Pericardial Metastasis Induced Tamponade from Urothelial Carcinoma: A Rare Entity

Urothelial carcinoma in a few cases may result in cardiac metastasis. A rare presentation of this condition is its diagnosis as a result of cardiac tamponade. Tamponade is an unusual entity as a result of urothelial carcinoma and has only been reported in four cases. There have also been only a total of fifteen cases of cardiac metastasis from this form of malignancy. It is through this discussion that we emphasize the importance of early detection and monitoring of cardiac symptoms with the implementation of echocardiogram imaging. Although not feasible in all patients it may be considered in those presenting with cardiac and pulmonary symptoms. In this case we discuss the presentation of a 71-year-old gentleman with a history of urothelial carcinoma after cystectomy and while on chemotherapy presented with new onset atrial fibrillation and later was diagnosed with cardiac tamponade as a result of malignant metastasis.

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A Rare Presentation of Cardiac Tamponade from Metastatic Urothelial Carcinoma of the Bladder

Case Reports in Cardiology ◽

10.1155/2018/6750264 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sowmya Palam ◽

Ridhima Kapoor ◽

Jacquelyn Kulinski

Keyword(s):

Urothelial Carcinoma ◽

Cardiac Tamponade ◽

English Literature ◽

Pericardial Fluid ◽

High Grade ◽

Rare Presentation ◽

Pericardial Window ◽

Cardiac Metastases ◽

History Of ◽

Carcinoma Of The Bladder

A 62-year-old man presented with 2 weeks of progressive dyspnea and chest pain. He was previously diagnosed with high-grade invasive urothelial carcinoma (UC) of the bladder and underwent neoadjuvant chemotherapy followed by radical cystectomy 10 months earlier, resulting in pathologic complete remission. Clinical evaluation and echocardiographic imaging was consistent with a diagnosis of cardiac tamponade. Due to a history of malignancy, the patient was referred for a surgical pericardial window, to include biopsy of the pericardium. Pericardial fluid and pericardial biopsy specimens were consistent with metastatic UC. Cardiac tamponade due to metastatic UC is a rare presentation, and, to our knowledge, there have been only 5 cases reported in the English literature. We report a rare case of cardiac tamponade due to isolated pericardial metastases from high grade UC of the bladder and discuss the symptoms, treatment, and prognosis of this pathologic condition. We also present a brief review of previously published literature. Through this discussion, we would like to emphasize the (1) consideration of cardiac metastases in the differential diagnosis for patients with a history of UC presenting with cardiac or pulmonary symptoms and (2) improved diagnostics with pericardial biopsy and pericardiocentesis over pericardiocentesis alone.

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Atrial fibrillation in a child with COVID-19 infection

Cardiology in the Young ◽

10.1017/s1047951120003893 ◽

2020 ◽

pp. 1-4

Author(s):

Aura Daniella Santi ◽

Paolo Aquino ◽

Molly Dorfman

Keyword(s):

Atrial Fibrillation ◽

Delay In Diagnosis ◽

History Of ◽

Short And Long Term ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract The SARS-CoV-2 (COVID-19) pandemic has challenged our initial predictions of its ramifications, both short and long term. Cardiovascular manifestations of COVID-19 in children remain a topic of investigation as literature is lacking. We describe new onset atrial fibrillation in a child with a history of COVID-19 infection. Understanding of cardiogenic effects of COVID-19 can help minimise the delay in diagnosis.

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Vaginal metastasis of bladder urothelial carcinoma: Description of a case and revision of literature

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.2.156 ◽

2017 ◽

Vol 89 (2) ◽

pp. 156 ◽

Cited By ~ 1

Author(s):

Carmelo A. Di Franco ◽

Daniele Porru ◽

Giovanni Giliberto ◽

Alessandra Viglio ◽

Bruno Rovereto

Keyword(s):

Bladder Cancer ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Vaginal Bleeding ◽

Urothelial Cancer ◽

Vaginal Wall ◽

Rare Entity ◽

Bladder Urothelial Carcinoma ◽

Vaginal Metastasis ◽

History Of

Vaginal metastases from urothelial cancer are a rare entity and in literature, few cases are described. We report a case of a 68 year-old woman with history of bladder urothelial carcinoma underwent to radical cystectomy who came in our department after 5 months for pelvic pain and vaginal bleeding. Objective examination revealed an ulcerative, solid vaginal lesion in the upper vaginal wall. We performed a vaginal biopsy that showed urothelial carcinoma compatible with the primitive bladder cancer. The patient underwent to surgery and was sent to oncological evaluation.

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ECG Predictors for New-Onset Atrial Fibrillation Within a Year After Radiofrequency Ablation of Counterclockwise-Rotating Atrial Flutter

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.739350 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hailei Liu ◽

Zhoushan Gu ◽

Chao Zhu ◽

Mingfang Li ◽

Jincheng Jiao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Atrial Flutter ◽

P Wave ◽

Negative Component ◽

Typical Atrial Flutter ◽

History Of ◽

Electrocardiographic Parameters ◽

Onset Atrial Fibrillation ◽

New Onset

Background: New-onset atrial fibrillation (AF) after ablation of typical atrial flutter (AFL) is not rare. This study aimed to investigate the predictive value of electrocardiographic parameters on new-onset AF post-typical AFL ablation.Methods: A total of 158 consecutive patients (79.1% males, mean age 57.8 ± 14.3 years) with typical AFL were enrolled between January 2012 and August 2017 in this single-center study. Patients with a history of AF before ablation were excluded. ECGs during sinus rhythm (SR) and AFL were collected. The duration of the negative component of flutter wave in lead II (DFNII), proportion of the DFNII of the total circle length of AFL (DFNII%), amplitude of the negative component of flutter wave in lead II (AFNII), duration (DPNV1), and amplitude (APNV1) of negative component of the P wave in lead V1, and P wave duration in lead II (DPII) during sinus rhythm were measured.Results: During a median follow-up of 26.9 ± 11.8 months, 22 cases (13.9%) developed new-onset AF. DFNII was significantly longer in patients with new-onset AF compared to patients without AF (114.7 ± 29.6 ms vs. 82.7 ± 12.8 ms, p < 0.0001). AFNII was significantly lower (0.118 ± 0.034 mV vs. 0.168 ± 0.051 mV, p < 0.0001), DPII (144.21 ± 23.77 ms vs. 111.46 ± 14.19 ms, p < 0.0001), and DPNV1 was significantly longer (81.07 ± 16.87 ms vs. 59.86 ± 14.42 ms, p < 0.0001) in patients with new-onset AF. In the multivariate analysis, DFNII [odds ratio (OR), 1.428; 95% CI, 1.039–1.962; p = 0.028] and DPII (OR, 1.429; 95% CI, 1.046–1.953; p = 0.025) were found to be independently associated with new-onset AF after typical AFL ablation.Conclusion: Parameters representing left atrial activation time under both the SR and AFL were independently associated with new-onset AF post-typical AFL ablation and may be useful in risk prediction, which needs to be confirmed by further prospective studies.

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Abstract 15403: New-onset Atrial Fibrillation is Infrequent in Acute COVID-19 but Maybe Associated With Worse Outcomes

Circulation ◽

10.1161/circ.142.suppl_3.15403 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ruifang Yang ◽

Sokol Kalaveshi ◽

David Goldgrab ◽

Jearim Craig ◽

Stephen Mester ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systemic Inflammation ◽

Cardiac Disease ◽

Total Mortality ◽

Cardiovascular Death ◽

Cardiovascular Complications ◽

Significant Difference ◽

History Of ◽

Onset Atrial Fibrillation ◽

New Onset

Introduction: The COVID-19 has reached pandemic status with significant morbidity and mortality including cardiovascular complications. Systemic inflammation caused by the COVID-19 infection has been associated with an intense release of multiple cytokines which directly cause myocardial injury. New-onset atrial fibrillation (noAF) is a common consequence of systemic inflammation in bacterial pneumonia as well as influenza and has been shown to have independently poorer outcomes. Hypothesis: We sought to determine the incidence and significance of noAF in patients with confirmed COVID-19 infection. Methods: We prospectively studied patients with acute COVID-19 infection admitted to our referral center between March and May 2020. Data of demographics, clinical features, comorbidities and complications were collected. Cardiac rhythms were observed using 12-lead electrocardiogram and continuous telemetry. Results: Total 62 patients were followed. The end-point included incidence of any episode of AF, cardiovascular death and total mortality. Mean age was 66 ±17 years, 56% were males, 37 patients without history of cardiac disease, 25 patients with documented cardiac disease including 31% of coronary artery disease (CAD), 28% of congestive heart failure (CHF), 11% of history of prior atrial fibrillation (hoAF). Four (6.5%) patients manifested noAF during hospitalization (95% CI, 1.8, 16). There was a significant difference in mortality between patients with and without cardiac diseases (P = 0.02) (Table). All patients with noAF required ventilation support and had significantly higher mortality compared to patients without cardiac disease (P < 0.05) (Figure). Conclusions: New-onset AF was infrequently observed, however was associated with a poorer prognosis for hospitalized patients with acute COVID-19 infection. Larger studies are needed to confirm these findings as well as identify measures of AF prevention in this population.

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Metastatic urothelial carcinoma to pericardia manifested by dyspnea from cardiac tamponade during systemic chemotherapy: case report and literature review

Canadian Urological Association Journal ◽

10.5489/cuaj.23 ◽

2012 ◽

Vol 6 (5) ◽

Author(s):

Seiya Hattori ◽

Akira Miyajima ◽

Takahiro Maeda ◽

Toshikazu Takeda ◽

Shinya Morita ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Cardiac Tamponade ◽

Systemic Chemotherapy ◽

Pathological Condition ◽

Lumbar Pain ◽

Cardiac Metastasis ◽

Advanced Malignancy ◽

Multiple Metastases ◽

Metastatic Urothelial Carcinoma ◽

Pericardial Involvement

A 53-year-old man presented for further evaluation due to microscopic hematuria and left lumbar pain. Computed tomography revealed a large tumour in the left renal pelvis with multiple metastases. Despite effective systemic chemotherapy, he developed dyspnea, and was diagnosed with cardiac tamponade. Pericardial involvement in an advanced malignancy is common, but symptomatic cardiac metastasis from urothelial carcinoma is rare. Of the reports of symptomatic cardiac metastasis from urothelial carcinoma, only 3 cases presented as cardiac tamponade. We report here a rare case of cardiac tamponade caused by a renal pelvic carcinoma with positive cytodiagnosis of pericardial effusion. We also summarize and discuss the symptoms, treatment, and prognosis of the pathological condition, and present a brief review of previously published reports.

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New-onset atrial fibrillation: incidence, characteristics, and related events following a national COVID-19 lockdown of 5.6 million people

European Heart Journal ◽

10.1093/eurheartj/ehaa494 ◽

2020 ◽

Vol 41 (32) ◽

pp. 3072-3079 ◽

Cited By ~ 14

Author(s):

Anders Holt ◽

Gunnar H Gislason ◽

Morten Schou ◽

Bochra Zareini ◽

Tor Biering-Sørensen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Odds Ratio ◽

Patient Characteristics ◽

Related Event ◽

History Of ◽

Rate Ratios ◽

Onset Atrial Fibrillation ◽

History Of Cancer ◽

New Onset

Abstract Aim To determine the incidence, patient characteristics, and related events associated with new-onset atrial fibrillation (AF) during a national COVID-19 lockdown. Methods and results Using nationwide Danish registries, we included all patients, aged 18–90 years, receiving a new-onset AF diagnosis during the first 3 months of 2019 and 2020. The main comparison was between patients diagnosed during lockdown (12 March 12–1 April 2020) and patients diagnosed in the corresponding period 1 year previously. We found a lower incidence of new-onset AF during the 3 weeks of lockdown compared with the corresponding weeks in 2019 [incidence rate ratios with 95% confidence intervals (CIs) for the 3 weeks: 0.66 (0.56–0.78), 0.53 (0.45–0.64), and 0.41 (0.34–0.50)]. There was a 47% drop in total numbers (562 vs. 1053). Patients diagnosed during lockdown were younger and with a lower CHA2DS2-VASc score, while history of cancer, heart failure, and vascular disease were more prevalent. During lockdown, 30 (5.3%) patients with new-onset AF suffered an ischaemic stroke and 15 (2.7%) died, compared with 45 (4.3%) and 14 (1.3%) patients during the corresponding 2019 period, respectively. The adjusted odds ratio of a related event (ischaemic stroke or all-cause death) during lock-down compared with the corresponding weeks was 1.41 (95% CI 0.93–2.12). Conclusions Following a national lockdown in Denmark, a 47% drop in registered new-onset AF cases was observed. In the event of prolonged or subsequent lockdowns, the risk of undiagnosed AF patients developing complications could potentially translate into poorer outcomes in patients with AF during the COVID-19 pandemic.

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Cardiac Tamponade after Thrombolysis for Acute Ischemic Stroke - A Case with an Excellent Outcome

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001534 ◽

2020 ◽

Author(s):

Ana Vera-Cruz ◽

Marta Cerol ◽

Maria Margarida Pereira ◽

Sónia Canadas ◽

Juliana Mortágua ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cardiac Tamponade ◽

Intravenous Thrombolysis ◽

Major Complication ◽

Recombinant Tissue Plasminogen Activator ◽

Serious Adverse Events ◽

Excellent Outcome ◽

Cardiac Symptoms ◽

History Of

Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is the established treatment for acute ischemic stroke and has been highly effective in reducing the neurological deficit. Serious adverse events are not uncommon, with hemorrhage being the major complication. We describe the case of a patient with acute ischemic stroke that also presented with vague cardiac symptoms and was treated with rtPA, which was complicated by a hemopericardium causing cardiac tamponade. Pericardiocentesis was promptly performed, which resulted in rapid resolution of the cardiogenic shock. The patient recovered consciousness within a few minutes. A search of the MEDLINE database shows that this is the first report of cardiac tamponade after rtPA thrombolysis occurring in a patient with no history of recent myocardial infarction or aortic dissection.

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Progressive subtalar joint dislocation and limb-length inequality. An unusual case

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-88-4-176 ◽

1998 ◽

Vol 88 (4) ◽

pp. 176-180 ◽

Cited By ~ 2

Author(s):

B Resseque ◽

RG Volpe

Keyword(s):

Subtalar Joint ◽

Unusual Case ◽

Rare Entity ◽

Leg Lengthening ◽

Rare Presentation ◽

Joint Dislocation ◽

Short Limb ◽

Lateral Subluxation ◽

History Of ◽

Limb Length Inequality

Subtalar joint dislocation is a rare entity, accounting for only 1% of all traumatic dislocations. The authors report a case of an adolescent with gradual lateral subluxation of an anatomically abnormal subtalar joint with no history of trauma, an extremely rare presentation. The patient also had a congenitally short limb. The patient underwent llizarov leg lengthening along with multiple surgeries of the subtalar joint. The choice of the Ilizarov technique to lengthen the leg and realign the subtalar joint in this case is discussed.

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