Capnocytophaga Induced Acute Necrotizing and Exudative Pericarditis with Abscess Formation

We present the case of a 55-year-old gentleman, with bilateral pulmonary embolism and a large pericardial effusion that lead to a pericardial window with evacuation of creamy pus. Gram stains were negative, with culture growing Capnocytophaga. Pathology revealed acute necrotizing and exudative changes, including frank abscess formation. In developed countries, pericardial abscess and acute pericarditis are uncommon due to availability of broad-spectrum antibiotics. Pericardial abscess due to Capnocytophaga is even more uncommon.

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

Journal of Medical Case Reports ◽

10.1186/s13256-020-02467-w ◽

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.

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

Journal of the American Heart Association ◽

10.1161/jaha.120.018950 ◽

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.

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1095 Effective image-guided medical management in effusive constrictive pericarditis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.646 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Montes ◽

A Cecconi ◽

T Alvarado ◽

A Vera ◽

A Barrios ◽

...

Keyword(s):

Pericardial Effusion ◽

Medical Treatment ◽

Constrictive Pericarditis ◽

Pericardial Fluid ◽

Pericardial Window ◽

Acute Pericarditis ◽

Intravenous Corticosteroid ◽

Persistent Inflammation ◽

High Doses ◽

Effusive Constrictive Pericarditis

Abstract A 59 year old man was admited to hospitalization for persistent chest pain related to acute pericarditis. Within the admision tests, a transthoracic echography was performed, showing a moderate pericardial effusion with ventricular septal bounce and significant respiratory variations in mitral and tricuspid inflows, all of it consistent with effusive-constrictive pericarditis (Panel A). Anti-inflammatory treatment with ibuprofen and colchicine was started. During the first 48 hours of admission there was a clinical and hemodinamic worsening in the patient’s condition that forced the performance of a pericardial window, obtaining a very little quantity of dense pericardial fluid. Looking for a more accurate study of the pericardium, a cardiovascular magnetic resonance (CMR) was performed, revealing a thick heterogeneous pericardial effusion (Panel B) and a significant late gadolinium enhancement of both pericardial layers (Panel C). All these findings where consistent with an effusive constrictive pericarditis with persistent inflammatory activity despite high doses of conventional inflammatory treatment. Furthermore, the growth of Propionibacterium acnes in the pericardial fluid disclosed the etiology of this condition. Medical treatment was enhanced with high doses of intravenous corticosteroid, ceftriaxone and doxycycline. During the following days, the patient showed an excellent response achieving the complete clinical and echocardiographic relief of constrictive signs (Panel D). Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of .pericarditis. Our case is remarkable because it demonstrates the value of CMR to detect persistent inflammation of pericardium despite high doses of conventional medical treatment for pericaricarditis guiding the successful escalation to intravenous corticosteroid and avoiding the risk of an unnecessary cardiac surgery. Abstract 1095 Figure.

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Subacute idiopathic pericarditis with a large pericardial effusion in a young adult seven months post COVID-19 (SARS-Cov-2) infection

World Journal of Advanced Research and Reviews ◽

10.30574/wjarr.2021.10.1.0187 ◽

2021 ◽

Vol 10 (1) ◽

pp. 340-342

Author(s):

Ashan T Hatharasinghe ◽

Andrey E Manov

Keyword(s):

Pericardial Effusion ◽

Time Frame ◽

Young Female ◽

Past Medical History ◽

Active Infection ◽

Pericardial Window ◽

Large Pericardial Effusion ◽

The World ◽

History Of ◽

Short Time

The number of COVID-19 (SARS-Cov-2) cases has risen substantially throughout the world, and consequently we are finding there are several extrapulmonary manifestations associated with this disease. Viral pericarditis and pericardial effusion have been reported several times in COVID-19 patients, however the majority of these cases occurred during active infection or within a relatively short time frame afterwards. The following case is a young female with only a past medical history of COVID-19 pneumonia, seven months prior, presenting with abdominal pain and progressively worsening dyspnea. She was subsequently found to have a large pericardial effusion without tamponade, but requiring a pericardial window. Gross pathology showed fibrinous pericarditis. It is suspected her symptoms and pericardial effusion resulted from a subacute idiopathic pericarditis likely as post-viral complication of COVID-19.

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Acute and recurrent pericarditis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0376 ◽

2018 ◽

pp. 1563-1572

Author(s):

Massimo Imazio ◽

Fiorenzo Gaita ◽

Yehuda Adler

Keyword(s):

Oral Anticoagulant Therapy ◽

Developed Countries ◽

Acute Onset ◽

Recurrent Pericarditis ◽

Acute Pericarditis ◽

Clear Cut ◽

Large Pericardial Effusion ◽

Anti Inflammatory ◽

Low Prevalence

Viral and idiopathic pericarditis are the most common forms of pericarditis encountered in clinical practice in developed countries with a low prevalence of tuberculosis. The course of these cases is relatively benign and self-limiting, the most common complication being recurrence. The mainstay of therapy is empiric anti-inflammatory therapy with aspirin or a non-steroidal anti-inflammatory drug (NSAID) plus colchicine. Specific features at presentation may suggest the increased risk of complications during follow-up and non-viral aetiologies (e.g. high fever >38ºC (100.4ºF), subacute course with symptoms over several days without a clear-cut acute onset, evidence of large pericardial effusion with diastolic echo-free space >20 mm, cardiac tamponade, failure to respond within 7 days to aspirin/NSAID, associated myocarditis (myopericarditis), immunodepression, trauma, and oral anticoagulant therapy). The presence of one or more of these features identifies a potentially high-risk case of pericarditis to be admitted. In these cases an aetiology search is mandatory. Patients with pericarditis and no risk features can be considered at low risk and managed as outpatients. In these cases follow-up is mandatory after 1 week to assess the response to empiric anti-inflammatory therapy. Recurrent pericarditis is the most troublesome complication following acute pericarditis and occurs in 20–50% of patients. Most cases of recurrent pericarditis are idiopathic and the pathogenesis is presumed to be immune mediated or autoinflammatory. The prognosis of idiopathic recurrent pericarditis is generally good with the risk of chronic evolution towards constrictive pericarditis related to the aetiology and not the number of recurrences.

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Anterior parasternal approach for creation of a pericardial window

Annals of The Royal College of Surgeons of England ◽

10.1308/003588415x14181254789925 ◽

2015 ◽

Vol 97 (5) ◽

pp. 375-378 ◽

Cited By ~ 3

Author(s):

E Altman ◽

O Rutsky ◽

A Shturman ◽

Y Yampolsky ◽

S Atar

Keyword(s):

Pericardial Effusion ◽

Symptomatic Improvement ◽

Obese Patients ◽

Pericardial Window ◽

Optimal Method ◽

Large Pericardial Effusion ◽

Novel Approach ◽

Underlying Malignancy ◽

Discharged Patients ◽

The Mean

Introduction The optimal method for creation of a pericardial window (PW) is still controversial and it remains a surgical challenge, mainly in obese patients. The aim of this study was to evaluate the efficacy and safety of a novel approach that has not been described previously, for creation of a PW in patients with symptomatic, chronic, large pericardial effusion. Methods We retrospectively analysed the records of 30 patients (14 men, 16 women) who underwent a PW procedure between 2001 and 2011. The mean age was 63 years (standard deviation [SD]: 17 years, median: 60 years, range: 27–90 years) and the mean body mass index was 34kg/m 2 (SD: 2kg/m 2 ). The operation was performed through a curvilinear parasternal approach, 6–8cm in length, followed by a mini-thoracotomy between ribs 4 and 5. Discharged patients were followed up clinically. Results The mean operative time was 73 minutes (SD: 21 minutes) and a median of 658ml (range: 300–1,500ml) of fluid was evacuated. The main aetiologies were idiopathic in 17 patients (57%) and malignant in 9 (30%). Seven patients (23%) died in hospital owing to underlying malignancy. Postoperative complications included mild renal failure (20%), respiratory failure (20%), pneumonia (13%), atrial fibrillation (10%) and atelectasis (6%). There were no wound infections. The median length of stay following the procedure was 8 days. In a median follow-up period of 3.8 years, 16 patients with non-malignant effusion were free of recurrence of pericardial effusion. Conclusions The anterior parasternal approach for creation of a PW is simple, safe and efficacious, and results in long-term symptomatic improvement, specifically in patients with non-malignant effusions. This approach may be more appealing in obese patients.

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Diagnosis and treatment of effusive–constrictive pericarditis: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab174 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Yousif Al-Saiegh ◽

Jenna Spears ◽

Tim Barry ◽

Christopher Lee ◽

Howard Haber ◽

...

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Sleep Apnoea ◽

Therapeutic Interventions ◽

Right Atrial ◽

Pericardial Window ◽

Acute Pericarditis ◽

Obstructive Sleep ◽

Obesity Hypertension ◽

Effusive Constrictive Pericarditis

Abstract Background Effusive–constrictive pericarditis (ECP) is a rare syndrome involving pericardial effusion and concomitant constrictive pericarditis. The hallmark is a persistently elevated right atrial pressure of >10 mmHg or reduction of less than 50% from baseline despite pericardiocentesis. Aetiologies include radiation, infection, malignancy, and autoimmune disease. Case summary A 71-year-old man with a history of atrial fibrillation, obesity, hypertension, obstructive sleep apnoea, managed with continuous positive airway pressure presented with acute pericarditis complicated by pericardial effusion leading to cardiac tamponade. He was diagnosed with ECP after pericardiocentesis and was managed surgically with a pericardial window. Discussion Early detected cases of ECP can be managed by medical therapy. Therapeutic interventions include pericardiocentesis, balloon pericardiostomy, and pericardiectomy. This report describes a case of new-onset congestive heart failure secondary to ECP.

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SAT-484 Presyncope as Initial Presentation of Massive Pericardial Effusion with Tamponade in a Patient with Primary Hypothyroidism

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.391 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Susan Garcia ◽

Su Lei Tin

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Primary Hypothyroidism ◽

Initial Presentation ◽

Polymorphonuclear Cells ◽

Normal Range ◽

Pericardial Window ◽

Large Pericardial Effusion

Abstract Presyncope as initial presentation of massive pericardial effusion with tamponade in a patient with primary hypothyroidism Background: Hypothyroidism is an endocrinologic disorder that affects multiple systems ranging from cardiovascular, central nervous system, musculoskeletal, etc. One of the possible cardiovascular complications of hypothyroidism is pericardial effusion which is only rarely associated with tamponade. In this case report we have a 49 years old woman who presented with impending pericardial tamponade secondary to chronic primary hypothyroidism. Clinical case: A 49 years old woman with history of hypothyroidism presented to the hospital on account of headache, dizziness with presyncope episode, generalized weakness and shortness of breath for 7 days, physical exam showed normal vital signs, distant heart sounds, laboratory tests showed TSH:29.5 uIU/mL (normal range 0.270- 0.4200 uIU/mL), fT4: <0.1ng/dL (normal range 0.9–1.8 ng/dL), fT3: 1.68 pg/mL (normal range 1.80–4.60 pg/mL. Electrocardiogram showed low voltage QRS, chest CT showed large pericardial effusion with findings suggestive of right heart failure, Echocardiogram showed left ventricular dysfunction and large pericardial effusion. The patient was taken to the operating room for emergent pericardial window creation with pericardiectomy and was admitted to the Cardiac Care Unit for management of tamponade status post pericardial window. Levothyroxine 150 mcg, Liothyronine 25 mcg and Hydrocortisone 50 mg were started, the steroid was discontinued after adrenal insufficiency was ruled out. The pericardial drain was removed after 8 days and repeated tests showed TSH: 13.1 uIU/mL, fT3: 3.37 pg/mL, fT4: 0.5 ng/dL, studies of pericardial fluid only showed polymorphonuclear cells. The patient’s symptoms resolved and she was discharged on Levothyroxine 150 mcg and Liothyronine 25 mcg. During follow up visits the thyroid function tests were normal, Liothyronine was discontinued and a repeated Echocardiogram showed normal systolic function. Conclusions: Pericardial effusion can be found in 3–30% of patients with hypothyroidism but only in very rare cases (less than 3%) is associated with cardiac tamponade and occurs when there is a severe underlying condition like myxedema coma or prolonged untreated hypothyroidism (1). It is important not to miss that dizziness and presyncope in a patient with hypothyroidism may be a manifestation of cardiac tamponade. Once the diagnosis of hypothyroidism is made it is imperative to start treatment early as untreated hypothyroidism can cause severe cardiovascular complications but even when such are present, they can be reversible with thyroid replacement therapy. Reference: (1) Kahaly, G. and Dillmann, W. (2005). Thyroid Hormone Action in the Heart. Available at: https://academic.oup.com/edrv/article/26/5/704/2355198 [Accessed July 12 2019].

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

Circulation ◽

10.1161/circ.130.suppl_2.17341 ◽

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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P5: SYSTEMIC MASTOCYTOSIS PRESENTING AS CARDIAC TAMPONADE WITH CD25+ PERICARDIAL MAST CELLS

Journal of Investigative Medicine ◽

10.1136/jim-2016-000080.45 ◽

2016 ◽

Vol 64 (3) ◽

pp. 819.1-819

Author(s):

VK Sukrithan ◽

JN Salamon ◽

G Berulava ◽

NE Sibinga ◽

AK Verma

Keyword(s):

Bone Marrow ◽

Lymph Node ◽

Mast Cells ◽

Pericardial Effusion ◽

Systemic Mastocytosis ◽

Maculopapular Rash ◽

Epinephrine Infusion ◽

Pericardial Window ◽

Bone Marrow Biopsies ◽

Large Pericardial Effusion

Purpose of StudyCase.Methods UsedDescriptive.Summary of ResultsA 59 year old man with a history of lymphadenopathy, presented with shortness of breath and pleuritic chest pain since three days. A hyperpigmented maculopapular rash with urticaria was present along with multiple syncopal episodes and chronic diarrhea. CT scan of the abdomen in 2006 revealed lymphadenopathy, hepatosplenomegaly, and osteosclerosis. Inguinal and cervical lymph node biopsies in 2006 and 2012, and two bone marrow biopsies in 2012 were negative for malignancy. In 2009, he was diagnosed with non-ischemic cardiomyopathy with an ejection fraction of 40%. Peripheral blood, lymph node, and bone marrow flow cytometry were also unrevealing. On admission, the eosinophil count on admission was 500/µL. Echocardiography showed a large pericardial effusion with impaired right ventricular filling and significant respiratory variation in transmitral flow velocity. A pericardial window was placed, with drainage of approximately 1 liter of exudative fluid. During the surgery, the patient suffered sudden hypotension requiring epinephrine infusion. Tryptase levels drawn were 115 and 154 ng/ml. Pericardial tissue showed scattered c-Kit+ and CD25+ mast cells and blood PCR showed D816V mutation in the c-KIT gene. Re-stained stomach biopsy specimens from 2006 showed two clusters of c-Kit+ and CD25+ mast cells. A bone marrow biopsy showed aggregates of c-Kit+, tryptase+, CD25+ mast cells consistent with Systemic Mastocytosis. The transient hypotension was likely due to distributive shock from mast cell degranulation. Hyperactive mast cells may have served as mediators of the inflammatory response, contributing to production of the pericardial effusion leading to tamponade.ConclusionsSM with tamponade.Abstract P5 Figure 1

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