Tuberculous Pericarditis Causing Severe Pericardial Effusion: A Case Study

Aims Tuberculous pericarditis is present in only one to two percent of the tuberculosis cases, i.e. considered rare. The disease is responsible for 4% and 7% of acute pericarditis and cardiac tamponade cases, respectively. Moreover, these conditions are associated with hazardous side effects. Thus, timely and precise diagnosis of the disease could prevent such complications. Case report We reported an 85-year-old male case who was referred with clinical signs of breath shortness, cardiac murmur, and swollen jugular veins. Besides, the relevant laboratory findings indicated elevated white blood cell counts (11.6). In addition, other diagnostic measures, such as thoracic radiography and echocardiography were performed on the patient. Then, the diagnosis indicated a 28mm diameter of pericardial fluid; accordingly, the patient was selected as a candidate for emergency pericardiotomy. The fluid was drained, and therapeutic medication, as well as antibiotics were administered for the patient. Finally, the patient was discharged with an appropriate general condition. Conclusion A sample of pericardial fluid was tested using polymerase chain reaction)method for the diagnosis of tuberculosis, which provided a positive result. Considering the dangerous complications of this disease, it is recommended for all patients who could suction severe pericardial effusion to be tested for this disease.

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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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Pericardial Fluid in a COVID-19 Patient: Is It Exudate or Transudate?

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001703 ◽

2020 ◽

Author(s):

Hassan H Allam ◽

Abdulhalim Jamal Kinsara ◽

Tareq Tuaima ◽

Shadwan Alfakeh

Keyword(s):

Lactate Dehydrogenase ◽

Pericardial Effusion ◽

Pericardial Fluid ◽

Case Description ◽

Limited Information ◽

Additional Insight ◽

Laboratory Findings ◽

Large Pericardial Effusion ◽

Insight Into ◽

High Lactate

Background: Very limited information is available on pericardial effusion as a complication of COVID-19 infection. There are no reports regarding pericardial fluid findings in COVID-19 patients. Case description: We describe a 41-year-old woman, with confirmed COVID-19, who presented with a large pericardial effusion. The pericardial fluid was drained. We present the laboratory findings to improve knowledge of this virus. Discussion: We believe this is the first such reported case. Findings suggested the fluid was exudative, with remarkably high lactate dehydrogenase and albumin levels. We hope our data provide additional insight into the diagnosis and therapeutic options for managing this infection.

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Pericardial diseases

10.1093/med/9780199643219.003.0009 ◽

2012 ◽

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Tuberculous Pericarditis ◽

Pericardial Diseases ◽

Effusive Constrictive Pericarditis

Aetiology 460Syndromes of pericardial disease 461Acute pericarditis without effusion 461Pericardial effusion with or without tamponade 462Constrictive pericarditis 464Effusive-constrictive pericarditis 465Calcific pericarditis without constriction 465Viral pericarditis 466Tuberculous pericarditis 468Uraemic pericarditis 469Neoplastic pericardial disease 470Myxoedematous effusion ...

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An Unusual Presentation of Tuberculous Pericardial Effusion

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1014 ◽

2009 ◽

Vol 1 (3) ◽

pp. 71-72

Author(s):

Shaheen LNU ◽

Rajyashri Sharma ◽

Parvez Anjum ◽

Pathak Jayshree

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Pericardial Fluid ◽

Accurate Diagnosis ◽

Unusual Presentation ◽

Severe Bleeding ◽

Acute Pericarditis ◽

Prompt Treatment ◽

Antitubercular Treatment ◽

Life Saving

ABSTRACT Tuberculosis accounts for upto 4% of acute pericarditis and 7% cases of cardiac tamponade. 19% of women with tuberculosis can present with menorrhagia. Prompt treatment can be life saving but requires accurate diagnosis. We report a case of 25-year-old women who presented with severe bleeding per vaginum for four days. She was in shock. Echocardiography showed moderate pericardial effusion with features of cardiac tamponade. ADA was positive in aspirated pericardial fluid. The patient responded well to antitubercular treatment.

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Cardiac manifestations of tuberculosis in a tertiary care center of Nepal

Nepalese Heart Journal ◽

10.3126/njh.v15i1.19714 ◽

2018 ◽

Vol 15 (1) ◽

pp. 35-38

Author(s):

Smriti Shakya ◽

Sunil Chandra Jha

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Care Center ◽

Tertiary Care ◽

Pericardial Fluid ◽

Age Group ◽

Acute Pericarditis ◽

Old Patients ◽

Large Pericardial Effusion ◽

2D Echocardiography

Background and Aims: Tuberculosis remains an important etiological cause of pericarditis and pericardial effusion in developing countries like Nepal. The objective of this study is to identify the various presentations of tuberculous pericarditis along with the demographic profile in our context and their short term outcome.Methods: We studied 53 patients from September 2015 to August 2017 regardless of age and gender who presented to Manmohan Cardiothoracic Vascular and Transplant Center with pericarditis of tubercular origin. The various manifestations of the disease were categorized with 2D echocardiography. Pericardiocentesis was done in patients with large pericardial effusion especially in cardiac tamponade and pericardiectomy done in chronic constrictive pericarditis(CCP). Antitubercular therapy with steroids was instituted.Results: Out of 53 patients, 62% were male and 38% were female. The ages ranged from 6-71 years (42±19.5). Twenty three percent of patients were from the age group 61-70yrs, 20% seen in age group 21-30 years, 8% in less than 10 yrs and 2% in above 70yrs old patients. The most common manifestation seen was large pericardial effusion (32%), followed by CCP (22.6%), 19% presented in cardiac tamponade, 2% had pyopericardium, 2% had perimyocarditis and 4% had acute pericarditis. Adenosine deaminase (ADA) was positive in 75% of the cases when pericardial fluid was tapped. Two patients developed CCP during follow up. Two patients succumbed to death during hospital stay.Conclusion: A high index of suspicion of tubercular pericarditis is inevitable in our settings where other sophisticated investigations are still lacking.Nepalese Heart Journal 2018; 15(1) 35-38

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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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Desquamation in Kawasaki Disease

Children ◽

10.3390/children8050317 ◽

2021 ◽

Vol 8 (5) ◽

pp. 317

Author(s):

Ling-Sai Chang ◽

Ken-Pen Weng ◽

Jia-Huei Yan ◽

Wan-Shan Lo ◽

Mindy Ming-Huey Guo ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Laboratory Data ◽

Ivig Treatment ◽

Low Grade ◽

High Grade ◽

Laboratory Findings ◽

Coronary Artery Abnormalities ◽

Cell Counts ◽

Hands And Feet

(1) Background: Desquamation is a common characteristic of Kawasaki disease (KD). In this study, we analyzed patients’ varying desquamation levels in their hands or feet, in correlation with clinical presentation, to assess the relationship. (2) Methods: We retrospectively reviewed children with KD. We analyzed their age, laboratory data before intravenous immunoglobulin (IVIG) treatment and coronary artery abnormalities (CAA) based on the desquamation level of their hands and feet. We classified the desquamation level from 0 to 3 and defined high-grade desquamation as grade 2 and 3. (3) Results: We enrolled a total 112 patients in the study. We found the hands’ high-grade desquamation was positively associated with age and segmented neutrophil percentage (p = 0.047 and 0.029, respectively) but negatively associated with lymphocyte and monocyte percentage (p = 0.03 and 0.006, respectively). Meanwhile, the feet’s high-grade desquamation was positively associated with total white blood cell counts (p = 0.033). Furthermore, we found that high-grade hand desquamation had less probability of CAA formation compared with that of a low grade (7.1% vs. 40.8%, p = 0.016). (4) Conclusions: This report is the first to demonstrate that the desquamation level of hands or feet in KD is associated with different coronary artery abnormalities and laboratory findings.

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Malignant pericardial effusion complicated by cardiac tamponade under atezolizumab

SAGE Open Medical Case Reports ◽

10.1177/2050313x211036005 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110360

Author(s):

Lardinois Benjamin ◽

Goeminne Jean-Charles ◽

Miller Laurence ◽

Randazzo Adrien ◽

Laurent Terry ◽

...

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Cardiac Toxicity ◽

Checkpoint Inhibitors ◽

Final Diagnosis ◽

Pericardial Fluid ◽

Malignant Pericardial Effusion ◽

Typical Cell ◽

High Fluorescence ◽

Tomography Scan

Immune-related adverse events including cardiac toxicity are increasingly described in patients receiving immune checkpoint inhibitors. We described a malignant pericardial effusion complicated by a cardiac tamponade in an advanced non-small cell lung cancer patient who had received five infusions of atezolizumab, a PDL-1 monoclonal antibody, in combination with cabozantinib. The definitive diagnosis was quickly made by cytology examination showing typical cell abnormalities and high fluorescence cell information provided by the hematology analyzer. The administration of atezolizumab and cabozantinib was temporarily discontinued due to cardiogenic hepatic failure following cardiac tamponade. After the re-initiation of the treatment, pericardial effusion relapsed. In this patient, the analysis of the pericardial fluid led to the final diagnosis of pericardial tumor progression. This was afterwards confirmed by the finding of proliferating intrapericardial tissue by computed tomography scan and ultrasound. This report emphasizes the value of cytology analysis performed in a hematology laboratory as an accurate and immediate tool for malignancy detection in pericardial effusions.

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SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

BMC Infectious Diseases ◽

10.1186/s12879-021-06456-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Heidi Luise Schulte ◽

José Diego Brito-Sousa ◽

Marcus Vinicius Guimarães Lacerda ◽

Luciana Ansaneli Naves ◽

Eliana Teles de Gois ◽

...

Keyword(s):

Clinical Signs ◽

Federal District ◽

Therapeutic Interventions ◽

Diagnostic Process ◽

The Novel ◽

Prevention Measures ◽

Laboratory Findings ◽

Novel Coronavirus ◽

The Impact

Abstract Background Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. Methods Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. Results Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. Conclusions The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic areas.

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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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