An unusual presentation of cardiac tamponade

A case of pericardial effusion with tamponade that presented as an acute abdomen is described.     

超声引导下心包置管在创伤性心包压塞中的应用

目的探讨心包置管在治疗创伤性心包压塞中的应用价值. 方法 1998年3月～2003年9月,我们对9例创伤性心包压塞在超声引导下穿刺积血心包,置入导管,通过导管抽出心包积血,然后及时引流心包内出血. 结果置管引流后,病人的压塞症状明显好转.4例在引流4～8 h内行心脏修补术,2例创伤好转后择期手术,2例引流后痊愈,1例因颅脑创伤严重而死亡. 结论该方法安全可靠,能迅速缓解创伤性心包压塞症状,为心脏修补手术创造较好的条件和较充分的时间,部分病人可以避免手术.     

Central venous catheterization and fatal cardiac tamponade

Cardiac tamponade is a poorly recognized complication of centralvenous catheterization associated with a high mortality. Wepresent a case of fatal cardiac tamponade after intra- pericardialinfusion of total parenteral nutrition in a patient who hadtwo central venous catheters. We suggest that catheter tip positionshould always be confirmed before use of a catheter. Tamponadeshould be suspected in a patient who deteriorates when a centralvenous catheter is used and resuscitation via the catheter shouldbe avoided. Br J Anaesth 2001; 87: 298–302     

Cardiac tamponade: An unusual complication of ventriculo-atrial drainage of hydrocephalus

This is a report of a case of cardiac tamponade secondary to perforation of the myocardium by the introduction of a catheter on a stylet during revision of a ventriculo-atrial shunt.     

Cardiac tamponade masquerading as headache: A diagnostic conundrum

Cardiac tamponade and its protean presentations are well documented. Tamponade presenting after recent cardiac surgery in a patient on anticoagulation is not unknown. However, severe headache as a presenting feature of tamponade is not documented. We describe how one can be misled into investigating causes of headache while the real cause, tamponade, lies hidden.     

Cardiac tamponade as a terminal event in the hemolytic uremic syndrome in childhood

The case of a 6-year-old Inuit female with the epidemic form of hemolytic uremic syndrome (HUS) with myocardial involvement and probable cardiac tamponade is presented. This case illustrates the multisystemic nature of the syndrome, and to our knowledge, cardiac tamponate as a probable terminal event in HUS has not been reported previously.     

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.     

心脏直视手术后延迟性心包填塞的诊治分析

报告624例体外循环心脏直视手术患者中，6例术后发生延迟性心包填塞（DelayedCardiacTamponade，DCT）。分别发生于手术后9～71天。5例为瓣膜置换患者，1例发生在房间隔缺损修补术后。治愈5例，死亡1例。发病率和死亡率分别为0．96％（6／624）和16．7％（1／6）。认为心脏手术1周后患者出现低心排和充血性心衰时，要高度怀疑DCT，特别是正在接受抗凝治疗和内科治疗低心排和心衰不见改善时，应立即进行超声心动图检查。超声心动图检查对DCT的诊断具有重要价值。一旦DCT诊断成立，应及时手术治疗。     

Working Capacity and Cardiopulmonary Function After Extensive Lung Resections

Twelve patients were investigated 7–168 months after pneumonectomy. Two of them had also undergone resection of a segment of the remaining lung. The follow-up included studies of working capacity, static and dynamic lung volumes, alveolar gas exchange, diffusing capacity, blood gases and central haemodynamics with right heart catheterization. The working capacity was markedly reduced, limited by dyspnoea in 10/12 patients. The dyspnoea was related to reduced static and dynamic lung volumes (50% of normal). The diffusing capacity of the remaining lung was half of that predicted for two lungs from total haemoglobin and age and the transfer capacity of the lungs for oxygen was loaded to its maximum even at submaximal loads, resulting in a decrease in arterial oxygen tension and saturation and an increase in the alveolo-arterial oxygen tension difference. The central circulation was hypokinetic at submaximal loads and the stroke volume was small. The reduction in working capacity was caused by a number of coacting factors, inactivity, reduced lung function and small stroke volume. It was not possible from the present investigation to single out any of these factors as the main cause of dyspnoea during exercise and thereby the reduced working capacity.     

Acute pericardial tamponade complicating spinal surgery in a child with Duchenne muscular dystrophy

Summary A hitherto unrecognised problem of pericardial tamponade complicating spinal surgery in a child with Duchenne muscular dystrophy is reported in this paper.     

宫腔填塞术联合欣母沛治疗剖宫产产后出血18例临床观察

目的：探讨子宫腔填塞纱条联合欣母沛治疗剖宫产产后出血的临床疗效。方法36例剖宫产产后出血患者随机分为对照组和治疗组各18例，对照组采用按摩子宫、注射催产素、舌下含服米索前列醇等治疗，治疗组在对照组的基础上联合欣母沛、子宫腔填塞纱条治疗，比较两组的治疗效果，手术时间及产后2、24h出血量。结果对照组的有效率为72.2%，治疗组的有效率为94.4%，治疗组的有效率显著高于对照组，差异有统计学意义（P＜0.05）。治疗组的手术时间明显短于对照组，差异有统计学意义（P＜0.05）。治疗组产后2、24h出血量均显著少于对照组，差异有高度统计学意义（P＜0.01）。结论欣母沛联合子宫腔填塞纱条是治疗剖宫产产后出血的一种有效方法。     

Lymphatic cardiac tamponade after open-heart surgery with liver dysfunction

A 46-year-old female with alcoholic liver dysfunction was admitted for mitral regurgitation due to infective endocarditis. She underwent mitral valvuloplasty and resection of the vegetation without complication. After removal of the chest tube, late cardiac tamponade occurred and subsequently recurred. On the 64th day after mitral valvuloplasty, we performed redo median sternotomy with small laparotomy trying to reveal and repair injured lymphatic vessels in the pericardial space and successfully cured the leakage of lymph. The post reoperative course was uneventful and the patient was discharged 20 days after reoperation. We review a rare complication of recurrent cardiac tamponade of lymphatic leakage associated with liver dysfunction.     

Primary cardiac angiosarcoma: presenting with cardiac tamponade followed by cerebral hemorrhage with brain metastases

A 49-year-old man presented with palpitation and shortness of breath. He was seen to have a massive pleural and pericardial effusion on radiography and echocardiography. Computed tomography (CT) scanning showed that cardiac tumors arose from the right atrium with epicardial and endocardial extension. Pathology examination of samples at pericardiotomy revealed them to be angiosarcoma. Two days after the surgery, he developed left hemiparesis. CT scans showed a large cerebral hemorrhage on the right temporal lobe with midline shift by brain metastases. He died 37 days after the surgery. At autopsy, he had metastases in the brain, multiple bones, and soft tissues but no lung or left-side heart involvement. Primary cardiac angiosarcoma is rare, and mostly arises from the right side of the heart. Common metastatic sites are the lungs and liver. There are only a few reports of brain metastases. In conclusion, this is a rare report of cardiac angiosarcoma presenting with pericardial tamponade. There were rapid brain and multiple bone metastases but no lung or left-side heart lesions.     

Multiple organ dysfunction due to a rare complication of Nuss procedure for pectus excavatum: A case report

A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department. With organ function supportive treatment, the etiology was finally identified to be a bone spur located at the inner border of the left costa due to repeated friction between the implanted steel bar and the rib, which damaged the heart repeatedly and induced the consequent acute cardiac tamponade. After operation, the patient was successfully managed and discharged. Follow-ups till three years indicated a good recovery.     

Angiosarcoma causing cardiac rupture

We report the 7th known case in the literature of cardiac angiosarcoma resulting in cardiac rupture. A 34-year-old woman was admitted presenting chest pain and pericardial effusion. After the patient had been treated for 3 months under the diagnosis of pericarditis of unknown etiology, she became hypotensive. Doppler echocardiography showed increased pericardial effusion and a communication between the right atrium and the pericardial cavity. An emergency operation was undertaken to drain the effusion and explore the etiology. We found the ruptured right atrium and the irregularly shaped tumor extending from the pericardium near the inferior caval vein to the right ventricle. There was no apparent tumor on the right atrium, but its wall was extensively thin, which we replaced with autologous pericardium. The patient died on the 44th postoperative day. Clinical diagnosis of cardiac angiosarcoma is usually very difficult. If Doppler echocardiography demonstrates pericardial effusion and find a ruptured right atrium with or without mass formation, we should suspect cardiac angiosarcoma.