scholarly journals Primary Cardiac Burkitt Lymphoma Presenting with Abdominal Pain

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Dimitrios Tzachanis ◽  
Rajan Dewar ◽  
Katarina Luptakova ◽  
James D. Chang ◽  
Robin M. Joyce
Keyword(s):  
Abdominal Pain ◽  
Pericardial Effusion ◽  
Burkitt Lymphoma ◽  
Pericardial Fluid ◽  
Nuclear Chromatin ◽  
Epigastric Discomfort ◽  
Abdominal Bloating ◽  
Large Pericardial Effusion ◽  
Large Nucleolus

We describe the case of a 44-year-old woman with primary Burkitt lymphoma of the heart who presented with abdominal bloating and epigastric discomfort secondary to tamponade physiology caused by a large pericardial effusion. The pericardial fluid contained a large number of highly atypical lymphocytes with moderate basophilic cytoplasm, rare punched-out vacuoles, a vesicular nuclear chromatin, large nucleolus, and marginated chromatin that by FISH were positive for the 8;14 translocation. She had no other sites of disease. She was treated with four alternating cycles of modified CODOX-M and IVAC in combination with rituximab and remains in remission more than 5 years since diagnosis.

scholarly journals P1262 If anything can go wrong, it will: management of a pericardial effusion in a young patient

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J P Dias Ferreira Reis ◽  
T Mendonca ◽  
T Mano ◽  
G Portugal ◽  
P Silva Cunha ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pericardial Effusion ◽  
Accessory Pathway ◽  
Pericardial Fluid ◽  
Nucleic Acid Amplification ◽  
Right Atrial ◽  
Oral Steroid ◽  
Large Pericardial Effusion ◽  
Increased Risk ◽  
Oncologic Patients

Abstract Case Report A 25 year-old male patient with an unremarkable past medical history presented to the Emergency Department due to a hemodynamically stable wide complex tachycardia at 260bpm with no response to adenosine, which was successfully treated with synchronized electrical cardioversion. Post cardioversion EKG revealed a pre excitation pattern and the transthoracic echocardiogram showed a large pericardial effusion with diastolic right atrial collapse. The patient was admitted in the Cardiology Department for emergent pericardiocentesis and further investigation. A total of 800 mL of bloody pericardial fluid was removed, compatible with an exudate, but fluid culture and cytology were inconclusive. Due to a rapid reaccumulation of pericardial fluid, the patient underwent a pericardial window, after which he developed an intractable pleuritic thoracalgia, refractory to the combination of ibuprofen, colchicine and oral steroid, despite the resolution of the pericardial effusion. He was also submitted to an electrophysiologic study with successful ablation of a right sided accessory pathway. Analysis of the pericardial fluid and biopsy were inconclusive once again, including a low level of adenosine deaminase and negative acid-fast bacilli test and nucleic acid amplification test for Mycobacterium tuberculosis. The patient was afebrile and denied any constitutional symptoms or relevant epidemiological context. The remainder etiological study was unremarkable, with the exception of fluctuating antibody titers for adenovirus, Borrelia burgdorferi and Mycoplasma pneumoniae, which were interpreted as a result of cross-reactivity. Nevertheless, a course of 21 days of doxycycline was tried without any significant improvement. Thoracic-abdominal-pelvic CT and PET scan were normal. Direct inoculation in guinea pig led to positive results for Mycobacterium tuberculosis and antituberculous therapy was started. Despite pathogen directed antibiotic treatment, there was no clinical improvement and the pericardial effusion gradually relapsed, evolving to cardiac tamponade requiring emergent drainage. Histologic examination of pericardial fragments finally revealed massive infiltration by an undifferentiated malignant tumor compatible with a malignant epithelioid hemangioendothelioma. Due to the patient’s poor performance status and rapidly deteriorating clinical course, it was decided not to start chemotherapy. The patient eventually died, 6 months after his admission to the ED and 2 weeks after the neoplasm’s diagnosis. Conclusion In regions with a high Tuberculosis incidence, there should be a high degree of suspicion for tuberculous pericarditis, especially in cases of recurrent pericardial effusion. Immunosuppressed individuals, such as oncologic patients, are at an increased risk for tuberculosis. The management of relapsing pericardial effusion remains a diagnostic challenge as described in this clinical case.

scholarly journals Pericardial Fluid in a COVID-19 Patient: Is It Exudate or Transudate?

2020 ◽  
Author(s):  
Hassan H Allam ◽  
Abdulhalim Jamal Kinsara ◽  
Tareq Tuaima ◽  
Shadwan Alfakeh
Keyword(s):  
Lactate Dehydrogenase ◽  
Pericardial Effusion ◽  
Pericardial Fluid ◽  
Case Description ◽  
Limited Information ◽  
Additional Insight ◽  
Laboratory Findings ◽  
Large Pericardial Effusion ◽  
Insight Into ◽  
High Lactate

Background: Very limited information is available on pericardial effusion as a complication of COVID-19 infection. There are no reports regarding pericardial fluid findings in COVID-19 patients. Case description: We describe a 41-year-old woman, with confirmed COVID-19, who presented with a large pericardial effusion. The pericardial fluid was drained. We present the laboratory findings to improve knowledge of this virus. Discussion: We believe this is the first such reported case. Findings suggested the fluid was exudative, with remarkably high lactate dehydrogenase and albumin levels. We hope our data provide additional insight into the diagnosis and therapeutic options for managing this infection.

scholarly journals Cardiac tamponade and massive pleural effusion in a young COVID-19-positive adult

2021 ◽  
Vol 14 (9) ◽  
pp. e244518
Author(s):  
Dilip Johny ◽  
Kodangala Subramanyam ◽  
Nandakishore Baikunje ◽  
Giridhar Belur Hosmane
Keyword(s):  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Low Voltage ◽  
Pericardial Fluid ◽  
Rare Presentation ◽  
Large Pericardial Effusion ◽  
Left Pleural Effusion ◽  
Dimensional Echocardiography ◽  
Cardiac Manifestations

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.

Abstract 17341: A 19-Year-Old Female with Recurrent Chylopericardium

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Cheng-Han Chen ◽  
Angela Kleiber ◽  
Christine Megerdichian ◽  
Gregg C Fonarow ◽  
Arnold S Baas
Keyword(s):  
Pericardial Effusion ◽  
Thoracic Duct ◽  
Correct Diagnosis ◽  
Pericardial Fluid ◽  
Shortness Of Breath ◽  
Pericardial Window ◽  
Percutaneous Embolization ◽  
Fluid Analysis ◽  
Large Pericardial Effusion ◽  
Work Up

A 19-year-old female initially presented to an outside hospital with worsening shortness of breath over the course of hours. Echocardiogram revealed a large pericardial effusion with tamponade physiology. An urgent pericardiocentesis followed by a pericardial window yielded 600cc of cloudy fluid, and work-up for infectious, auto-immune, and malignant etiologies was unrevealing. She was discharged home, but over the next four weeks developed a repeat pericardial effusion requiring another pericardiocentesis yielding 750cc of cloudy fluid. She then presented to our hospital two weeks later with progressive shortness of breath. Echocardiogram revealed a large pericardial effusion with evidence of early tamponade physiology. Our differential diagnosis for her recurrent pericardial effusions remained broad, with infectious and malignant etiologies at the top of consideration. Computed tomography of the chest demonstrated the pericardial effusion and mild mediastinal adenopathy. She underwent another pericardial window with removal of 600cc of milky fluid, and fluid analysis was notable for a markedly elevated triglyceride level consistent with a diagnosis of chylopericardium. Work-up for malignancy as an etiology for recurrent chylopericardium was negative. A percutaneous lymphangiogram was then performed, which revealed a significant leak in the superior aspect of the thoracic duct into the pericardial space. Percutaneous embolization of the thoracic duct was performed using detachable coils along with embolic glue, resulting in resolution of the leak. She has since remained asymptomatic, and follow-up echocardiogram was without recurrence of any pericardial effusion. This case of idiopathic recurrent chylopericardium as the cause for pericardial effusion represents a rare manifestation of a relatively common cardiac condition. It illustrates the importance of routine pericardial fluid analysis for triglycerides, as this led to her correct diagnosis of chylopericardium. The use of percutaneous thoracic duct embolization has only recently been reported as a novel approach for treatment of chylous leak, and may emerge as a useful alternative to surgery for recurrent chylopericardium.

scholarly journals Cardiac manifestations of tuberculosis in a tertiary care center of Nepal

2018 ◽  
Vol 15 (1) ◽  
pp. 35-38
Author(s):  
Smriti Shakya ◽  
Sunil Chandra Jha
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Care Center ◽  
Tertiary Care ◽  
Pericardial Fluid ◽  
Age Group ◽  
Acute Pericarditis ◽  
Old Patients ◽  
Large Pericardial Effusion ◽  
2D Echocardiography

Background and Aims: Tuberculosis remains an important etiological cause of pericarditis and pericardial effusion in developing countries like Nepal. The objective of this study is to identify the various presentations of tuberculous pericarditis along with the demographic profile in our context and their short term outcome.Methods: We studied 53 patients from September 2015 to August 2017 regardless of age and gender who presented to Manmohan Cardiothoracic Vascular and Transplant Center with pericarditis of tubercular origin. The various manifestations of the disease were categorized with 2D echocardiography. Pericardiocentesis was done in patients with large pericardial effusion especially in cardiac tamponade and pericardiectomy done in chronic constrictive pericarditis(CCP). Antitubercular therapy with steroids was instituted.Results: Out of 53 patients, 62% were male and 38% were female. The ages ranged from 6-71 years (42±19.5). Twenty three percent of patients were from the age group 61-70yrs, 20% seen in age group 21-30 years, 8% in less than 10 yrs and 2% in above 70yrs old patients. The most common manifestation seen was large pericardial effusion (32%), followed by CCP (22.6%), 19% presented in cardiac tamponade, 2% had pyopericardium, 2% had perimyocarditis and 4% had acute pericarditis. Adenosine deaminase (ADA) was positive in 75% of the cases when pericardial fluid was tapped. Two patients developed CCP during follow up. Two patients succumbed to death during hospital stay.Conclusion: A high index of suspicion of tubercular pericarditis is inevitable in our settings where other sophisticated investigations are still lacking.Nepalese Heart Journal 2018; 15(1) 35-38

scholarly journals Pericardial effusion as first presentation of disseminated non-Hodgkin’s lymphoma

2018 ◽  
pp. bcr-2018-225926 ◽  
Author(s):  
Lauren Christina Giudicatti ◽  
Melita Cirillo ◽  
Benjamin King
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Involvement ◽  
Palliative Chemotherapy ◽  
Conduction Block ◽  
B Cell Lymphoma ◽  
Pericardial Fluid ◽  
Pleuritic Chest Pain ◽  
Large B Cell Lymphoma ◽  
Large Pericardial Effusion ◽  
Positron Emission

A 46-year-old woman with quiescent lupus presented with worsening pleuritic chest pain and dyspnoea. Bedside echocardiogram confirmed large pericardial effusion with cardiac tamponade. Emergency bedside pericardiocentesis was performed. Pericardial fluid cytology confirmed diffuse large B cell lymphoma, stage four on positron emission tomography. Conventional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy achieved good response in all sites except the pericardium. Progressive cardiac involvement was complicated by atrioventricular conduction block requiring permanent pacemaker. Second-line palliative chemotherapy was performed.

Pericardial involvement in neoplastic disease

ESC CardioMed ◽  
2018 ◽  
pp. 1585-1587
Author(s):  
Dor Lotan ◽  
Yehuda Adler
Keyword(s):  
Pericardial Effusion ◽  
Gold Standard ◽  
Diagnostic Tests ◽  
Poor Prognosis ◽  
Pericardial Fluid ◽  
Neoplastic Disease ◽  
Large Pericardial Effusion ◽  
Life Threatening ◽  
Pericardial Involvement

Pericardial layer involvement in cancer patients is not rare and varies from malignant processes to therapy side effects (e.g. local irradiation). Primary pericardial masses are rare—mesothelioma being the most common—and have a poor prognosis. Secondary metastases to the pericardium form the majority of pericardial neoplasms with lung carcinoma being the most prevalent. Patients with neoplastic involvement of the pericardium may present with pericardial effusion that can deteriorate to life-threatening cardiac tamponade which carries a very poor prognosis. Diagnosis of neoplastic involvement of the pericardium is of clinical significant but carries diagnostic challenges. Symptoms such as dyspnoea or chest pain are not specific and diagnosis is usually incidental through imaging studies or diagnosed at a late stage when large effusions are present. In cases of large pericardial effusion or repetitive effusion with unknown aetiology, further investigation is advised by drainage of pericardial fluid (pericardiocentesis) for diagnostic purposes and relief of symptoms. Different diagnostic tests performed on pericardial fluid exist in practice with cytology and pathology as the gold standard, but may fail to detect neoplastic cells in some cases. Although carrying a poor prognosis, pericardial investigation and treatment should be considered in patients with suspected pericardial involvement and may prolong and improve quality of life, especially if detected early.

scholarly journals Imatinib-induced pericardial effusion in a child

2019 ◽  
Vol 12 (9) ◽  
pp. e229975 ◽  
Author(s):  
Charlotte Terry ◽  
Pascale Avery ◽  
Sarah Morton ◽  
Jon Aron
Keyword(s):  
Differential Diagnosis ◽  
Pericardial Effusion ◽  
Kinase Inhibitor ◽  
Pericardial Fluid ◽  
Ultrasound Scan ◽  
Shortness Of Breath ◽  
Graft Versus Host ◽  
Fluid Analysis ◽  
Large Pericardial Effusion

A 12-year-old boy presented with central chest pain, shortness of breath and type 1 respiratory failure. He had a background of graft versus host disease (GvHD), which was currently managed with imatinib therapy. A focused bedside ultrasound scan was performed revealing a large pericardial effusion. The child was referred to a tertiary paediatric cardiology centre where he underwent emergency pericardiocentesis, draining a total of 800 mL of pericardial fluid. Fluid analysis excluded infection, and with no other concerns for a GvHD flare the diagnosis of an imatinib-induced pericardial effusion was made. On terminating the therapy, the pericardial collection did not reaccumulate. Tyrosine kinase inhibitor-induced pericardial and/or pleural effusion should be considered as a differential diagnosis in paediatric patients on this therapy presenting in a similar manner.

The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

2016 ◽  
Vol 19 (1) ◽  
pp. 023 ◽  
Author(s):  
Mehmet Yildirim ◽  
Recep Ustaalioglu ◽  
Murat Erkan ◽  
Bala Basak Oven Ustaalioglu ◽  
Hatice Demirbag ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Thoracoscopic Surgery ◽  
Pericardial Tamponade ◽  
Pericardial Fluid ◽  
Pathological Examination ◽  
Common Disease ◽  
Pericardial Window ◽  
Surgical Interventions ◽  
History Of ◽  
Recurrent Pericardial Effusion

<strong>Background:</strong> Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. <br /><strong>Methods:</strong> We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. <br /><strong>Results:</strong> Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. <br /><strong>Conclusion:</strong> Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

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