scholarly journals Effusive-constrictive cholesterol pericarditis: a case report

2020 ◽  
Author(s):  
Simran Shergill ◽  
James Davies ◽  
Naomi Cairns
Keyword(s):  
Venous Pressure ◽  
Adhesion Formation ◽  
Signs And Symptoms ◽  
Cholesterol Concentration ◽  
Crystal Formation ◽  
Pericardial Window ◽  
Pericardial Disease ◽  
Cholesterol Crystals ◽  
Fluid Analysis ◽  
Ankle Oedema

Abstract Background Cholesterol pericarditis (CP) remains a rare pericardial disease characterized by chronic pericardial effusions with high cholesterol concentrations with or without the formation of cholesterol crystals. Effusions are often large and can cause ventricular compression and subsequent pericardial adhesion formation. CP can be idiopathic but has associations with rheumatoid arthritis (RA), tuberculosis and hypothyroidism. Case summary We present a case of a 72-year-old male with a background of seropositive RA with a finding of an incidental pericardial effusion on computed tomography thorax abdomen and pelvis. Transthoracic echocardiogram demonstrated a large effusion with echocardiographic features of tamponade. On review, he was breathless with a raised venous pressure, bilateral ankle oedema, and pulsus paradoxus was present. Pericardial drainage was performed with fluid analysis demonstrating a cholesterol concentration of 8.3 mmol/L and numerous cholesterol crystal formation. Interval imaging demonstrated recurrence of the effusion with pericardial thickening and progressive constriction. He remained asymptomatic and underwent a successful pericardial window. At present, he is under close clinical outpatient surveillance with symptoms guiding a future pericardiectomy if warranted. Discussion CP can present as an emergent situation with signs and symptoms of acute heart failure with prompt pericardiocentesis required in cases of clinical tamponade. However, the disease course is often one of chronicity with relapsing large effusions that tend to recur following drainage, with the development of pericardial constriction necessitating pericardiectomy for definitive management.

scholarly journals Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Christina Walker ◽  
Vincent Peyko ◽  
Charles Farrell ◽  
Jeanine Awad-Spirtos ◽  
Matthew Adamo ◽  
...  
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Case Reports ◽  
Healthy Woman ◽  
Signs And Symptoms ◽  
Rare Presentation ◽  
Pericardial Window ◽  
Acute Pericarditis ◽  
Novel Coronavirus

Abstract Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.

scholarly journals Tympano-Mastoid Cholesterol Granuloma: Case Report and Review of the Literature

2020 ◽  
Vol 13 ◽  
pp. 117954762095872
Author(s):  
Annalisa Pace ◽  
Giannicola Iannella ◽  
Mara Riminucci ◽  
Alessandro Corsi ◽  
Giuseppe Magliulo
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Foreign Body Giant Cell ◽  
Cholesterol Granuloma ◽  
Review Of The Literature ◽  
Cell Reaction ◽  
Cholesterol Crystals ◽  
Specific Sign

Cholesterol granuloma (CG) is a rare condition histological consisting of a foreign body, giant cell reaction to cholesterol crystals and haemosiderin derived from the ruptured of the erythrocytes. A 25-year-old man came to our Department presenting signs and symptoms of tympano-mastoid cholesterol granuloma. He showed all the specific sign and symptoms of the disease. However, considering the lack of literature regarding TMCG, this study was performed with the aim of presenting the main characteristics of tympano-mastoid CG, describing the case report and reviewing the literature.

Plication of the Sapheno–Femoral Junction: Effects on Incompetence after Two Years

1991 ◽  
Vol 6 (3) ◽  
pp. 159-165 ◽  
Author(s):  
Giovanni V. Belcaro
Keyword(s):  
Coronary Artery ◽  
Saphenous Vein ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Signs And Symptoms ◽  
Long Term Results ◽  
Pressure Measurements ◽  
Venous Reflux ◽  
Long Saphenous Vein

Plication of the long saphenous vein at the sapheno–femoral junction (SFJ) is an alternative to flush ligation and stripping. This technique abolishes reflux at the SFJ without altering the vein; this may then be used for arterial surgery or coronary artery grafting. Candidates for plication were selected on the basis of ambulatory venous pressure measurements and duplex scanning. These tests indicate and quantify the degree of superficial venous incompetence. Plication of the SFJ reduces the calibre of the vein to 60–70% for a length of 1.5 cm, allowing the value cusps to close when flow in the femoral vein is reversed. In this study 20 limbs were evaluated (in 20 patients) 6, 12 and 24 months after plication. Venous reflux was significantly reduced and there was an improvement in signs and symptoms. Thus, SFJ plication seems to be an effective physiological alternative to flush ligation in some subjects. However, long-term results (> 5 years) must be still evaluated.

scholarly journals Comparison of early stage electrocardiographic, echocardiographic and histopathologic results of partial pericardiectomy and thoracoscopic pericardial window techniques in an animal model

2018 ◽  
Vol 68 (3) ◽  
pp. 331
Author(s):  
H. SALCI ◽  
M. KOCATURK ◽  
V. VOLKAN IPEK ◽  
M. BICER ◽  
Z. YILMAZ ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Early Stage ◽  
Visceral Pleura ◽  
Pericardial Window ◽  
Pericardial Disease ◽  
Group I ◽  
Small Complex ◽  
Window Technique ◽  
Significant Difference ◽  
Histopathological Results

This study aimed to compare early stage electrocardiographic (ECG), echocardiographic (ECHO) and histopathologic results of the pericardial surgery techniques. Partial pericardiectomy by lateral thoracotomy and thoracoscopic pericardial window techniques was performed under general anesthesia in goats (n=6), which were separated into two groups; partial pericardiectomy was performed in group I (GRI) (n=3) and thoracoscopic pericardial window was performed in group II (GRII) (n=3). ECG and ECHO examinations were performed pre- and postoperatively on days 1, 7 and 30. All experimental animals were sacrificed at the end of day 30 and macroscopic investigations were performed. Histopathological examinations were performed on the lung, visceral pleura, epicardium and myocardial tissues. ECG findings included sinus tachycardia, small complex QRS and T wave peak on day 1 in both groups., The left atrial and ventricular diameters as well as the stroke volume were lower on the 1st postoperative day in both groups. The stroke volume was lower on postoperative days 1 and 30 in GRII. The observed ejection fraction was lower in GRII and higher in GRI on postoperative day 30 compared with their baselines. Macroscopic and histopathological findings of the lung and heart tissues were more severe in GRI, but there was no meaningful variation in the epicardium or visceral pleura. There was no significant difference in the histopathological results between the groups. Although the thoracoscopic pericardial window technique seem less traumatic and better tolerated than partial pericardiectomy, our ECHO and histopathologic results indicate that both techniques can safely be performed by surgeons according to the pericardial disease indication.

Management of pericardial tamponade

2016 ◽  
Author(s):  
Santanu Biswas ◽  
John J. Frank
Keyword(s):  
Management Strategy ◽  
Venous Pressure ◽  
Optimal Choice ◽  
Pericardial Fluid ◽  
Pericardial Window ◽  
Fluid Removal ◽  
First Choice ◽  
Surgical Methods ◽  
Definitive Therapy ◽  
The Creation

Cardiac tamponade is an emergency, and definitive therapy is fluid removal by pericardiocentesis. In certain conditions, fluid removal is still the optimal choice, but a conservative approach using haemodialysis may be employed. Factors that influence the management strategy include evaluating the cause, providing haemodynamic support, and choosing the technique. Fluid resuscitation to maintain venous pressure and circulation may be beneficial up to a point, after which, tamponade may be aggravated. While inotropes have theoretical benefit, studies involving humans are few. Fluid removal strategies are broadly grouped into percutaneous and surgical methods. In most cases, the percutaneous approach is favoured. However, surgery is typically the first choice in blunt trauma or in proximal aortic dissection. While the safety of percutaneous methods is well established, imaging guidance is needed to avoid common complications associated with a blind technique. The proper management strategy should also minimize effusion recurrence, common methods to do so include placement of a drainage catheter, infusion of a sclerosing agent, and a balloon pericardiotomy procedure. Surgical methods for removal of pericardial fluid include the creation pericardial window, insertion of a pericardioperitoneal shunt, and pericardiectomy. The creation of a pericardial window and pericardioperitoneal shunt are safe, but pericardiectomy is associated with increased morbidity. After fluid removal has been completed, the patient should be placed in a unit that is both familiar with the signs of tamponade and has the capacity to quickly treat a significant effusion if it recurs.

scholarly journals Diagnostic and therapeutic aspects of hemiplegic migraine

2020 ◽  
Vol 91 (7) ◽  
pp. 764-771 ◽  
Author(s):  
Vincenzo Di Stefano ◽  
Marianna Gabriella Rispoli ◽  
Noemi Pellegrino ◽  
Alessandro Graziosi ◽  
Eleonora Rotondo ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Dominant Mode ◽  
Speech Impairment ◽  
Hemiplegic Migraine ◽  
Cerebrospinal Fluid Analysis ◽  
Motor Weakness ◽  
Fluid Analysis ◽  
Randomised Controlled

Hemiplegic migraine (HM) is a clinically and genetically heterogeneous condition with attacks of headache and motor weakness which may be associated with impaired consciousness, cerebellar ataxia and intellectual disability. Motor symptoms usually last <72 hours and are associated with visual or sensory manifestations, speech impairment or brainstem aura. HM can occur as a sporadic HM or familiar HM with an autosomal dominant mode of inheritance. Mutations in CACNA1A, ATP1A2 and SCN1A encoding proteins involved in ion transport are implicated. The pathophysiology of HM is close to the process of typical migraine with aura, but appearing with a lower threshold and more severity. We reviewed epidemiology, clinical presentation, diagnostic assessment, differential diagnosis and treatment of HM to offer the best evidence of this rare condition. The differential diagnosis of HM is broad, including other types of migraine and any condition that can cause transitory neurological signs and symptoms. Neuroimaging, cerebrospinal fluid analysis and electroencephalography are useful, but the diagnosis is clinical with a genetic confirmation. The management relies on the control of triggering factors and even hospitalisation in case of long-lasting auras. As HM is a rare condition, there are no randomised controlled trials, but the evidence for the treatment comes from small studies.

A Reassessment of the Role of Perforating Veins in Chronic Venous Insufficiency

1990 ◽  
Vol 5 (2) ◽  
pp. 85-94 ◽  
Author(s):  
G.M. McMullin ◽  
H.J. Scott ◽  
P.D. Coleridge Smith ◽  
J.H. Scurr
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Reverse Flow ◽  
Venous Pressure ◽  
Signs And Symptoms ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Perforating Veins ◽  
Clinically Normal

Ambulatory venous hypertension is closely associated with the signs and symptoms of venous disease. It has been shown that reverse flow of blood in the superficial and deep veins is responsible. The pressure derangement caused by incompetence of perforating veins has not been established. The present study documents the pressure disturbances caused by incompetence in each of the three compartments of the venous system, the deep, the superficial and the perforating veins. In total 90 limbs of 49 patients with chronic venous insufficiency were examined and classified by duplex scanning and ascending venography. Ambulatory venous pressure measurements were performed on all 90 limbs and a venous sufficiency index (VSI) for each limb calculated from the percentage drop in pressure and refilling time. VSI was lowest in the group with deep vein incompetence (median 0.9, range 0–36.9), intermediate in the groups with superficial vein incompetence (median 7.6, range 0.4–59) and with incompetent perforating veins (median 14.6, range 0.4–35.7) and highest in the group with normal veins (median 41.7, range 3.5–87.5). The association of symptoms and VSI was also examined. The lower the VSI the more severe were the clinical symptoms and all ulcerated limbs had a VSI < 20. However a number of clinically normal limbs were also found to have low values of VSI.

scholarly journals Perforation of the Right Ventricle Induced by Pulmonary Artery Catheter at Induction of Anesthesia for the Surgery for Liver Transplantation: A Case Report and Reviewed of Literature

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Maria Auxiliadora-Martins ◽  
Erick Apinagés dos Santos ◽  
Daniel Adans Wenzinger ◽  
Gil Cezar Alkmim-Teixeira ◽  
Gerardo Cristino de M. Neto ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Artery Catheter ◽  
Venous Pressure ◽  
Pulseless Electrical Activity ◽  
Technical Difficulty ◽  
Meld Score ◽  
Pericardial Window ◽  
The Right

We report a case of a 45-year-old male patient diagnosed with liver cirrhosis by hepatitis C and alcohol, with a Child-Pugh score C and a model for end-stage liver disease (MELD) score of 27, and submitted to liver transplantation. The subject underwent insertion of the pulmonary artery catheter (PAC) in the right internal jugular vein, with technical difficulty concerning catheter advance. There was sudden hypotension, increase in central venous pressure (CVP), and decrease inSvO215 minutes after the PAC had been inserted, followed by cardiorespiratory arrest in pulseless electrical activity (PEA), which was promptly assisted with resuscitation. Pericardiocentesis was performed without success, so the individual was subjected to a subxiphoid pericardial window, which led to output of large amounts of blood as well as PEA reversal to sinus rhythm. Sternotomy was performed; rupture of the apex of the right ventricle (RV) was detected, and suture of the site was accomplished. After hemodynamic stabilization, the patient was transferred to the ICU, where he developed septic shock and, despite adequate therapy, died on the eighteenth day after ICU admission.

scholarly journals Tubercular Pericardial Effusion Presenting as Cardiac Tamponade

2021 ◽  
Vol 18 (4) ◽  
pp. 795-797
Author(s):  
Alok Pradhan ◽  
Ranjit Babu Jasaraj ◽  
Bhesh Raj Karki ◽  
Anish Joshi
Keyword(s):  
Chest Pain ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Adenosine Deaminase ◽  
Heart Sound ◽  
Venous Pressure ◽  
Pericardial Fluid ◽  
Jugular Venous Pressure ◽  
Fluid Analysis ◽  
Extra Pulmonary

Pericardial effusion is an uncommon extra-pulmonary manifestation of tuberculosis, tamponade being even rarer. Here, a 14-year female presented with cough, chest pain and fever. She had raised jugular venous pressure, hypotension, and muffled heart sound, suggestive of cardiac tamponade, confirmed by echocardiogram. She underwent pericardiocentesis with continuous pericardial fluid drainage. Her jugular venous pressure normalized after the aspiration. The high adenosine deaminase level in pericardial fluid analysis was suggestive of tuberculosis for which she was treated with antitubercular therapy and steroid. This case highlights the importance of adenosine deaminase for diagnosing the etiology of a rare presentation.Keywords: Adenosine deaminase; echocardiography; pericardial effusion; tamponade; tuberculosis

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.

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