Idiopathic chylopericardium: an unusual cause of cardiac tamponade

Chylous pericardial effusion is an uncommon condition, and the treatment is difficult. We report a case of massive chylous pericardial effusion with tamponade in a 22-year-old man, managed successfully. Lymphoscintigraphy confirmed the communication between the lymphatic trunk and the pericardial space, which was surgically ligated. There are relatively few published reports of idiopathic chylopericardium, and its pathogenesis remains unknown. The most effective treatment is surgical ligation of the thoracic duct and creation of a pericardial window.     

Systemic lupus erythematosus: an unusual cause of cardiac tamponade in a young man.

Although pericarditis and pericardial effusion are common cardiac complications of systemic lupus erythematosus (SLE), cardiac tamponade is a very rare initial manifestation of this disease. We describe a case of a young male patient in whom cardiac tamponade secondary to a loculated pericardial effusion was the presenting symptom of SLE.     

An unusual case of cardiac tamponade

A 29-year-old woman with Ebstein's anomaly on anticoagulant therapy presented with chest pain. A diagnosis of pericarditis was made once a myocardial infarction and pulmonary embolus had been excluded. She was discharged but returned shortly thereafter with fever, tachypnea and tachycardia. A repeat chest film disclosed that the cardiac silhouette had enlarged greatly since prior admission. Despite the absence of pulsus paradoxus, right heart catheterization confirmed the clinical suspicion of pericardial tamponade.     

Amoebiasis: a rare cause of cardiac tamponade.

Cardiac tamponade secondary to perforation of a hepatic amoebic abscess developed six years after the patient had visited an area where Entamoeba histolytica is endemic. He was treated with metronidazole and imipenem, emergency percutaneous catheter drainage, and open surgical drainage.     

Uremic pericarditis as a cause of cardiac tamponade.

Uremic pericarditis may complicate either acute or, more commonly, chronic renal failure. When dialysis is not employed, uremic pericarditis is usually a preterminal event and is characterized by a serofibrinous exudation of an amount inadequate to cause cardiac tamponade. Nevertheless, cardiac tamponade may uncommonly be observed in nondialyzed patients. Cardiac tamponade, which may be life-threatening, is more common in dialyzed than in nondialyzed patients with chronic renal failure. The primary causes of cardiac tamponade in uremic pericarditis in order of decreasing frequency are (1) pericardial effusion, usually of the serosanguineous type, (2) massive hemorrhage into the pericardial sac and (3) collagenization of pericardial exudate. From pathologic evidence, the following forms of therapy appear appropriate to manage uremic pericarditis that has reached the stage of causing cardiac tamponade. For effusion, pericardiocentesis or parietal pericardiectomy are logical procedures. Massive hemorrhage into the pericardial sac is usually attended by clotting and requires pericardiotomy and evacuation of clot. Collagenization of exudate yields an encasing, fibrous shell over the heart and requires decortication, as is practised in classical constrictive pericarditis.     

An unusual cause of cardiac paradox.

A 67-year-old lady presented with a 2-week history of increasingdyspnea. She had a past history of metastatic renal cell carcinomatreated by radical nephrectomy 3 months previously. On examinationshe     

A case of delayed postoperative cardiac tamponade with unusual echocardiographic findings

Postoperative cardiac tamponade due to localized compression of the atria occurred in a 64-year-old man after aortic valve replacement and repair of an ascending aortic dissection. The clinical findings were subtle and the echocardiographic findings were unusual. Color Doppler flow imaging assisted in making the diagnosis of localized atrial compression.     

Giant intrasellar carotid aneurysm - an unusual cause of panhypopituitarism.

Carotid artery aneurysms represent a very rare cause of pituitary failure. We describe the case of a female patient harbouring a giant aneurysm of the left carotid artery that subsequently led to panhypopituitarism. Interestingly, the late postoperative course was complicated by severe hyponatremia, whose origin may have been due to inappropriate ADH secretion. This case illustrates the problems of diagnosis and postoperative handling of panhypopituitarism due to an intrasellar aneurysm.     

Aortic valve tumor: an unusual cause of coronary obstruction during cardiac catheterization

Coronary artery obstruction during cardiac catheterization is a rare but serious complication that has been reported to occur in 0.15 to 0.5% of cases. The most common causes of intraprocedural coronary occlusion include thromboembolism, air embolism, and coronary dissection. This report describes the angiographic findings of a patient who developed chest pain with electrocardiographic evidence of myocardial ischemia due to obstruction of the right coronary artery by an aortic valve tumor.     

An unusual case of undifferentiated connective tissue disease presenting as cardiac tamponade

Cardiac tamponade as an initial manifestation of undifferentiated connective tissue diseases (UCTD) is extremely rare, with only one case reported in literature thus far. We describe here, a case of a middle-aged man who presented with symptoms of fatigue, exertional dyspnea and orthopnea. His physical exam was significant for anasarca, elevated JVP and pulsus paradoxus. Chest X-ray showed pleural effusions and cardiomegaly, electrocardiogram revealed electrical alternans and a transthoracic echocardiogram demonstrated massive pericardial effusion with hemodynamic compromise. There was clear evidence of tamponade on right heart catheterization. All common causes of pericardial effusion were assiduously excluded before working up the patient for connective tissue disorders, which revealed a high antinuclear antibody titer (1:160), grossly elevated SSA, SSB antibodies and increased C-reactive protein levels (13.04 mg/dl). Patient had no signs or symptoms suggestive of systemic sclerosis (xerophthalmia or xerostomia) and did not meet criteria for any other known connective tissue diseases. He was therefore diagnosed with UCTD, and successfully treated with colchicine after emergency pericardiocentesis. This case presents UCTD as a rare cause of cardiac tamponade and large pericardial effusions and suggests that colchicine can be used to treat UCTD-associated effusions. These patients once diagnosed, are at risk of developing known connective tissue diseases within 5 years of disease onset and should be followed up in clinic periodically.     

心脏介入性手术中心脏压塞发生的原因、处理及预后

目的　报道因心脏介入手术所致的 12例心脏压塞病例 ,分析其可能原因、临床表现及治疗结果 ,随访其预后。方法　 5 0 4 0例心脏介入手术中共发生 12例心脏压塞 ,男性 4例 ,女性 8例 ,平均年龄 (5 6± 17)岁 ,其中 8例与导管标测和射频消融术有关 ,2例与经皮冠状动脉腔内成形术有关 ,2例与先天性心脏病介入治疗有关。结果　心脏压塞的主要原因包括左心室穿孔、心脏静脉破裂、冠状动脉和左心耳穿孔。 8例经立即心包穿刺抽液 15 0～ 10 0 0ml病情稳定 ,4例因出血量大进行了外科手术。出院后平均随访 (2 3 6± 13 1)个月 ,全部病人情况良好。结论　心脏压塞是心脏介入治疗过程中严重的并发症 ,及时发现和有效处理十分重要。     

Cardiac tamponade: an unusual, fatal complication of infective endocarditis

Infective endocarditis still occurs in Western countries and so far, it has been an important medical problem. The spectrum of infective endocarditis complications may be extremely wide. We report two unusual cases of infective endocarditis complicated with heart rupture and pericardial effusion. In one case, the infective process spread from the aortic valve developing a sinus of Valsalva aneurysm with subsequent aortic perforation. The perforation reached the right auricular epicardial region with subsequent epicardial rupture and hemopericardium. In the other patient, an infective process of the aortic cusps induced the formation of multiple abscesses in the left ventricle and in the right atrium. An annular abscess of the tricuspid valve was found. From the right atrium, an infected fistula spread through the atrial wall and perforated the epicardial surface of the right auricle. Aside from the rare occurrence of these complications in patients affected with infective endocarditis, these cases are of clinical interest because they raise the problem of the need of greater sensitivity to the diagnosis of endocarditis and proper diagnostic approach.