Right atrial mass presenting as cardiac tamponade

Intracavitary tumors such as angiosarcomas are prone to embolize, and occlude valves and vessels. Intramyocardial tumors cause cardiac failure and arrhythmias. Pericardial tumors cause effusions which result in tamponade. It is very rare that an intracavitary tumor presents itself with a cardiac tamponade. A 32-year old woman presented to the emergency room with palpitation and shortness of breath. Her physical examination revealed pulsus paradoxus and jugular venous distention. The transthoracic echocardiography showed normal left ventricular function, and an intracavitary right atrial mass. As the patients clinical status deteriorated an emergency operation was performed. The hemorrhagic pericardial fluid was cytologically positive for malignant cells. Histopathological findings were indicative of an angiosarcoma.     

Primary pericardial mesothelioma presenting as pericardial constriction: a case report

A 19 year old man presented with a six month history of chest pain, dyspnoea, and lethargy and was found on an echocardiogram to have a dilated left ventricle with a small pericardial effusion. Ramipril and a course of steroids were tried but serial echocardiograms showed a persistently thickened pericardium and slowly developing features of constriction. On computed tomography, a large mediastinal mass encasing the heart, along with para-aortic and paratracheal lymphadenopathy, was found. Right heart catheter studies showed equal pressures in all four chambers. His deteriorating clinical condition led to a pericardiectomy. Histology confirmed primary pericardial mesothelioma. The patient died soon after surgery.     

Primary pericardial fibrosarcoma presenting as "near" cardiac tamponade

A 19-year-old male presented with fever, substernal pain, dyspnea, and distended neck veins. Diagnostic investigations, such as echocardiography and magnetic resonance imaging, provided evidence of a large mass within the pericardial sac, attached by a broad base to the parietal pericardium and lying along the right ventricular free wall. A partial pericardiectomy was performed to relieve the patient's symptoms, and histologic examination of a biopsy specimen showed features of a malignant, spindle cell, mesenchymal neoplasm. The patient underwent surgical treatment during which the tumor was found to infiltrate the anterior surface of the right ventricle. Histologically, the tumor was identified as a high-grade fibrosarcoma, and additional chemotherapy was given.     

Right atrial aneurysm: case report.

We report the case of a 49-year-old patient, with recent onset of fatigue, who was diagnosed with atrial fibrillation, which was cardioverted electrically. A diagnosis of right atrial aneurysm, with no other cardiac pathology, was made. An aneurysmectomy was performed. Both surgery and postoperative recovery were uneventful.     

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.     

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.     

Hydatic disease of the heart presenting with pericardial effusion. A case report

The authors report a rare case of multiple mediastinal hydatid cysts which ruptured in a 48 year old man who presented with a pericardial effusion. The diagnosis was confirmed by 2D echocardiography, completed by CT scan and magnetic resonance imaging. The patient was operated as a semi-emergency and the outcome was good. This case underlines the rare pericardial involvement and the severity of the complications of cardiac hydatid disease.     

Adenocarcinoma of the lung presenting with pericardial tamponade: report of a case and review of the literature

In a patient with cancer, a diagnosis of cardiac tamponade should be considered when there is dyspnea, cough, thready pulse or pulsus paradoxus, low systolic blood pressure, engorged neck veins, an enlarged cardiac silhouette, and total or ventricular electrical alternans. Immediate pericardiocentesis is indicated in such patients to avoid the risk of sudden death. A pericardial window should be created for more prolonged palliation of cardiac tamponade. Cytologic examination of the pericardial fluid often reveals malignant or highly suspect cells. Metastatic carcinomas from the lung and breast are the most common tumors that involve the heart when they spread in a retrograde fashion through the cardiac lymphatic system. Total pericardiectomy for the treatment of cardiac tamponade that is due to cancer is not generally advisable. Radiation therapy in the cardiac area with or without systemic chemotherapy is effective in decreasing the amount and the recurrence of neoplastic pericardial effusion.     

Right ventricular wall hematoma due to thrombolytic therapy presenting as cardiac tamponade: a case report and review of literature

Intramyocardial hematoma is an uncommon condition, most often occurring after myocardial infarction or chest trauma. A 54-year-old male patient with a large right ventricular wall hematoma who presented with cardiac tamponade three days after acute inferoposterior myocardial infarction and thrombolysis is described. This is the first report of intramyocardial hematoma related to thrombolytic therapy. The patient was managed conservatively with complete resolution of the right ventricular hematoma.     

Right atrial thrombus masquerading as intracardiac cyst: a case report

Intracardiac cystic lesions are rare. Hydatid disease, blood cysts and bronchogenic cysts in various chambers of the heart have been reported. Right atrial thrombus presenting as a cystic lesion on echocardiogram has not been reported. We describe a patient with mitral regurgitation in atrial fibrillation with a right atrial cyst, which was found to be a cavitating thrombus.     

Lyme disease presenting as infarction pain. A case report

Lyme's disease is a multi-system condition due to infection with a spirochete (Borrelia Burgdorferi), transmitted by a tick. Cardiac involvement, which is not systematic, usually presents with transient atrioventricular block of varying degree. The authors describe an unusual presentation of the cardiac involvement of Lyme's disease with chest pain resembling an acute coronary syndrome in a 32 year old man. The characteristic skin lesion (erythema migrans), the positivity of IgM serology, the myocardial scintigraphic results and the negativity of the work-up of other causes of this pain led to a diagnosis of myocarditis, the outcome of which was favourable with treatment by amoxycillin (3 g/day, orally).     

Hepatic tuberculosis presenting as cholestatic jaundice. A case report.

We report three cases of hepatic tuberculosis with cholestatic jaundice. All three patients presented with cholestatic jaundice, anorexia, fever and weight loss. All had hepatomegaly. No biliary obstruction was detected. Two patients had evidence of extra hepatic tuberculosis but one had no such evidence. Diagnosis of hepatic tuberculosis was confirmed by liver biopsy. Little is known about tuberculous affecting the liver and the general belief is that it is a histopathological entity only, but these cases are a reminder of the unusual manifestation of a very common condition. All the cases recovered with anti-tuberculous treatment.