scholarly journals A giant fibrinoid pericardial mass in a patient with rheumatoid arthritis: a case report

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Felipe Cañas ◽  
Juan David Lopez Ponce de León ◽  
Juan Esteban Gomez ◽  
Carlos Alberto Cañas
Keyword(s):  
Rheumatoid Arthritis ◽  
Right Ventricle ◽  
Chronic Inflammatory Disease ◽  
Pericardial Disease ◽  
Prognostic Features ◽  
Cardiac Manifestation ◽  
Histopathological Studies ◽  
The Right ◽  
Pericardial Mass ◽  
Pericardial Thickening

Abstract Background  Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, which may extend to extra-articular organs. Extra-articular manifestations have been considered as prognostic features in RA, and pericardial disease is one of the most frequent occurrences. Rheumatoid arthritis pericarditis is usually asymptomatic and is frequently found on echocardiography as pericardial thickening with or without mild effusion. Severe and symptomatic cases are rare, but pericardial masses are even rarer. We report a patient with erosive, nodular seropositive RA, and progressive functional deterioration owing to a giant pericardial mass compressing the right cardiac chambers. Case summary The patient was a 79-year-old man. Cardiac magnetic resonance imaging revealed a pericardial lesion measuring 10 × 9 × 6 cm with complex structures in its interior, which had compressive effects on the right atrium and right ventricle, severely limiting diastole. Late gadolinium enhancement of the lesion walls and pericardium suggested pericarditis. Surgical resection was performed, and a soft mass with liquid content was extracted. The patient recovered well with improvements in symptoms and the functional status. Histopathological studies ruled out neoplasm, vasculitis, and infection, and the entire mass showed fibrinoid material associated with fibrinoid pericarditis. Discussion Symptomatic RA pericarditis is a rare cardiac manifestation of RA, whilst associated significant haemodynamic compromise is even rarer. The condition could manifest with a giant compressive pericardial mass composed of fibrinous material, with particular involvement of the right ventricle. Exclusion of other conditions, such as neoplasms and infections, is necessary.

Abstract 19722: Pericardial Mass in a Patient With Rheumatoid Arthritis: A Case Report

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mohammad A Al-Ani ◽  
Michelle H Weber ◽  
Alexandra R Lucas ◽  
Matthew D Kosboth
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Case Report ◽  
Chamber Pressure ◽  
Dramatic Improvement ◽  
Pericardial Disease ◽  
Ct Guided ◽  
Pressure Equalization ◽  
The Right ◽  
Pericardial Mass

Introduction: Rheumatoid arthritis (RA) can affect the heart via either inflammatory or ischemic processes. Pericardial disease is common in RA patients (30-50%) but is usually subclinical and not hemodynamically significant unless accompanied by infiltrative cardiomyopathy which carries a poor prognosis. Case report: A 65 year-old Caucasian male presented with long standing RA, severe fatigue and mild arthritis of MCP joints. Physical examination indicated S3, II/VI decrescendo diastolic murmur, and 2+ LL edema. ESR was normal but anti-CCP antibodies were > 250 units. On echocardiogram, a large pericardial mass was detected without atrial nor ventricular collapse and mild-moderate aortic regurgitation. Cardiac MRI defined the mass as a heterogeneous entity attached to the right, anterior, and inferior borders of the heart with compression of the right atrium, left and right ventricles, and the tricuspid valve. CT guided biopsy demonstrated fibrinous material without granulomas nor infection. Fatigue was initially attributed to uncontrolled RA and low dose prednisone and Leflunamide were started. 3 months later, he developed frank heart failure with NYHA class IIIb functional impairment. Cardiac Tamponade was confirmed by heart catheterization demonstrating typical 4-chamber pressure equalization. The mass was surgically excised with partial pericardiectomy. The patient had a dramatic improvement and 4 years later, he remains asymptomatic. Discussion: Our patient presented with uncontrolled RA and a pericardial mass that was not hemodynamically significant per the initial echocardiogram. Despite intensifying immunosuppression, his fatigue progressed with signs of congestive heart failure. Tamponade physiology was diagnosed invasively and the mass was resected with excellent recovery. Microscopically, the lesion consisted of a fibrous and exudative material. The patient likely had multiple asymptomatic episodes of pericarditis, gradually leading to this condition. We demonstrate with this case that RA pericardial disease can cause hemodynamic compromise while sparing myocardium and valves and that surgery is associated with very good prognosis. Physicians should be vigilant about a cardiac cause of fatigue in RA patients.

scholarly journals Suspected Pericardial Tuberculosis Revealed as an Amyloid Pericardial Mass

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Sebastiano Cicco ◽  
Antonio G. Solimando ◽  
Patrizia Leone ◽  
Stefano Battaglia ◽  
Roberto Ria ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Right Ventricle ◽  
Unusual Case ◽  
Air Bubbles ◽  
Fat Tissue ◽  
Dexamethasone Treatment ◽  
Immunoglobulin Deposits ◽  
The Right ◽  
Pericardial Mass ◽  
Monoclonal Component

Primary systemic amyloidosis is not easily diagnosed. The immunoglobulin deposits are usually localized in the kidney, heart, and liver. We describe an unusual case of a patient suffering from a pericardial amyloidoma with internal calcifications and air bubbles that compressed the right ventricle and shifted the heart to the left. Since the patient was in shock, urgent pericardiotomy was performed. This site showed PET uptake. A monoclonal component was present. On these findings, differential diagnoses included multiple myeloma and atypical pericardial tuberculosis, whereas a periumbilical fat tissue biopsy demonstrated amyloidosis. A previous Salmonella species infection had most likely stimulated the production of amyloid. The patient received bortezomib/dexamethasone treatment and achieved a good response.

scholarly journals Calcified pericardial band at the level of right ventricle causing midventricular obstruction: a case report of constrictive pericarditis

2012 ◽  
Vol 7 (4) ◽  
pp. 58-62
Author(s):  
MP Gautam ◽  
D Sharma ◽  
G Subramanyam ◽  
S Gautam ◽  
U Ghimire
Keyword(s):  
Constrictive Pericarditis ◽  
Young Female ◽  
Medical Sciences ◽  
Pericardial Disease ◽  
Management Journal ◽  
Antituberculous Treatment ◽  
Atrioventricular Groove ◽  
The Right ◽  
Pericardial Thickening ◽  
Midventricular Obstruction

Constrictive pericarditis is a debilitating but potentially curable disease. Diffuse pericardial thickening and calcification is a classic feature described; localized pericardial constrictions are very rare. Here we report a case of a young female who had presented with constrictive pericarditis and had localized calcific constrictive band located at the level distal to atrioventricular groove which had caused right midventricular obstruction. In many patients the cause of the pericardial disease is undetermined, and in them an asymptomatic or forgotten bout of viral or tubercular pericarditis, acute or idiopathic, may have been the inciting event. Our patient had pulmonary tuberculosis during childhood and received antituberculous treatment. Investigations revealed the presence of thickened pericardium and a thickened calcific constrictive band around the right ventricles at midventricle level causing midventricular obstruction. She was referred to another centre for further surgical management. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 58-62 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6813

Comprehensive Quantification of the Right Ventricle: Pediatric Reference Values from 0 to 18 Years

2016 ◽  
Vol 64 (S 02) ◽  
Author(s):  
J. Horst ◽  
A. Karabiyik ◽  
H. Körperich ◽  
M. Fischer ◽  
E. Klusmeier ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Reference Values ◽  
The Right

Right Ventricle Mass Removal from Tricuspid Valve Apparatus: An Unusual Thromboembolic Complication of Severe Ketoacidosis

2016 ◽  
Vol 19 (2) ◽  
pp. 077
Author(s):  
Ireneusz Haponiuk ◽  
Maciej Chojnicki ◽  
Konrad Paczkowski ◽  
Wojciech Kosiak ◽  
Radosław Jaworski ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Tricuspid Valve ◽  
Mild Hypothermia ◽  
Heart Function ◽  
Thromboembolic Complication ◽  
Surgical Removal ◽  
Unusual Complication ◽  
Type I ◽  
Definitive Therapy ◽  
The Right

The presence of a pathologic mass in the right ventricle (RV) may lead to hemodynamic consequences and to a life-threatening incident of pulmonary embolism. The diagnosis of an unstable thrombus in the right heart chamber usually necessitates intensive treatment to dissolve or remove the pathology. We present a report of an unusual complication of severe ketoacidosis: thrombus in the right ventricle, removed from the tricuspid valve (TV) apparatus. A four-year-old boy was diagnosed with diabetes mellitus (DM) type I de novo. During hospitalization, a 13.9 × 8.4 mm tumor in the RV was found in a routine cardiac ultrasound. The patient was referred for surgical removal of the floating lesion from the RV. The procedure was performed via midline sternotomy with extracorporeal circulation (ECC) and mild hypothermia. Control echocardiography showed complete tumor excision with normal atrioventricular valves and heart function. Surgical removal of the thrombus from the tricuspid valve apparatus was effective, safe, and a definitive therapy for thromboembolic complication of pediatric severe ketoacidosis.<br /><br />

Ligation of a Fistula between the Left Main Coronary Artery and Both the Pulmonary Artery and the Right Ventricle

2012 ◽  
Vol 15 (2) ◽  
pp. 119 ◽  
Author(s):  
I. Halil Algin ◽  
Aytekin Yesilay ◽  
N. Murat Akcar
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Left Main Coronary Artery ◽  
Coronary Artery Fistula ◽  
Left Main ◽  
Symptomatic Disease ◽  
Coronary Artery Fistulas ◽  
The Right

The frequency of coronary artery fistula among all coronary angiography patients is 0.1% to 0.2%; however, involvement of both the pulmonary artery and the right ventricle is a rare clinical entity. A 53-year-old man patient was admitted to our clinic with rarely occurring chest pain, palpitations, and dyspnea. A coronary angiogram showed a fistula between the left main coronary artery and both the pulmonary artery and the right ventricle. We performed a ligation of this fistula without cardiopulmonary bypass. Aorta and right ventricle sutures were made, and the proximal and distal portions of the fistula were obliterated with 5-0 Prolene sutures and previously prepared Teflon felt. The patient recovered and was discharged without any complications. The surgical indications for coronary artery fistulas are symptomatic disease, an aneurysmic coronary artery, signs of heart failure, and ischemia. The surgical options in such cases�depending on whether the fistula is complicated or not�are simple ligation or transarterial ligation under cardiopulmonary bypass.

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