malignant tendency and cause life‐threatening complications. Thus, it should be managed aggressively and completely resected.     

Large pericardial effusion in a family with recurrent pericarditis: A report of probable x-linked transmission

Three cases of recurrent pleuropericarditis were observed within the same family – in two sisters and their niece, who were 18, 35 and 18 years of age, respectively. One patient was treated with pericardiectomy, and the other two were treated with colchicine. Mutations associated with autoinflammatory diseases (tumour necrosis factor receptor-associated periodic syndrome and familial Mediterranean fever) were absent; the condition was found to be sex linked.     

Immune reconstitution inflammatory syndrome presenting as pericarditis and pericardial effusion

Immune reconstitution inflammatory syndrome (IRIS) affects 30-43% of HIV and tuberculosis (TB) co-infected patients after starting highly active antiretroviral therapy (HAART). Pericarditis and pericardial effusion are rare manifestations of IRIS. We report a case of HIV-TB related IRIS that developed pericardial involvement. This complication resolved after treatment with ibuprofen. Antituberculous treatment and HAART were not interrupted.     

Gonococcal arthritis complicated by acute pericarditis and pericardial effusion.

A woman of 23 presented with a painful, swollen left knee. A thick yellow fluid aspirated from the joint cavity grew Neisseria gonorrhoeae. Central pleuritic chest pain and ST segment elevation developed 48 hours after presentation. These signs and symptoms of pericarditis had settled two months after the acute illness.     

Intracranial Epstein-Barr virus-associated smooth muscle tumor with superimposed cryptococcal infection: A case report

Rationale:Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) are rare, virally-induced malignancies that occur almost exclusively in immunocompromised individuals. We report a very rare case of a dura-based EBV-SMT with superimposed local cryptococcal infection.Patient concerns:An adult male with a history of untreated acquired immunodeficiency syndrome presented to our hospital with worsening headaches, diarrhea, and diffuse myalgias.Diagnoses:Blood cultures were positive for methicillin-resistant Staphylococcus aureus and Cryptococcus neoformans serum antigen. Magnetic resonance imaging revealed 2 adjacent enhancing masses in the right temporal lobe, perilesional edema, and mass effect of the right lateral ventricle. Histological examination and immunohistochemical stains of the surgical specimen were consistent with EBV-SMT. Cryptococcus organisms were identified within the neoplasm.Interventions:The patient underwent complete tumor resection, received an extended course of amphotericin and flucytosine, and was restarted on antiretroviral therapy.Outcomes:The patient was discharged from the hospital with no focal neurological deficits.Lessons:Epstein-Barr virus associated smooth muscle tumors are rare malignancies that occur in immunocompromised patients. Prognosis is largely dependent on immune reconstitution and treatment of concomitant infections.     

糖皮质激素辅助治疗原发性甲状腺功能减退症大量心包积液一例

原发性甲状腺功能减退症(甲减)是临床常见的一种内分泌疾病，心包积液是其临床表现之一，但大量心包积液少见。传统的治疗方法为以小剂量甲状腺激素替代治疗开始，再逐步增加剂量。若患者能耐受，心包积液一般可以逐渐消退；若患者不能耐受，就会出现严重的心绞痛症状。为此，改变原有的思维模式，从自身免疫性疾病的角度理解大量心包积液产生的     

Hepatitis C virus-associated pericardial effusion and tamponade in a liver transplant recipient

A liver transplant recipient with hepatitis C presented with unexplained dyspnea, fatigue and edema. Diagnostic evaluation revealed a pericardial effusion with echocardiographic features of tamponade. The patient underwent therapeutic pericardial drainage, resulting in symptomatic relief. The pericardial fluid tested positive for hepatitis C virus (viral quantitation of 200,000 copies/mL, genotype 1b) and negative for other plausible etiologies. Pericardial biopsy revealed normal tissue. This is the fifth case of hepatitis C virus-associated pericardial disease worldwide and the first case in North America. It is the first in a liver transplant recipient. In contrast to previous reports, this patient demonstrated tamponade in the absence of cryoglobulinemia or systemic extrahepatic manifestations of hepatitis C.