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Cardio-oncology (London, England) Feb 2024This article provides an up-to-date overview of pericardial effusion in oncological practice and a guidance on its management. Furthermore, it addresses the question of... (Review)
Review
BACKGROUND
This article provides an up-to-date overview of pericardial effusion in oncological practice and a guidance on its management. Furthermore, it addresses the question of when malignancy should be suspected in case of newly diagnosed pericardial effusion.
MAIN BODY
Cancer-related pericardial effusion is commonly the result of localization of lung and breast cancer, melanoma, or lymphoma to the pericardium via direct invasion, lymphatic dissemination, or hematogenous spread. Several cancer therapies may also cause pericardial effusion, most often during or shortly after administration. Pericardial effusion following radiation therapy may instead develop after years. Other diseases, such as infections, and, rarely, primary tumors of the pericardium complete the spectrum of the possible etiologies of pericardial effusion in oncological patients. The diagnosis of cancer-related pericardial effusion is usually incidental, but cancer accounts for approximately one third of all cardiac tamponades. Drainage, which is mainly attained by pericardiocentesis, is needed when cancer or cancer treatment-related pericardial effusion leads to hemodynamic impairment. Placement of a pericardial catheter for 2-5 days is advised after pericardial fluid removal. In contrast, even a large pericardial effusion should be conservatively managed when the patient is stable, although the best frequency and timing of monitoring by echocardiography in this context are yet to be established. Pericardial effusion secondary to immune checkpoint inhibitors typically responds to corticosteroid therapy. Pericardiocentesis may also be considered to confirm the presence of neoplastic cells in the pericardial fluid, but the yield of cytological examination is low. In case of newly found pericardial effusion in individuals without active cancer and/or recent cancer treatment, a history of malignancy, unremitting or recurrent course, large effusion or presentation with cardiac tamponade, incomplete response to empirical therapy with nonsteroidal anti-inflammatory, and hemorrhagic fluid at pericardiocentesis suggest a neoplastic etiology.
PubMed: 38365812
DOI: 10.1186/s40959-024-00207-3 -
Cureus Jan 2024Purulent pericarditis is a rare but serious medical condition caused by an infection that spreads to the pericardial space surrounding the heart. Gram-positive organisms...
Purulent pericarditis is a rare but serious medical condition caused by an infection that spreads to the pericardial space surrounding the heart. Gram-positive organisms are the most common pathogens associated with purulent pericarditis. However, there has been a shift in recent years toward gram-negative bacteria. is a rare pathogen that has never been linked to purulent pericarditis. In this report, we describe the case of a 40-year-old male patient with chronic bronchiectasis who, two months after suffering an injury, developed purulent pericarditis due to an uncommon organism, . During his stay in the hospital, the patient developed several infections caused by These included bacteremia and ventilator-associated pneumonia (VAP). Beta-lactamase-inducible was grown in pericardial fluid culture following an emergency pericardiocentesis. The organism was resistant to carbapenems in a sputum culture, even though it was sensitive to meropenem in a blood culture. The patient had hypotension, requiring inotropes, and continued persistent bacteremia due to . The patient had a heart attack with no pulse or electrical activity and died despite getting the best care possible. In light of this example, it is crucial to think about and other rare organisms as possible pathogens in purulent pericarditis, especially in people who do not normally have known risk factors for this condition. Multidrug resistance patterns can make treatment more complicated, and aggressive care may be necessary in critically ill patients with chronic bacteremia.
PubMed: 38361706
DOI: 10.7759/cureus.52378 -
JACC. Case Reports Feb 2024This is a case of a 59-year-old man presenting with myopericarditis. Over a 2-week period, he developed progressive symptoms and worsening pericardial effusion, leading...
This is a case of a 59-year-old man presenting with myopericarditis. Over a 2-week period, he developed progressive symptoms and worsening pericardial effusion, leading to cardiac tamponade. Pericardiocentesis revealed hemopericardium, and multidetector computed tomography angiography showed left ventricular free wall rupture. The patient collapsed abruptly, and autopsy confirmed the findings.
PubMed: 38361552
DOI: 10.1016/j.jaccas.2023.102178 -
European Journal of Case Reports in... 2024Pericardial effusion is common in the setting of rheumatoid arthritis (RA); however, it is rarely its first manifestation.
INTRODUCTION
Pericardial effusion is common in the setting of rheumatoid arthritis (RA); however, it is rarely its first manifestation.
CASE DESCRIPTION
An 82-year-old male presented with abdominal pain, vomiting and fever. Blood analysis revealed elevated systemic inflammatory markers, and an abdominal computed tomography scan revealed non-specific alveolar condensation of the right pulmonary base and pericardial effusion subsequently quantified as medium size by transthoracic echocardiography. A large aetiological panel was requested, with the autoimmunity study revealing high levels of rheumatoid factor (RF) and anti-citrullinated cyclic peptide (anti-CCP) antibodies. Since the patient did not present articular involvement, the initial hypothesis was pericardial effusion due to pneumonia and no specific treatment for RA was started. At follow-up, the pericardial effusion recurred and a pericardiocentesis was performed. The pericardial fluid analysis was sterile, and no malignant cells were identified. A new serological study confirmed high levels of RF and anti-CCP antibodies, and immunomodulatory treatment was initiated. After one year, the pericardial effusion recurred due to non-compliance with immunomodulatory therapy. A surgical pleuro-pericardial window was performed, and the cytological study of the pericardial patch revealed submesothelial thickening and foci of perivascular lymphocytic infiltrate. The patient remained asymptomatic.
DISCUSSION
After exclusion of a large spectrum of infectious and non-infectious causes and the relapse after suspension of immunomodulatory treatment, the most probable aetiology for the pericardial effusion remains RA.
CONCLUSION
Pericardial syndromes can be the first manifestation of AR even in the absence of articular symptoms and this disease must be considered in the aetiological investigation.
LEARNING POINTS
The occurrence of pericardial effusion in the setting of rheumatoid arthritis (RA) is a usual finding but this form of extra-articular manifestation is possibly the first and only presentation of the disease.In the case of recurrent pericardial effusion, the diagnosis of RA must be considered in the aetiological investigation even in the absence of more common manifestations of the disease.
PubMed: 38352820
DOI: 10.12890/2024_004159 -
Cureus Jan 2024Pericardial effusion is a rare manifestation of tuberculosis (TB) that can present as a life-threatening emergency. It poses a diagnostic challenge, as its clinical...
Pericardial effusion is a rare manifestation of tuberculosis (TB) that can present as a life-threatening emergency. It poses a diagnostic challenge, as its clinical presentation may mimic other more common causes of acute cardiac emergencies. Emergency physicians should maintain a high index of suspicion for tuberculosis, particularly in regions where the prevalence of the disease is high. This case report is about a 17-year-old girl who presented to the emergency room with dyspnea, chest discomfort, and hemodynamic instability consistent with cardiac tamponade. Urgent diagnostic procedures, including point-of-care ultrasound (POCUS) and pericardiocentesis, were crucial to the successful management of this patient.
PubMed: 38344602
DOI: 10.7759/cureus.52142 -
The Journal of Invasive Cardiology Feb 2024An emergency transradial coronary angiography in a 68-year-old woman demonstrated sub-total occlusion of the proximal left anterior descending artery.
An emergency transradial coronary angiography in a 68-year-old woman demonstrated sub-total occlusion of the proximal left anterior descending artery.
Topics: Female; Humans; Aged; Arterioles; Percutaneous Coronary Intervention; Coronary Angiography; Coronary Vessels
PubMed: 38335513
DOI: 10.25270/jic/23.00152 -
International Journal of Emergency... Feb 2024Emergency pericardiocentesis is a life-saving procedure that is performed to aspirate fluid from the pericardial space in patients who have severe pericardial effusion...
INTRODUCTION
Emergency pericardiocentesis is a life-saving procedure that is performed to aspirate fluid from the pericardial space in patients who have severe pericardial effusion that is causing hemodynamic compromise. The current gold standard for pericardial fluid aspiration is ultrasound-guided pericardiocentesis. Echocardiography with a low-frequency transducer has generally been used in pericardiocentesis, but this method lacks real-time visualization of the needle trajectory, leading to complications. Therefore, we describe a case involving an ultrasound-guided pericardiocentesis method using a novel in-plane technique with a lateral-to-medial approach via the right parasternal and a high-frequency probe. The method was performed for an infant with cardiac tamponade.
CASE PRESENTATION
We present a case of a 14-month-old male infant who was brought to the emergency room with a history of cough, shortness of breath, and fever following recurrent chest infections. Despite prior treatments, his condition deteriorated, and signs of cardiac tamponade were evident upon examination. Cardiopulmonary point-of-care ultrasound confirmed the presence of a large pericardial effusion with tamponade. Emergency pericardiocentesis was performed using the novel in-plane technique, resulting in successful fluid aspiration and stabilization of the patient's condition.
TECHNIQUE DESCRIPTION
The proposed technique involves positioning a high-frequency ultrasound probe over the right parasternal area to obtain real-time visualization of the needle trajectory and surrounding structures, including the sternum, right internal thoracic vessels, pleural sliding end point, pericardial effusion, and myocardium. The needle is inserted laterally to medially at a 45-degree angle, ensuring safe passage between the pleural sliding endpoint and the right internal thoracic vessels while reaching the pericardial effusion.
CONCLUSION
The presented technique provides real-time visualization of the needle and surrounding structures, which may potentially help to avoid complications and improve accuracy. The proposed technique may potentially enable access for emergency pericardiocentesis and for loculated pericardial effusion that has formed around the right atrium. Nevertheless, further studies with large patient populations are needed.
PubMed: 38302868
DOI: 10.1186/s12245-024-00592-7 -
Cureus Dec 2023While cardiac tamponade is a commonly recognized complication in solid organ malignancies and acute leukemias, instances of cardiac involvement in the context...
While cardiac tamponade is a commonly recognized complication in solid organ malignancies and acute leukemias, instances of cardiac involvement in the context of chronic hematologic malignancies, such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), are rarely observed. A 66-year-old male, with a history of stage IV CLL/SLL, presented with three weeks of worsening edema, orthopnea, and dyspnea. Two days after admission, an echocardiogram revealed a large circumferential pericardial effusion. Given the concern about early signs of pericardial tamponade, the patient underwent emergent pericardiocentesis with the removal of 700 cc of sanguineous fluid. A pericardial biopsy and flow cytometry of the pericardial fluid confirmed the diagnosis of CLL/SLL with pericardial involvement. There were no signs of large cell lymphoma transformation at that point. This rare case demonstrates the importance of considering cardiac complications in CLL/SLL patients who present with worsening edema, orthopnea, and dyspnea.
PubMed: 38288237
DOI: 10.7759/cureus.51271 -
The Pan African Medical Journal 2023Cardiac tamponade as the initial manifestation of Hashimoto's thyroiditis is an exceedingly uncommon occurrence. We present the case of a 36-year-old female who was...
Cardiac tamponade as the initial manifestation of Hashimoto's thyroiditis is an exceedingly uncommon occurrence. We present the case of a 36-year-old female who was admitted due to acute respiratory distress. A cardiac ultrasound revealed a severe pericardial effusion with tamponade signs. Subsequently, percutaneous pericardiocentesis was performed, resulting in a swift clinical improvement. Laboratory examinations confirmed severe hypothyroidism associated with Hashimoto's disease. Despite undergoing hormone replacement therapy, histological analysis of the pericardium revealed a chronic inflammation process. A follow-up cardiac ultrasound conducted six months later indicated the presence of a well-tolerated chronic pericardial effusion. In conclusion, clinicians should consider hypothyroidism as a potential cause when cardiac tamponade is observed, particularly in the absence of tachycardia. The prognosis is generally favorable with hormone replacement therapy, but regular ultrasound monitoring should be maintained until the patient achieves a euthyroid state.
Topics: Female; Humans; Adult; Hashimoto Disease; Pericardial Effusion; Cardiac Tamponade; Hypothyroidism; Inflammation
PubMed: 38282768
DOI: 10.11604/pamj.2023.46.62.41687 -
Cureus Jan 2024Undifferentiated carcinoma (or poorly differentiated carcinoma) of the mediastinum is a relatively rare pathological variant of anterior mediastinal tumors. Pathologists...
Undifferentiated carcinoma (or poorly differentiated carcinoma) of the mediastinum is a relatively rare pathological variant of anterior mediastinal tumors. Pathologists usually use the term to describe an epithelial tumor with no histological features that enable the identification of its site of origin. Invasion of adjacent vital cardiopulmonary structures is among the most problematic complications of anterior mediastinal masses. We report a case of a 60-year-old male presenting with easy fatiguability, significant weight loss, and chest pain. A CT scan of the chest revealed a large anterior mediastinal mass, compression of the main pulmonary artery, and a large pericardial effusion. The patient underwent pericardiocentesis, emergent radiotherapy, and platinum-based chemotherapy. His condition dramatically improved, and he was subsequently discharged home for further follow-up.
PubMed: 38268992
DOI: 10.7759/cureus.52789