scholarly journals P646 Cardiac tamponade as initial manifestation of small cell lung carcinoma

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M-C-T Murdila ◽  
B Zamfirescu ◽  
A C Popescu
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Vena Cava ◽  
Small Cell ◽  
Right Atrial ◽  
Thoracic Wall ◽  
Respiratory Variation ◽  
Initial Manifestation ◽  
Cell Lung Carcinoma ◽  
Large Pericardial Effusion

Abstract We report the case of a 69 years old woman, ex-smoker, with a history of hypertension, dyslipidemia, diabetes and right leg partial amputation after childhood osteomyelitis, presented at the emergency department for dyspnoea, posterior thoracic pain and progressive distention of the abdomen. She was tachycardic, slightly hypoxemic but normotensive. Electrocardiography: sinus tachycardia, normal axis, diffuse microvoltage and electric alternans. Chest X-ray showed enlarged cardiac silouhette, bilateral pleural effusion and upper right pulmonary lobe consolidation. Transthoracic echocardiography revealed large pericardial effusion, swinging heart, right atrial and right ventricular colapse, significant respiratory variation of transmitral and transtricuspidian flow, dilated inferior vena cava without respiratory variation, all suggesting cardiac tamponade. Computed tomography showed a mediastinal and pulmonary mass in the upper right pulmonary lobe, invading the posterior right thoracic wall and multiple mediastinal voluminous lymphadenopaty and ascites. She became hypotensive and was transferred to a tertiary hospital for urgent drainage of pericardial effusion. Over 1200 mL of serohematic fluid was evacuated with the removal of the drainage catheter in the following 48 hours. A biopsy was performed through bronchoscopy and small cell carcinoma of the lung was diagnosed. Considering the advanced stage of the carcinoma the option of pallative treatment was pursued. Discussions Chronic accumulation of large amounts of pericardial fluid is well tolerated, especially in patients that have limited physical activity. Ecocardiography allows early detection of cardiac tamponade. Development of cardiac tamponade in the evolution of malignancy confers a poor prognosis. The particularity of the case Cardiac tamponade as initial manifestation of lung cancer is a very rare occurrence and only limited data exist in literature. Conclusion Simultaneous presence of ascites, pleural and pericardial effusion should rise the suspicion of malignancy. Abstract P646 Figure.

Coronary sinus diameter to inferior vena cava diameter ratio in the diagnosis of cardiac tamponade: a novel approach

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E.H Ozcan Cetin ◽  
M.S Cetin ◽  
B Tekin Tak ◽  
F.A Ekizler ◽  
F Ozcan ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Cardiac Tamponade ◽  
Coronary Sinus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Area Under The Curve ◽  
Right Atrial ◽  
P Value ◽  
Large Pericardial Effusion

Abstract Background and aim Coronary sinus (CS) as an intrapericardial, low-pressure, thin-walled structure can be easily compressed in cardiac tamponade. Whereas, inferior vena cava (IVC) is an extrapericardial structure which dilates in tamponade as opposed to the response of CS. The inverse relationship between these two venous structures may augment their role in the evaluation of tamponade imaging. Therefore, we assessed the usefullness of computerized tomographic measures of CS diameter, and also CS to IVC ratio (CS/IVC) to predict tamponade in clinically stable patients with large pericardial effusion. Materials and methods 66 clinically stable patients who had large pericardial effusions, were included to the study. CS diameter was measured from the point at 1 cm proximal to the CS ostium11. IVC diameter was measured from the segment between its right atrial orifice and hepatic vein. Results Patients with tamponade had 40% smaller CS diameter (5.3±1.8 vs 8.8±2.6 mm p<0.001) and 35% lower CS/IVC ratio (20.7±5.5 vs 34.7±10.5% p<0.001).After adjusting with other parameters, only either CS diameter or CS/IVC ratio predicted tamponade respectively. (Nagelkerke r square value for CS diameter was 53.7% and 72.1% for CS/IVC ratio). 1 mm increase in CS diameter and 1% increase in CS/IVC ratio were associated with an increased odds ratio of 59% and 39% in predicting tamponade, respectively (p value <0.001).In ROC analysis, a cut of value of 6.85 mm for CS diameter, had 82.6% sensitivity and 83.7% specificity for predicting cardiac tamponade (Area under the curve 0.879, p<0.001). Additionally, a cut of value of 27% for CS / IVC ratio had 87.0% sensitivity and 86.0% specificity for predicting cardiac tamponade (Area under the curve 0.945, p<0.001). Conclusion The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals A Life-Threatening Presentation of Primary Small Cell Colorectal Non-Hodgkin Lymphoma as Cardiac Tamponade and Its Challenging Management

2021 ◽  
Author(s):  
Amr Elkammash ◽  
Mohamed Ayman Abdel-Hay ◽  
Saleh Kanaan ◽  
Mustafa Alsinan ◽  
Yosra Taha ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Hodgkin Lymphoma ◽  
Small Cell ◽  
Whole Body ◽  
Tumour Mass ◽  
Non Hodgkin Lymphoma ◽  
Large Pericardial Effusion ◽  
Life Threatening

Colorectal NHL is quite aggressive and rare, forming only less than 1% of all cases of colorectal cancer. The pericardium is an extremely rare first site of metastasis. Cardiac tamponade can be a life-threatening initial presentation. We report a 55-year-old lady who presented with severe shortness of breath, intermittent abdominal pain and altered bowel habits. She had low blood pressure with congested neck veins. Her echocardiogram showed pericardial and cardiac infiltration with tumour mass; a large pericardial effusion with signs of cardiac tamponade. There was no safe window for percutaneous drainage, and the patient was not physically fit for surgical drainage. A multidisciplinary approach was used to diagnose and manage the case involving a cardiologist, gastroenterologist, pathologist, radiologist and oncologist. CT scans of the whole body showed a large rectosigmoid mass infiltrating the uterus and adnexa. Flexible sigmoidoscopy showed a large bleeding mass at the rectosigmoid junction. The biopsy confirmed small cell non-Hodgkin lymphoma (NHL). Urgent three cycles of chemotherapy were commenced over a period of 5 weeks ( one cycle of CVP; two cycles of CHOP). The patient showed significant symptomatic improvement. A five-week follow-up echocardiogram showed that the d pericardial tumour had disappeared and only a small rim of pericardial effusion. Effusion did not recollect in her follow-up echocardiography. A year later, she was referred to the palliative care team due to the further spreading of her lymphoma. In conclusion, colorectal small cell NHL might initially present as cardiac tamponade. Urgent initiation of chemotherapy can be a treatment option whenever a drainage procedure is unsafe.

scholarly journals Use of ultrasound-measured internal jugular vein collapsibility index to determine static intracardiac pressures in patients with presumed pulmonary hypertension

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Raj Parikh ◽  
Matthew Spring ◽  
Janice Weinberg ◽  
Christine C. Reardon ◽  
Harrison W. Farber
Keyword(s):  
Pulmonary Hypertension ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Vena Cava ◽  
Right Atrial ◽  
Volume Status ◽  
Manual Compression ◽  
Respiratory Variation ◽  
Fluid Status ◽  
Collapsibility Index

Abstract Background Bedside ultrasound helps to estimate volume status in critically ill patients and has traditionally relied on diameter, respiratory variation, and collapsibility of the inferior vena cava (IVC) to reflect fluid status. We evaluated collapsibility of the internal jugular vein (IJ) with ultrasound and correlated it with concomitant right heart catheterization (RHC) measurements in patients with presumed pulmonary hypertension. Methods and results We studied 71 patients undergoing RHC for evaluation of pulmonary hypertension. Using two-dimensional ultrasound (Sonosite, Washington, USA), we measured the diameter of the IJ at rest, during respiratory variation, and during manual compression. Collapsibility index during respiration (respiratory CI) and during manual compression (compression CI) was calculated. We correlated mean right atrial pressure (mRAP) and pulmonary artery occlusion pressure (PAOP) defined by RHC measurements with respiratory and compression CI. A secondary goal was examining correlations between CI calculations and B-type natriuretic peptide (BNP) levels. Baseline characteristics demonstrated female predominance (n = 51; 71.8%), mean age 59.5 years, and BMI 27.3. There were significant correlations between decrease in compression CI and increase in both mRAP (Spearman: − 0.43; p value = 0.0002) and PAOP (Spearman: − 0.35; p value = 0.0027). In contrast, there was no significant correlation between respiratory CI and either mRAP (Spearman: − 0.14; p value = 0.35) or PAOP (Spearman:− 0.12; p value = 0.31). We also observed significant negative correlation between compression CI and BNP (Spearman: − 0.31; p value = 0.01) but not between respiratory CI and BNP (Spearman: − 0.12; p value = 0.35). Conclusion Increasing use of ultrasound has led to innovative techniques for estimating volume status. While prior ultrasound studies have used clinical parameters to estimate fluid status, our study used RHC measurements and demonstrated that compression CI potentially reflects directly measured mRAP and PAOP.

scholarly journals US Database Study of Clinical Burden and Unmet Need in Recurrent Pericarditis

2021 ◽  
Author(s):  
Allan Klein ◽  
Paul Cremer ◽  
Apostolos Kontzias ◽  
Muhammad Furqan ◽  
Ryan Tubman ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Treatment Response ◽  
Constrictive Pericarditis ◽  
Unmet Need ◽  
Recurrent Pericarditis ◽  
Pericardial Window ◽  
Clinical Burden ◽  
Large Pericardial Effusion ◽  
Multiple Recurrences

Background Patients with recurrent pericarditis (RP) may develop complications, multiple recurrences, or inadequate treatment response. This study aimed to characterize disease burden and unmet needs in RP. Methods and Results This retrospective US database analysis included newly diagnosed patients with RP with ≥24 months of continuous history following their first pericarditis episode. RP was defined as ≥2 pericarditis episodes ≥28 days apart. Some patients had ≥2 recurrences, while others had a single recurrence with a serious complication, ie, constrictive pericarditis, cardiac tamponade, or a large pericardial effusion with pericardiocentesis/pericardial window. Among these patients with multiple recurrences and/or complications, some had features relating to treatment history, including long‐term corticosteroid use (corticosteroids started within 30 days of flare, continuing ≥90 consecutive days) or inadequate treatment response (pericarditis recurring despite corticosteroids and/or colchicine, or other drugs [excluding NSAIDs] within 30 days of flare, or prior pericardiectomy). Patients (N=2096) had hypertension (60%), cardiomegaly (9%), congestive heart failure (17%), atrial fibrillation (16%), autoimmune diseases (18%), diabetes mellitus (21%), renal disease (20%), anxiety (21%), and depression (14%). Complications included pericardial effusion (50%), cardiac tamponade (9%), and constrictive pericarditis (4%). Pharmacotherapy included colchicine (51%), NSAIDs (40%), and corticosteroids (30%), often in combination. This study estimates 37 000 US patients with RP; incidence was 6.0/100 000/year (95% CI, 5.6‒6.3), and prevalence was 11.2/100 000 (95% CI, 10.6‒11.7). Conclusions Patients with RP may have multiple recurrences and/or complications, often because of inadequate treatment response and persistent underlying disease. Corticosteroid use is frequent despite known side‐effect risks, potentially exacerbated by prevalent comorbidities. Substantial clinical burden and lack of effective treatments underscore the high unmet need.

Experimental cardiac tamponade: correlation of pressure, flow velocity, and echocardiographic changes

1990 ◽  
Vol 69 (3) ◽  
pp. 924-931 ◽  
Author(s):  
M. L. Cohen
Keyword(s):  
Cardiac Tamponade ◽  
Flow Velocity ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Diastolic Flow ◽  
Ventricular Filling

Seven episodes of experimental cardiac tamponade were induced in five anesthetized closed-chest dogs. Simultaneous pericardial and intracavitary pressures were synchronized with superior vena caval and transvalvular pulsed-Doppler flow tracings. The earliest indication of tamponade was the development of a negative transmural right atrial pressure that occurred during early ventricular diastole and was associated with echocardiographic evidence of right atrial collapse. This was also associated with reversal of diastolic flow in the superior vena cava and with diminished early diastolic flow velocity across the tricuspid as well as the mitral valve. During more advanced cardiac tamponade, the transmural right atrial pressure became negative during both early and late ventricular diastole as well as during isovolumic ventricular systole. This was associated with a disappearance of early diastolic ventricular filling and right ventricular diastolic collapse as observed on two-dimensional echocardiography. In hypotensive cardiac tamponade (cardiac output diminished by 70%), the decreased transmural right atrial pressure that developed during ventricular systole was accompanied by diminished antegrade flow in the superior vena cava. In advanced and hypotensive tamponade, ventricular filling occurred mainly during atrial contraction.

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.

Modified Fontan Procedure with the Simultaneous Bidirectional Cavopulmonary Shunt

1995 ◽  
Vol 3 (1) ◽  
pp. 29-34
Author(s):  
Kim Yong Jin ◽  
Jun Tae Gook ◽  
Lee Jeong Ryul ◽  
Rho Joon Ryang ◽  
Suh Kyung Phill
Keyword(s):  
Pericardial Effusion ◽  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Vena Cava ◽  
Right Atrial ◽  
Postoperative Arrhythmia ◽  
Bidirectional Cavopulmonary Shunt ◽  
Group 2 ◽  
Cavopulmonary Shunt ◽  
Group 1

We reviewed our experience of 56 patients from 1989 to 1992 who underwent a modified Fontan procedure and a bidirectional cavopulmonary shunt simultaneously. There were 39 male and 17 female patients and their weight ranged from 6.54 to 29kg (mean weight 13.58 ± 3.96kg). Patient age ranged from 16 to 135 months (mean age 42.8 ± 3.7 months). Diagnoses included single ventricle in 29, tricuspid atresia in 11, double outlet of right ventricle in 10, hypoplastic left heart syndrome in 4, and pulmonary atresia with intact ventricular septum in 2 patients. The techniques of inferior vena cava to pulmonary artery (IVC-PA) connection were anastomosis of proximal superior vena cava (SVC) to pulmonary artery (PA) in 27 (group 1), direct atriopulmonary anastomosis with roof formation in 29 patients (group 2). There were significant differences in postoperative 1-hour right atrial (RA) pressure and period of chest tube drainage between group 1 and group 2. The early mortality was 12.5% (7/56), and 2 late deaths (4.1%) occurred with a mean follow-up period of 22.4 months. Risk factors for the late postoperative arrhythmia were immediate postoperative arrhythmia and prolonged pleuro-pericardial effusion. Direct connection of the remaining proximal SVC to PA with the bidirectional cavopulmonary shunt may have less pleuro-pericardial effusion and late arrhythmia than atriopulmonary anastomosis.

Sign in / Sign up

Export Citation Format

Share Document