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The Journal of Trauma and Acute Care... Apr 2019
Topics: Abdominal Injuries; Aneurysm, False; Cardiopulmonary Bypass; Computed Tomography Angiography; Heart Ventricles; Hemothorax; Humans; Lung Injury; Male; Middle Aged; Pericardial Window Techniques; Postoperative Complications; Reoperation; Syncope; Thoracic Injuries; Thoracic Surgery, Video-Assisted; Wounds, Gunshot
PubMed: 30629012
DOI: 10.1097/TA.0000000000002189 -
BMJ Case Reports Aug 2018A 61-year-old Caucasian man presented with a fever of unknown origin, a transient erythematous rash on his right upper extremity and chest pressure after being treated...
A 61-year-old Caucasian man presented with a fever of unknown origin, a transient erythematous rash on his right upper extremity and chest pressure after being treated for erythema migrans (Lyme disease). Echocardiogram demonstrated a large pericardial effusion with tamponade. He underwent pericardiostomy with tube placement. Workup for infectious and malignant etiologies was negative. Histology of the pericardium showed acute on chronic fibrinous haemorrhagic pericarditis. The patient met criteria for adult-onset Still's disease. Symptoms resolved following treatment with methylprednisolone and anakinra. We believe this is the first case of adult-onset Still's disease precipitated by acute Lyme disease.
Topics: Age of Onset; Antirheumatic Agents; Cardiac Tamponade; Glucocorticoids; Humans; Interleukin 1 Receptor Antagonist Protein; Lyme Disease; Male; Methylprednisolone; Middle Aged; Pericardial Effusion; Still's Disease, Adult-Onset
PubMed: 30115716
DOI: 10.1136/bcr-2018-225517 -
Experimental and Clinical... Aug 2019Pneumopericardium is a rare cause of cardiac tamponade, and it is an extremely rare complication of liver transplant. Here, we present a patient with cryptogenic liver...
Pneumopericardium is a rare cause of cardiac tamponade, and it is an extremely rare complication of liver transplant. Here, we present a patient with cryptogenic liver cirrhosis who experienced cardiac tamponade secondary to a tension pneumopericardium during the postoperative course after liver transplant.
Topics: Cardiac Tamponade; Humans; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Pericardial Window Techniques; Pneumopericardium; Treatment Outcome
PubMed: 30066625
DOI: 10.6002/ect.2017.0287 -
Journal of Cardiothoracic Surgery Jul 2018Pericardial effusion (PE) is a common finding in patients who have chronic cardiac failure, who had undergone cardiac surgery, or who have certain other benign and...
BACKGROUND
Pericardial effusion (PE) is a common finding in patients who have chronic cardiac failure, who had undergone cardiac surgery, or who have certain other benign and malignant diseases. Pericardial drainage procedures are often requested for both diagnostic and therapeutic purposes. The perceived benefit is that it allows for diagnosis of malignancy or infection for patients with PEs of unclear etiology. The purpose of the study is to determine the diagnostic yield of surgical drainage procedures.
METHODS
We conducted a retrospective chart review of patients who underwent surgical drainage procedures of PEs from July 1st, 2011 to January 1st, 2017 at a single institution. The variables included data on preoperative, intraoperative, and postoperative findings; morbidity; and survival.
RESULTS
A total of 145 patients with an average age of 61 ± 5 and primarily men (53%) were evaluated. All of the surgical drainage procedures were performed through the sub-xiphoid approach. Twenty-five of the 145 patients (17.2%) had diagnostic findings in either the pericardial tissue or fluid. The cytology alone was diagnostic in 4.8% (N = 7) of patients with mixed findings including adenocarcinoma of the lung and breast. The pathology was diagnostic for cancer in 1.4% (N = 2) of patients with Melanoma and Lung cancer identified. The cytology and pathology were concordant in 4.0% (N = 6) identifying cancers that included mesothelioma and adenocarcinoma. Infection was identified in the pericardial fluid in 6.9% (N = 10) of the patients.
CONCLUSION
Surgical pericardial drainage procedures allow for removal of PE that may lead to tamponade physiology and potential mortality. Although there is therapeutic benefit from these procedures there is only a small diagnostic benefit.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pericardial Window Techniques; Pericardium; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 30021617
DOI: 10.1186/s13019-018-0774-x -
BMJ Case Reports Jun 2018A 72-year-old Chinese man presented with mild symptoms of heart failure. Transthoracic echocardiography showed signs of cardiac tamponade though clinically he was...
A 72-year-old Chinese man presented with mild symptoms of heart failure. Transthoracic echocardiography showed signs of cardiac tamponade though clinically he was relatively well. The option of pericardiocentesis was not carried out due to a narrow window for aspiration with only a thin layer of effusion seen surrounding the apex and right ventricle on subcostal view.Pericardial window was done via a left anterolateral thoracotomy. Intraoperatively, 500 cm of purulent fluid was drained. Microbiology screens were all negative. We present the atypical clinical course of this elderly man presenting with a large pyopericardium.
Topics: Aged; Cardiac Tamponade; Drainage; Echocardiography; Humans; Male; Medical Illustration; Pericardial Effusion; Pericardial Window Techniques; Pericardium; Thoracotomy
PubMed: 29950501
DOI: 10.1136/bcr-2018-224741 -
BMJ Case Reports Feb 2018A 59-year-old woman with paroxysmal atrial fibrillation (AF) presented with severe non-productive cough, malaise, low-grade fever and AF flare-up 3 weeks following...
A 59-year-old woman with paroxysmal atrial fibrillation (AF) presented with severe non-productive cough, malaise, low-grade fever and AF flare-up 3 weeks following pulmonary vein isolation with radiofrequency catheter ablation. She denied chest pain or dyspnoea. Patient was haemodynamically stable. There was no pulsus paradoxus. Laboratories showed leucocytosis and elevated C-reactive protein. ECG showed sinus tachycardia. CT abdomen and pelvis showed a large pericardial effusion (PE). Shortly after admission, she developed AF with rapid ventricular response, responsive to intravenous amiodarone. Transthoracic echocardiogram revealed 2.4 cm posterior PE without tamponade physiology, non-amenable to pericardiocentesis via sub-xiphoid approach. Patient underwent left thoracoscopic pericardial window with removal of 250 cc bloody fibrinous fluid. Cough improved significantly and she was discharged on oral amiodarone and apixaban. Repeat CT chest after 2 weeks for recurrent cough showed a small PE, treated with oral prednisone for suspected postablation pericarditis, with complete resolution of cough. Amiodarone was stopped without recurrence of AF.
Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Catheter Ablation; Cough; Echocardiography; Female; Fever; Humans; Middle Aged; Pericardial Effusion; Pericardial Window Techniques; Pericarditis; Postoperative Complications; Prednisone; Pyrazoles; Pyridones; Recurrence; Treatment Outcome
PubMed: 29437733
DOI: 10.1136/bcr-2017-222327 -
Journal of Medical Case Reports Jan 2018Cytomegalovirus infection is known to cause symptomatic disease in immunocompromised patients, while an infection in immunocompetent individuals normally causes few or...
BACKGROUND
Cytomegalovirus infection is known to cause symptomatic disease in immunocompromised patients, while an infection in immunocompetent individuals normally causes few or no symptoms. We present the case of an immunocompetent adult patient with unexpected severe evolution.
CASE PRESENTATION
An otherwise healthy, 72-year-old Caucasian woman presented with complaints of progressive shoulder pain and dyspnoea on exertion. The blood test results showed elevated inflammation parameters and elevated hepatic transaminase levels. Radiologic examinations were carried out, and the computed tomography scan revealed a hepatomegaly and a chest X-ray showed evidence of a unilateral pleural effusion. A transthoracic echocardiography detected pericardial effusion with consecutive hemodynamic changes. Since it was considered that using ultrasound-guided pericardiocentesis could significantly increase the risk of liver injury due to hepatomegaly, a pericardial window was performed instead. Further investigation showed that our patient tested positive for an acute cytomegalovirus infection in the serologic tests. Laboratory findings included new evidence of immunoglobulin M seroconversion and high immunoglobulin G avidity, so we considered the possibility that a former cytomegalovirus infection may be coexisting with a new cytomegalovirus reinfection.
CONCLUSIONS
In immunocompetent individuals, a symptomatic cytomegalovirus primary infection or reinfection should be considered in patients presenting with pericardial effusion and serositis.
Topics: Aged; Cytomegalovirus; Cytomegalovirus Infections; Echocardiography; Female; Hepatomegaly; Humans; Immunocompetence; Immunoglobulin G; Immunoglobulin M; Pericardial Effusion; Pericardial Window Techniques; Radiography; Recurrence; Seroconversion; Tomography, X-Ray Computed
PubMed: 29347961
DOI: 10.1186/s13256-017-1542-6 -
Korean Circulation Journal Nov 2017A 40-year-old male patient underwent radiofrequency catheter ablation for symptomatic paroxysmal atrial fibrillation (AF). Although pulmonary vein (PV) isolation was...
A 40-year-old male patient underwent radiofrequency catheter ablation for symptomatic paroxysmal atrial fibrillation (AF). Although pulmonary vein (PV) isolation was successfully completed without acute complications, the patient began complaining of sustained retrosternal pain. Seventeen days after ablation, the patient visited the emergency room with fever and severe chest pain with pericarditis-like features. Chest computed tomography (CT) revealed clustered air bubbles in the pericardial space. Esophagography confirmed leakage of contrast agent into the pericardial space but not into the left atrium. While performing pericardiostomy, the operator confirmed the absence of active bleeding from the left atrium. Because there were no signs of left atrial-esophageal fistula, such as systemic embolization, conservative management based on strict fasting with fluids and antibiotic therapy was undertaken. Follow-up esophagography performed 2 weeks later showed no more contrast agent leakage, and the patient was discharged without further incident.
PubMed: 29171210
DOI: 10.4070/kcj.2016.0364 -
Methods (San Diego, Calif.) Sep 2017Pathologists rely on microscopy to diagnose disease states in tissues and organs. They utilize both high-resolution, high-magnification images to interpret the staining...
Pathologists rely on microscopy to diagnose disease states in tissues and organs. They utilize both high-resolution, high-magnification images to interpret the staining and morphology of individual cells, as well as low-magnification overviews to give context and location to these cells. Intravital imaging is a powerful technique for studying cells and tissues in their native, live environment and can yield sub-cellular resolution images similar to those used by pathologists. However, technical limitations prevent the straightforward acquisition of low-magnification images during intravital imaging, and they are hence not typically captured. The serial acquisition, mosaicking, and stitching together of many high-resolution, high-magnification fields of view is a technique that overcomes these limitations in fixed and ex vivo tissues. The technique however, has not to date been widely applied to intravital imaging as movements caused by the living animal induce image distortions that are difficult to compensate for computationally. To address this, we have developed techniques for the stabilization of numerous tissues, including extremely compliant tissues, that have traditionally been extremely difficult to image. We present a novel combination of these stabilization techniques with mosaicked and stitched intravital imaging, resulting in a process we call Large-Volume High-Resolution Intravital Imaging (LVHR-IVI). The techniques we present are validated and make large volume intravital imaging accessible to any lab with a multiphoton microscope.
Topics: Animals; Cell Movement; Fluorescent Dyes; Intravital Microscopy; Mice; Mice, Inbred C57BL; Microscopy, Fluorescence, Multiphoton; Pericardial Window Techniques; Single-Cell Analysis; Time-Lapse Imaging
PubMed: 28911733
DOI: 10.1016/j.ymeth.2017.07.019 -
BMJ Case Reports Aug 2017An 80-year-old woman initially presented with an episode of pleuritic chest pain 10 days after implantation of a dual chamber permanent pacemaker. She returned to...
An 80-year-old woman initially presented with an episode of pleuritic chest pain 10 days after implantation of a dual chamber permanent pacemaker. She returned to hospital a day later with vomiting and fever. She was found to have new atrial fibrillation in addition to right-sided weakness and dysarthria. An infarct in the left anterior inferior cerebellar artery territory was later confirmed on CT. She continued to have recurrent febrile episodes associated with vomiting and dyspnoea. Extensive investigations for infection were negative, and her symptoms were initially attributed to aspiration pneumonia. The patient gradually deteriorated despite antibiotics and became progressively short of breath, with development of large pleural and pericardial effusions. A diagnosis of postcardiac injury syndrome was made after exclusion of other differentials. The patient recovered well after pleurocentesis, pericardiocentesis and a pericardial window, with resolution of symptoms without further medical therapy.
Topics: Aged, 80 and over; Arrhythmias, Cardiac; Female; Humans; Pacemaker, Artificial; Pericardial Effusion; Pericardial Window Techniques; Postoperative Complications; Stroke; Treatment Outcome
PubMed: 28801329
DOI: 10.1136/bcr-2017-220572