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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 -
Frontiers in Cardiovascular Medicine 2023Coronavirus disease (COVID-19)-associated acute pericarditis has recently received much attention owing to its high frequency associated with pericardial tamponade (PT),...
BACKGROUND
Coronavirus disease (COVID-19)-associated acute pericarditis has recently received much attention owing to its high frequency associated with pericardial tamponade (PT), showing unfavorable prognosis. However, early diagnosis and treatment remain challenging in cases of non-specific signs and symptoms.
CASE PRESENTATION
A 64-year-old man was admitted to our hospital for acute osteomyelitis of the toes and was properly treated with antimicrobial agents. Three days after admission, the patient developed mild COVID-19 without pneumonia, for which early anti-COVID-19 agents were initiated. Nevertheless, the patient developed hemorrhagic PT due to acute pericarditis 2 weeks later, which was confirmed by cardiac magnetic resonance, requiring an urgent pericardiocentesis. Although cytological analysis of the hemorrhagic pericardial fluid strongly suggested adenocarcinoma, the atypical cells were eventually proven to be mesothelial cells with reactive atypia. Furthermore, lymph nodes swelling with abnormal 2-[18F]-fluoro-2-deoxy-D-glucose accumulation on imaging were suggestive of malignancy. However, biopsy examination revealed multiple non-caseating granulomas in the lymph node, unlikely due to malignancy. Eventually, the temporal association of the preceding COVID-19 with the occurrence of subacute PT without other identifiable cause led to a final diagnosis of COVID-19-associated acute pericarditis. With anti-inflammatory and corticosteroids treatment, the patient's symptoms involving the pericardial structure and function were completely resolved along with improvements in size of the affected lymphadenopathies.
CONCLUSIONS
We encountered a unique case of COVID-19-associated acute pericarditis exhibiting hemorrhagic PT. This case underscores the residual risk of delayed pericardial involvement even in patients with mild COVID-19 who receive early treatment, and the recognition that COVID-19 may cause various cytomorphological and histological features. Additionally, the importance of considering this rare entity as a cause of hemorrhagic pericardial effusions should be highlighted.
PubMed: 38264260
DOI: 10.3389/fcvm.2023.1329952