Milk of calcium pericardial effusion confirmed with postmortem computed tomography and autopsy findings: A case report

We present the postmortem computed tomography and autopsy findings of a 60-year-old man who developed milk of calcium pericardial effusion and died of constrictive epicarditis. He experienced out-of-hospital cardiopulmonary arrest, and spontaneous circulation returned at the hospital. However, 7 h after recovery, the patient died. He had a swollen neck, had been experiencing coughing from 4 to 5 days earlier, and had no significant medical or surgical history. On computed tomography (CT), highly dense pericardial fluid (CT value: 130–150 Hounsfield units) and multiple calcifications along the epicardium and pericardium were visualized. The epicardium and pericardium were thick, hard, rough, and widely calcified with mild adhesions on autopsy. The pericardial cavity contained a pale, reddish brown, turbid, and highly viscous liquid. Bacteriological tests of pericardial fluid cultures revealed the presence of group G β-hemolytic streptococci. Hence, we diagnosed the patient’s cause of death as heart failure due to constrictive epicarditis. We believe that this case of milk of calcium pericardial effusion is the first case confirmed with postmortem CT and autopsy findings.     

Hyperdense pericardial effusion in dermatomyositis and contrast induced nephropathy

Pericardial involvement in dermatomyositis is rare and usually asymptomatic. In many instances, a diagnosis of pericardial involvement is not found until autopsy. Renal failure associated with connective tissue disorders can result in or potentially exaggerate pericardial inflammation. We report an unusual case of high-density pericardial effusion in a patient with dermatomyositis consequent upon contrast nephropathy as demonstrated by computed tomography. High-density pericardial effusion can be a result of an insidious cause such as pericardial inflammation rather than the more usual causes such as coronary or cardiac perforation.     

Illustrative cases in pericardial effusion misdetection: Correlation of echocardiography and CT

Eight equivocal two-dimensional echocardiograms with concurrent CT scans were evaluated to identify potential pitfalls in pericardial effusion detection. By echocardiography, two pleural effusions were felt to be pericardial, two hemopericardiums were interpreted as normal myocardium, three loculated pericardial effusions were not seen or were misinterpreted as other mediastinal collections, and one epicardial lipoma was called a pericardial effusion. When the clinical suspicion for pericardial effusion does not correlate with echocardiographic findings, CT scanning may be the definitive arbiter of pericardial disease.     

Silent pericardial effusion in late pregnancy: A new entity

Of 123 healthy pregnant women examined systematically by M-mode and two-dimensional echocardiography at various stages of gestation, 46 were in their late pregnancy (32nd–38th week) of whom 19 (41.3%) showed unexpected signs of pericardial effusion on the echocardiogram. Following Horowitz’s criteria, the effusion was large in 2, moderate in 4, and small in 13 cases; in all women the condition was clinically silent. Clinical examination was normal in all but 3 women, in whom high blood pressure returned to normal after delivery. The ECG was usually normal (16 of 19 cases) or showed nonspecific ST-T changes. The entity appeared in late pregnancy (not before the 32nd week), was transient, and no longer could be seen within a month after delivery of a normal child. Cause of the effusion was attributed to excessive water and salt retention in those women with an abnormal echocardiogram who at this late stage of gestation had a mean weight gain significantly higher (P<0.03) than in others (13.60±4.28 vs 10.96±3.7 kg) — an observation not reported before in normal pregnancy. Since pericardial effusion cannot be detected by clinical examination or ECG, echocardiography affords a safe and reliable diagnostic approach.     

结核性心包积液的临床与影像学诊断(附29例分析)

目的探讨结核性心包积液的临床与影像学诊断。方法29例临床上高度怀疑结核性心包积液(TPE)患者均经超声心动图和胸部X线检查。8例患者又经胸部CT研究。回顾性分析了全部患者的影像与临床资料。结果超声心动图证实了所有患者的心包积液伴胸腔积液及心脏疾患。X线(透视,胸片)发现18例心包与胸腔积液及3例肺结核。CT检查不但能发现全部患者的心包与胸腔积液,而且还发现了X线胸片上未显示的3例肺内云絮状钙化灶与3例心包壁增厚。29例患者中,最常见的症状是胸疼(100%),气急(41.4%),及心悸(24.1%)。心包液的实验室检验表明,ADA>45UL-1见于8例,TR-PCR阳性5例,PPD阳性10例。结论及时影像检查与临床资料的综合分析是早期确诊TPE关键性因素。     

Significance of incidental pericardial effusion on computed tomography in cardiac trauma: A report of two cases

We describe computed tomographic (CT) findings in two patients with cardiac injury who required emergency surgery. Chest CT revealed an unexpected low-density area, indicating pericardial effusion. We emphasize that, given the situation of trauma, an incidental low-density area covering more than two slices along the inferior border of the heart suggests pericardial effusion, which may be caused by cardiac injury.     

Motion artifacts on coronary CT angiography images in patients with a pericardial effusion

BackgroundPatients with a pericardial effusion can have a pendulum-like movement of the heart. No reports associate the presence of pericardial fluid with coronary CT angiography (CTA) images that are degraded by motion artifact.ObjectiveWe tested the hypothesis that patients with pericardial effusion have coronary CTA images compromised by motion artifacts, even when other known causes of motion artifact in coronary imaging are minimized.MethodsAmong the prospectively electrocardiogram-gated single heart beat 320-detector row coronary CTA studies performed from September 2009 to May 2013, 13 consecutive studies acquired with a heart rate <60 beats/min that indicate a pericardial effusion formed an effusion cohort. A control cohort included 13 studies with no pericardial fluid performed by the same CT scanner; these were pair-matched to the effusion cohort for heart rate, sex, age, and body mass index. All studies were free of arrhythmia and respiratory motion. Motion artifact was separately assessed (3-point scale) at 8 coronary segments by 2 cardiovascular imaging teams.ResultsThe mean pericardial effusion volume for the effusion cohort was 129 ± 57 mL (range, 39–222 mL). Intra-observer/interobserver reproducibility of the motion artifact scores were good (κ = 0.636–0.791). Motion artifacts were more frequently observed in the effusion cohort for the left circumflex (no, mild, severe artifact, 54%, 46%, 0% vs 81%, 19%, 0%, respectively, for effusion vs control; P = .039) and right coronary arteries (no, mild, severe artifact = 41%, 44% 15% vs 79%, 21%, 0%, respectively, for effusion vs control; P < .001), especially for the middle or distal segments. Larger effusion volumes were associated with more severe motion artifacts.ConclusionPatients with pericardial effusion have coronary CTA images compromised by cardiac motion artifacts, particularly in the left circumflex and right coronary arteries.     

Role of computed tomography and magnetic resonance imaging in diagnosing pericardial lesions

Objective

In this research, patients who had pericardial lesions are imaged by either CT or MRI and the purpose of this paper is to discuss which imaging modality should be used in the assessment of patients with different pericardial diseases.

Patients and methods

Thirty patients ranging in age between 3 months and 46 years diagnosed as having pericardial lesions by transthoracic echocardiography were prospectively studied. All patients were examined by history taking, chest X-ray, clinical examination, transthoracic echocardiography, Multidetector CT and/or magnetic resonance imaging.

Result

Several types of lesions were identified including constrictive pericarditis (n = 10), pericardial simple effusion (n = 9), pericardial tumors (n = 5), pericardial abscess (n = 4), pericardial hemorrhage (n = 4) and one case of pericardial cyst. Three patients had combined lesions.

Conclusion

CT and MR imaging should be used when findings at echocardiography are difficult to interpret, inconclusive or conflict with clinical findings. CT is better used for the assessment of postoperative cases while MRI is superior in detecting and diagnosing pericardiac masses and constrictive pericarditis.Also, because of radiation involving CT scan should be avoided in children if possible but has the advantage of fast imaging speed and often no need for sedation of patients and children.     

450例心包积液患者年龄相关病因构成的调查

目的 了解心包积液患者随年龄增长其病因构成的变化情况。方法 450例确诊为心包积液的住院患者按年龄分为少儿组(0～19岁)、青年组(20～39岁)、中年组(40～59岁)、老年组(60～79岁)和高龄老年组(80岁以上)5个年龄段,建立心包积液住院患者临床资料数据库,对比分析各组的病因构成。结果 随着年龄的增加,心包积液的病因构成也发生着变化。所有患者前三位的基础病因为肿瘤(22．22％)、结核(19．11％)、心力衰竭(16．44％)。高龄老年组心包积液病因构成相对集中,心肺功能异常导致的心包积液约占50％。老年患者最多见的病因为肿瘤(23．5％)和心力衰竭(19．13％);中年组常见的为肿瘤(28．68％)和结核(22．06％);少儿组和青年组以结核最多见,分别为25．3％、30．43％。结论 随着年龄增长,心包积液患者的病因中肿瘤、心力衰竭、肺感染所占比例呈上升趋势,结核则呈下降走势。上述特点在心包积液的诊断和治疗中应当引起注意。     

CT引导下穿刺引流心包积液

目的探讨CT引导下穿刺引流心包积液的可行性和安全性。方法14例心包积液致心脏压塞患者在CT引导下以Seldinger法穿刺置管引流心包积液。结果所有患者均穿刺置管引流成功,无任何严重并发症。操作用时15～23min。结论当超声不能为心包穿刺引流准确定位的时候,CT引导下穿刺引流心包积液可行、安全。     

心包窦及隐窝积液的16层螺旋CT影像学表现特征及其解剖学基础

目的 结合横、冠、矢状面解剖尸体标本，采用16层螺旋CT（MSCT）三维（3D）重组技术，评价心包窦、隐窝积液的CT表现特征及其影像学意义。方法 观察横、冠、矢状面尸体标本各1具的心包窦、隐窝的解剖及其通连关系，以及104例心包窦、隐窝积液患者的16层MSCT影像学表现特征，并对积液的显示率进行分析。结果 3具断面尸体标本以及MSCT图像均显示心包窦、隐窝系心包脏、壁两层在出人心脏大血管的根部相互移行而形成的腔隙。心包少量积液组与中至大量积液各组心包窦、隐窝积液的显示率差异有统计学意义（P〈0．05）。心包积液易积聚于主动脉上隐窝。结论 MSCT3D重组技术能直观、立体地显示心包窦、隐窝积液的形态学特征以及与固有心包腔的直接通连关系，能有效地与纵隔或心包内其他病变相鉴别。     

彩色多谱勒超声引导心包积液穿刺临床价值

目的：探讨彩色多谱勒引导心包积液穿刺价值。方法：回顾分析29例心包积液经彩超引导穿刺抽液、生化及脱落细胞检查证实的临床资料，分析心包积液声像图与穿刺抽液的临床价值。结果：29例心包积液均穿刺成功，疾病不同，心包积液颜色性质可不同，心包积液量不等，穿刺体位、方法可不同。结论：经彩超引导心包积液穿刺抽液具有准确，安全等优点，是诊断心包积液性质方法之一。     

超声引导下心包穿刺置管引流术治疗心包积液的疗效分析

 目的 探讨超声引导下心包穿刺置管引流急慢性心包积液的疗效。方法 回顾分析2009-01至2019-08医院161例行超声引导下心包穿刺置管引流术患者的临床资料,并对其病因、症状、缓解情况进行分析。结果 161例心包积液患者前三位的病因分别为肿瘤、心力衰竭、创伤或手术,经超声引导下心包穿刺置管术治疗后症状缓解率均在70%以上。结论 超声引导下心包穿刺置管引流术治疗心包积液疗效确切,可作为临床治疗心包积液特别是急性心包压塞的首选治疗方式。     

18F-FDG PET/CT显像诊断心包恶性病变的价值

目的 评价18F-脱氧葡萄糖（FDG）PET/CT对心包恶性病变的诊断价值.方法 对23例心包积液患者进行18F-FDG PET/CT显像,并采用两独立样本非参数检验分析良恶性病灶最大标准摄取值（SUVmax）差异有无统计学意义.结果 经病理检查证实恶性心包积液14例,良性心包积液9例.1例PET/CT假阴性,2例PET/CT假阳性.18F-FDG PET/CT鉴别诊断良恶性心包积液的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为92.9%（13/14）、7/9、87.0%（20/23）、86.7%（13/15）和7/8.良、恶性病变的SUVmax中位值分别为2.2和6.0,两者间比较差异有统计学意义（z=-3.279,P=0.001）.结论 18F-FDG PET/CT是评价心包恶性病变较好的无创性手段,对良恶性心包积液的诊断与鉴别诊断有一定临床价值.     

Purulent pericarditis in advanced thymoma: A case report

Thymoma is the most common primary anterior mediastinum mass with various clinical manifestations, and one of the manifestations is pericardial effusion. While pericardial effusion in thymoma is usually serous, it can become purulent when an infection occurs in a nearby organ, albeit rare. In this report, we present a rare case of a 27-year-old woman who had purulent pericarditis secondary to an advanced thymoma. The patient came to the emergency department with the chief complaints of worsening chest discomfort, non-productive cough, and fever in the past 2 weeks. The patient was diagnosed with thymoma 5 months prior. Based on the examinations, it was discovered that the patient had pericarditis. After the pericardiocentesis was performed and the fluid was examined, the patient was diagnosed with purulent pericarditis secondary to thymoma. The patient was then treated with intravenous antibiotic and pericardial drain. Unfortunately, the patient''s condition deteriorated, and the patient died on the fifth day of hospitalization. This case highlights an infrequent but potentially life-threatening complication of thymoma. In addition, thymic pathologies should be included as a rare etiology in the differential diagnosis of purulent pericardial effusion.     

CT引导下中心静脉导管置管引流心包积液的临床分析

目的 探讨CT引导下应用中心静脉导管置管引流心包积液的临床可行性、操作安全性、具体穿刺方法及相关注意事项.方法 对114例心包积液患者随机分为CT引导组(A组),超声体表定位组(B组),比较两组平均穿刺成功时间、平均穿刺次数、穿刺成功率及并发症的发生率.结果 A组第1针穿刺成功率为96.6％,B组为78.6％,P＜0.05,在穿刺成功率上两组差异有统计学意义.总并发症发生率A组为3.4％,B组为16.1％.并发症的发生两组相比差异有统计学意义.结论 在CT引导下进行中心静脉导管置管引流心包积液,成功率高、不良反应少、引流彻底、方便注药.操作安全有效,值得在临床推广应用.     

A Rare Case of Isolated Pericardial Effusion Detected by SPECT/CT on a Post-Therapeutic Radioiodine Whole-Body Scan

We reported a rare finding of isolated pericardial uptake detected by SPECT/CT on posttherapeutic radioiodine whole body scan. This case highlights the usefulness of hybrid SPECT/CT, with subsequent correlation with biochemical results, in ruling out metastatic pericardial effusion in the postsurgical radioiodine remnant ablation setting. The effusion was resolved after reinstituted thyroid replacement therapy. Recombinant thyrotropin is recommended to avoid such rare but life-threatening complication.     

两种剂量rmhTNF治疗晚期肿瘤恶性心包积液的疗效观察

目的探讨重组改构人肿瘤坏死因子（rmhTNF）在恶性心包积液治疗中的疗效及毒性反应;并比较两种不同剂量rmhTNF在疗效和毒副反应方面的差异。方法 56例肿瘤患者随机分为两组,分别于心包腔内置管灌注rmhTNF1500万IU（大剂量组）、rmhTNF500万IU（常规剂量组）,连续治疗4次。1个月后按WHO标准评价疗效和毒副反应。结果大剂量组总有效率达到92.9%,完全缓解率达到71.4%;常规剂量组总有效率达到53.6%,完全缓解率达到28.6%两组相比差异有统计学意义（P〈0.05）。毒副反应两组相似,无统计学意义（P〉0.05）。结论 rmhTNF治疗癌性心包积液疗效好,毒副反应小。在治疗恶性心包积液中,大剂量组rmhTNF与常规剂量组比较,疗效更显著,而毒副反应差别不明显。