Cardiac Tamponade - A Hypothyroidism Associated Emergency: A Report of 2 Cases

Pericardial effusion in commonly seen in-patient with hypothyroidism but effusion large enough to cause cardiac tamponade is not a common presenting feature whereas myxedema coma is a commonly defined medical emergency in-patient with hypothyroidism. We report 2 cases of hypothyroid associated medical emergencies. First case is a young female with history of recurrent pericardial effusion presenting to the emergency department with cardiac tamponade and later on diagnosed as having hypothyroidism. The second patient is a known case of hypothyroidism non-compliant to thyroid supplement and presented with lethargy, fatigue, decreased talking and breathlessness who was later diagnosed as having myxedema coma and impending cardiac tamponade. Both the patient required percutaneous pericardiocentesis and improved with medical management.

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The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

The Heart Surgery Forum ◽

10.1532/hsf.1328 ◽

2016 ◽

Vol 19 (1) ◽

pp. 023 ◽

Cited By ~ 2

Author(s):

Mehmet Yildirim ◽

Recep Ustaalioglu ◽

Murat Erkan ◽

Bala Basak Oven Ustaalioglu ◽

Hatice Demirbag ◽

...

Keyword(s):

Pericardial Effusion ◽

Thoracoscopic Surgery ◽

Pericardial Tamponade ◽

Pericardial Fluid ◽

Pathological Examination ◽

Common Disease ◽

Pericardial Window ◽

Surgical Interventions ◽

History Of ◽

Recurrent Pericardial Effusion

Background: Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. Methods: We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. Results: Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. Conclusion: Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

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Mesothelioma in two sheep with pericardial effusion and ascites

Veterinary Record Case Reports ◽

10.1136/vetreccr-2019-001031 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001031

Author(s):

Nicola Fletcher ◽

Camilla Brena ◽

Amanda Carson ◽

Mark Wessels ◽

Tobias Floyd

Keyword(s):

Differential Diagnosis ◽

Pericardial Effusion ◽

Domestic Animals ◽

Diagnostic Pathology ◽

First Case ◽

Clinical Presentations ◽

Rare Tumours ◽

Microscopic Features ◽

History Of ◽

The Right

Mesotheliomas are rare tumours in domestic animals. These tumours have a range of clinical presentations, and a range of gross and microscopic features can be present. We report mesotheliomas in two sheep submitted to Animal and Plant Health Agency’s diagnostic pathology service with diverse clinical presentations. The first case was a 2-year-old ewe with a history of sudden death that had a nodular mass in the wall of the right auricle and marked pericardial effusion and ascites. The second case was a 3-year-old ewe with a history of recumbency which had a papillary mass in the peritoneal cavity and marked ascites. A diagnosis of mesothelioma in both cases was confirmed by immunohistochemistry for cytokeratin and vimentin. These cases highlight the diverse presenting signs that can be present with mesothelioma, and this tumour should be considered as a differential diagnosis in sheep with peritoneal, pericardial or pleural effusion at gross postmortem.

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Mediastinal Pseudocyst and Cardiac Tamponade Due to Massive Pericardial Effusion in Pediatric Chronic Calcific Pancreatitis

Journal of Pediatric Intensive Care ◽

10.1055/s-0036-1587326 ◽

2016 ◽

Vol 06 (03) ◽

pp. 194-198 ◽

Cited By ~ 1

Author(s):

Suprit Basu ◽

Mala Bhatacharya ◽

Bidyut Debnath ◽

Sandip Sen ◽

Anish Chatterjee ◽

...

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Pancreatic Enzyme ◽

Recurrent Abdominal Pain ◽

Chronic Calcific Pancreatitis ◽

Contrast Enhanced ◽

History Of ◽

Posterior Mediastinal ◽

Enhanced Computed Tomography

AbstractA 7-year-old male patient with a history of recurrent abdominal pain over 1 year presented with cardiac tamponade due to massive pericardial effusion, which was percutaneously drained. Contrast-enhanced computed tomography revealed a large posterior mediastinal cyst and calcified, heterogeneous pancreatic parenchyma. Elevated amylase and lipase levels of the cyst fluid confirmed the diagnosis of pancreatic pseudocyst, which was treated with an octreotide infusion and Roux-en-Y cystojejunostomy. The child was discharged on pancreatic enzyme supplement and was asymptomatic on follow-up.

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A case report: delayed right ventricular pericardial fistula and aneurysm following penetrating traumatic injury—a controversial aetiology

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa183 ◽

2020 ◽

Vol 4 (4) ◽

pp. 1-5

Author(s):

Martina Steinmaurer ◽

Blanche Cupido ◽

Matthew Hannington ◽

Rodgers Manganyi

Keyword(s):

Pericardial Effusion ◽

Right Ventricular ◽

Cardiac Tamponade ◽

Traumatic Injury ◽

Clinical Signs ◽

The Body ◽

Delayed Presentation ◽

True Aneurysm ◽

History Of

Abstract Background Right ventricular aneurysms (RVAs) are rare. We present a case with a combined RVA and right ventricular pericardial fistula resulting in a pericardial effusion and cardiac tamponade. The RVA was detected 47 days after the patient suffered a gunshot wound. This report adds to the body of scarce literature on RVA aetiology, diagnoses, and treatment. Case summary A 30-year-old male patient presented with worsening respiratory distress over a 7-day period with clinical signs of cardiac tamponade following a history of a gunshot (with associated liver laceration, pulmonary embolism, right nephrectomy, and sepsis) 47 days prior. Transthoracic echocardiography showed a large circumferential pericardial effusion and an RVA. The patient was emergently taken for surgical repair of the RVA. Discussion Our case presents a delayed presentation of a gunshot heart and an aetiology with indications of and against a true aneurysm. It brings attention to possible complications of penetrating precordial injuries, with the need for consideration and possible evaluation at follow-up. The literature on the operative excision of RVA is reviewed and various aetiological factors and consequences are discussed.

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Qualität des Antikoagulationsmanagements bei ambulanten Patienten mit Vorhofflimmern

Praxis ◽

10.1024/0369-8394.92.21.991 ◽

2003 ◽

Vol 92 (21) ◽

pp. 991-995 ◽

Cited By ~ 1

Author(s):

Gubler ◽

Martina ◽

Arpagaus ◽

Dieterle

Keyword(s):

Atrial Fibrillation ◽

Emergency Department ◽

Oral Anticoagulation ◽

Medical Emergency ◽

Psychiatric Disease ◽

Recurrent Falls ◽

History Of ◽

Acute Condition

Many patients with atrial fibrillation do not receive anticoagulation due to accepted contraindications but also due to considerable underuse. We screened 2215 consecutive patients when they entered the Medical Emergency Department for any acute condition. The decision on correct use or underuse of oral anticoagulation was made from the charts by consensus of two experienced physicians. The prevalence of atrial fibrillation was 3.7%. 43 of 83 patients with atrial fibrillation had oral anticoagulation (52%, mean age 76 years). 32 patients were treated with Aspirin only (38%, mean age 79 years). 29 patients (35%) did not receive anticoagulation because of accepted contraindications, i.e., dementia and risk for recurrent falls (n = 16), history of bleeding (n = 6), drug malcompliance due to forgetfulness (n = 4) and psychiatric disease (n = 1). Underuse of anticoagulation occurred only in three patients (4%, unclear reasons in two patients, patient's unwillingness in one patient). Conclusion: We did not observe substantial underuse of anticoagulation in patients with atrial fibrillation.

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PP-024 Recurrent pericardial effusion complicated by cardiac tamponade due to brucellosis

International Journal of Infectious Diseases ◽

10.1016/s1201-9712(11)60177-x ◽

2011 ◽

Vol 15 ◽

pp. S52

Author(s):

F. Abbasi ◽

M. Mardani

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Recurrent Pericardial Effusion

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Probable Hydrochlorothiazide-Induced Myopericarditis: First Case Reported

Case Reports in Medicine ◽

10.1155/2015/319086 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Toufik Mahfood Haddad ◽

Muhammad Sarfraz Nawaz ◽

Ahmed S. Abuzaid ◽

Smrithy Upadhyay ◽

Pallavi Bellamkonda ◽

...

Keyword(s):

Pericardial Effusion ◽

Past History ◽

Uncontrolled Hypertension ◽

African American Female ◽

Pericardial Disease ◽

First Case ◽

Segmental Wall Motion ◽

Segmental Wall ◽

History Of ◽

Artery Disease

Hydrochlorothiazide has never been reported as a reason for myopericarditis. An African American female, with past history of hypertension, coronary artery disease, and sulfa allergy, presented with indolent onset and retrosternal chest pain which was positional, pleuritic, and unresponsive to sublingual nitroglycerin. Her medications included hydrochlorothiazide (HCTZ) which was started three months ago for uncontrolled hypertension. Significant laboratory parameters included erythrocyte sedimentation rate (ESR) of 47 mm/hr and peak troponin of 0.26 ng/mL. Transthoracic echocardiogram (TTE) revealed preserved ejection fraction with no segmental wall motion abnormalities; however, it showed moderate pericardial effusion without tamponade physiology. We hypothesize that this myopericarditis could be due to HCTZ allergic reaction after all other common etiologies have been ruled out. There is a scarcity of the literature regarding HCTZ as an etiology for pericardial disease, with only one case reported as presumed hydrochlorothiazide-induced pericardial effusion. Management involves discontinuation of HCTZ and starting anti-inflammatory therapy.

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Unusual case of Marchiafava-Bignami disease presenting as axial hypotonia

Vojnosanitetski pregled ◽

10.2298/vsp160523099m ◽

2019 ◽

Vol 76 (6) ◽

pp. 645-647

Author(s):

Svetlana Miletic-Drakulic ◽

Jasna Jevdjic ◽

Dejan Aleksic ◽

Gordana Toncev

Keyword(s):

Alcohol Consumption ◽

Corpus Callosum ◽

Motor Coordination ◽

Early Recognition ◽

Medical Emergency ◽

First Case ◽

Heavy Alcohol Consumption ◽

History Of ◽

Acute Form ◽

The Brain

Introduction. Marchiafava-Bignami disease is a rare disorder mostly associated with chronic heavy alcohol consumption that results in progressive demyelination and necrosis of the corpus callosum. Case report. We reported a 35-year-old woman with a history of alcohol consumption and malnutrition. Neurological examination revealed axial hypotonia, dysarthric speech and lack of motor coordination. The brain multislice computed tomography imaging demonstrated hypodense lesion of the corpus callosum. On the basis of her history, clinical features and imaging studies, the diagnosis of an acute form of Marchiava-Bignami disease was made. Definite diagnosis was confirmed at autopsy. Conclusion. Marchiafava-Bignami disease is of a medical emergency and early recognition and early aggressive treatment are critical for a good clinical outcome. To our knowledge, this is the first case of Marchiafava-Bignami disease presented with axial hypotonia.

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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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Candidate Criteria for Living Versus Deceased Donor Liver Grafts

10.1093/oso/9780197618202.003.0014 ◽

2021 ◽

pp. 327-349

Author(s):

Lainie Friedman ◽

J. Richard Thistlethwaite, Jr

Keyword(s):

Liver Transplant ◽

Living Donor ◽

Suicide Attempts ◽

Deceased Donor ◽

Young Female ◽

Donor Liver ◽

First Case ◽

Living Donor Liver Transplant ◽

History Of ◽

Donor Liver Transplant

This chapter explores whether living donor liver transplant (LDLT) is morally permissible when the candidate is ineligible for a deceased donor liver transplant (DDLT). Two cases are evaluated: a woman with metastatic colorectal cancer (CRC) and a young female liver transplant recipient with a history of multiple suicide attempts who is in acute liver failure due to another intentional drug overdose. Although both women could benefit (gain life years) from liver transplant, neither is deemed eligible for DDLT by their transplant teams because of a short post-transplant life expectancy in the first case and expected poor organ stewardship in the second case. This chapter argues that LDLT is morally permissible in candidates ineligible for DDLT if the living donor provides a voluntary informed consent, knows he or she can withdraw at any time, and understands that the recipient candidate will not be listed for a DDLT should the LDLT fail.

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