-
Radiology Case Reports Sep 2023Cardiovascular disorders are significantly associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Herein, we describe a case of...
Cardiovascular disorders are significantly associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Herein, we describe a case of myopericarditis and subsequent transient constrictive pericarditis after coronavirus disease 2019 (COVID-19). Three weeks following a mild SARS-CoV-2 illness, a 53-year-old woman was referred to the hospital with acute pleuritic chest pain, which was not attributable to any known cause and was only temporarily relieved. The pain persisted for the next few weeks until her second COVID-19 infection, which occurred 5 months after her first affliction. This time, Transthoracic echocardiography (TTE) revealed mild pericardial effusion, and cardiac magnetic resonance imaging (CMR) confirmed myopericarditis, leading to the administration of anti-inflammatory therapy for the patient. Despite a relative resolution of symptoms, her second CMR performed 8 months later revealed active perimyocarditis with transient constrictive pericarditis (CP). Additionally, fluorescent antinuclear antibody (FANA) and antimitochondrial Ab M2 (AMA) were tested positive for the first time. Thereafter, the patient was started on concurrent anti-inflammatory and immunosuppressant therapies, which were effective after 3 months. The transient CP was resolved, and there was no sign of active pericarditis on her last echocardiography. Acute pericarditis and its subsequent constrictive pericarditis are infrequent adverse outcomes of COVID-19. The unique feature of this case is the uncertainty regarding the underlying reason for cardiac complications, whether it is the first presentation of systemic lupus erythematosus (SLE) or viral-induced myopericarditis followed by a consequent transient CP.
PubMed: 37359249
DOI: 10.1016/j.radcr.2023.05.071 -
BMC Cardiovascular Disorders Jun 2023Epipericardial fat necrosis (EFN) is a benign and self-limited condition of unknown cause with a good prognosis, usually affecting otherwise healthy patients....
Epipericardial fat necrosis in chest CT and MRI: a case report of an unusual cause of chest pain associated with the initial diagnosis of undifferentiated connective tissue disease.
BACKGROUND
Epipericardial fat necrosis (EFN) is a benign and self-limited condition of unknown cause with a good prognosis, usually affecting otherwise healthy patients. Clinically, it presents with severe acute left pleuritic chest pain, often leading the patient to the Emergency Room (ER).
CASE PRESENTATION
A 23-year-old male, smoker (5 pack-years), was evaluated in the ER due to left pleuritic chest pain, worsening with deep breathing and Valsalva maneuver. It was not associated with trauma and did not present other symptoms. The physical examination was unremarkable. The arterial blood gases while breathing room air and the laboratory tests, including D-dimers and high-sensitivity cardiac Troponin T, were normal. The chest radiograph, electrocardiogram, and transthoracic echocardiogram showed no abnormalities. A computed tomography (CT) pulmonary angiogram showed no signs of pulmonary embolism but depicted at the left cardiophrenic angle a focal 3 cm ovoid-shaped fat lesion with stranding and thin soft tissue margins, consistent with necrosis of the epicardial fat, which was confirmed by magnetic resonance (MRI) of the chest. The patient was medicated with ibuprofen and pantoprazole, with clinical improvement in four weeks. At a two-month follow-up, he was asymptomatic and presented radiologic resolution of the inflammatory changes of the epicardial fat of the left cardiophrenic angle on chest CT. Laboratory tests revealed positive antinuclear antibodies, positive anti-RNP antibody, and positive lupus anticoagulant. The patient complained of biphasic Raynaud's phenomenon initiated five years ago, and a diagnosis of undifferentiated connective tissue disease (UCTD) was made.
CONCLUSIONS
This case report highlights the diagnosis of EFN as a rare and frequently unknown clinical condition, which should be considered in the differential diagnosis of acute chest pain. It can mimic emergent conditions such as pulmonary embolism, acute coronary syndrome, or acute pericarditis. The diagnosis is confirmed by CT of the thorax or MRI. The treatment is supportive and usually includes non-steroidal anti-inflammatory drugs. The association of EFN with UCTD has not been previously described in the medical literature.
Topics: Male; Humans; Young Adult; Adult; Fat Necrosis; Undifferentiated Connective Tissue Diseases; Chest Pain; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Thorax; Pulmonary Embolism
PubMed: 37349709
DOI: 10.1186/s12872-023-03349-x -
Clinical Case Reports Jun 2023Nonspecific symptoms such as pleuritic or pericardial chest pain in cardiovascular implantable electronic devices patients, even with unremarkable ECG or device...
KEY CLINICAL MESSAGE
Nonspecific symptoms such as pleuritic or pericardial chest pain in cardiovascular implantable electronic devices patients, even with unremarkable ECG or device parameters, should always raise suspicion of electrode perforation, regardless of how long ago the implantation was performed.
ABSTRACT
We report the successful percutaneous management of a 77-year-old woman who had a dual-chamber pacemaker implanted more than 1 year ago and presented with pericarditis pain and compensated pericardial hemorrhagic tamponade. The symptoms were due to very late acute perforation of the atrial lead. This report is intended to raise awareness of procedure-related complications in the large group of cardiovascular implantable electronic device patients. Pleuritic or pericardial pain in these patients should raise suspicion of electrode perforation, as the risk of perforation is not restricted to the period immediately after implantation and a lifelong risk cannot apparently be excluded.
PubMed: 37327138
DOI: 10.1002/ccr3.7525 -
European Heart Journal. Case Reports Jun 2023Catheter ablation is a common treatment for atrial fibrillation (AF). Atrial-oesophageal fistula (AOF) is a rare yet fatal complication of catheter ablation. Chest...
BACKGROUND
Catheter ablation is a common treatment for atrial fibrillation (AF). Atrial-oesophageal fistula (AOF) is a rare yet fatal complication of catheter ablation. Chest computed tomography (CT) is the diagnostic modality of choice but may be undiagnostic in up to 24% of cases.
CASE SUMMARY
We present the case of a 61-year-old male who presented with pleuritic chest pain, hypotension, fever, and coffee-ground emesis 20 days after cryoablation for AF. His chest CT was undiagnostic. Atrial-oesophageal fistula was diagnosed by injecting agitated saline into the nasogastric tube during a transthoracic echocardiogram (TTE) that showed bubbles in the left atrium and ventricle.
DISCUSSION
In the case presented, as often happens, the diagnosis of AOF was delayed for several days, during which the patient presented with septic shock and concomitant multiorgan failure. The high mortality rate associated with AOF is partially attributable to delayed diagnosis. As prompt surgical intervention offers the best chance of survival, a high level of suspicion is of the utmost importance. We suggest contrast-enhanced TTE as a potential diagnostic tool when a rapid and definitive diagnosis is crucial and CT is inconclusive. Since this procedure is not without risk, proper risk consideration and management are necessary.
PubMed: 37323534
DOI: 10.1093/ehjcr/ytad254 -
Cureus May 2023Breast augmentation surgery, like any other surgery, has potential complications, including the less common complication of pleural effusion. We present a unique case of...
Breast augmentation surgery, like any other surgery, has potential complications, including the less common complication of pleural effusion. We present a unique case of a 44-year-old female who developed pleuritic chest pain and shortness of breath 10 days after her breast augmentation surgery, with no prior history of cardiac or autoimmune conditions. The temporal relationship between the surgery and the onset of symptoms suggested a possible direct link to the implants. Imaging showed a small- to moderate-sized left pleural effusion, and pleural fluid analysis revealed findings suggestive of a foreign body reaction (FBR), including evidence of mesothelial and inflammatory cells with a lymphocyte percentage of 44% and monocytes of 30%. The patient received intravenous steroids at a dose of 40 mg every eight hours for three days while hospitalized, followed by a tapered oral dose of steroids upon discharge, for over three weeks. Follow-up imaging studies showed complete resolution of the pleural effusion. The diagnosis of pleural effusion resulting from FBR to silicone gel-filled breast implants involves a clinical history, cytopathological examination, and the exclusion of other potential causes. This case highlights the importance of considering FBR as a potential cause of pleural effusion post-breast augmentation surgery.
PubMed: 37303460
DOI: 10.7759/cureus.38734 -
Cureus May 2023Libman-Sacks endocarditis is a rare cardiovascular manifestation of systemic lupus erythematosus. It is described as sterile vegetative lesions which can damage heart...
Libman-Sacks endocarditis is a rare cardiovascular manifestation of systemic lupus erythematosus. It is described as sterile vegetative lesions which can damage heart valves resulting in complications such as acute coronary syndrome and heart failure and can embolize to cause cerebral and renal infarcts. We present the case of a young African American female presenting with pleuritic chest pain. She was initially admitted for acute coronary syndrome. She was later found to have severe mitral regurgitation and eventually received a transesophageal echocardiogram which confirmed the diagnosis of Libman-Sacks endocarditis. Her course was complicated with acute diastolic heart failure and several embolic strokes in the watershed anterior cerebral artery/middle cerebral artery (ACA/MCA) territories. She was started on anticoagulation and antiplatelet agents. Her underlying lupus was treated with immunosuppressive agents. This case demonstrates that a high index of suspicion for Libman-Sacks is crucial in patients with lupus if presenting with cardiovascular symptoms. Early and prompt diagnosis can prevent and lessen the many side effects associated with thromboembolism.
PubMed: 37303379
DOI: 10.7759/cureus.38849 -
Cureus May 2023Angiosarcoma is a rare soft tissue sarcoma originating from endothelial cells. It can occur anywhere when there is a blood vessel or lymphatic channel, making highly...
Pulmonary Angiosarcoma With Synchronous Invasive Aspergillosis Presenting as Diffuse Alveolar Hemorrhage and Acute Kidney Injury: A Case Report of a Previously Unreported Combination Posing a Diagnostic Challenge.
Angiosarcoma is a rare soft tissue sarcoma originating from endothelial cells. It can occur anywhere when there is a blood vessel or lymphatic channel, making highly perfused cutaneous sites their usual location, though they can also develop within visceral structures. Pulmonary angiosarcoma is usually caused by metastasis from other primary sites. The clinical course of pulmonary angiosarcoma is very aggressive, and the prognosis is poor. We present a case of a 55-year-old man who presented to the hospital with progressive exertional dyspnea and right-sided pleuritic chest pain for the past few days. He was found to have recurrent anemia and acute kidney injury. His hospital course was complicated by the development of hypoxia and hemoptysis. Computed tomography of the chest without contrast revealed bilateral nodular, ground-glass opacities compatible with diffuse alveolar hemorrhage. Further investigation with a lung biopsy revealed epithelioid angiosarcoma with extensive microvascular tumor emboli and invasive pulmonary aspergillosis () with patchy necrotizing pneumonia. He later developed acute hypoxic respiratory failure and worsening kidney failure, so he was transferred to the intensive care unit. Upon discussing with the family, the patient was put on comfort measures, and he passed away the following day. We present a rare presentation of concurrence of pulmonary angiosarcoma and invasive aspergillosis. Upon searching the literature, our case is one of the first to report such concurrence. Because of its rarity, the non-specific clinical presentation makes the diagnosis challenging.
PubMed: 37284386
DOI: 10.7759/cureus.38507 -
Radiology Case Reports Aug 2023A pulmonary embolism (PE) occurs when a venous thrombotic material from the lower extremities embolizes to the pulmonary vasculature. Common presenting symptoms include...
A pulmonary embolism (PE) occurs when a venous thrombotic material from the lower extremities embolizes to the pulmonary vasculature. Common presenting symptoms include shortness of breath and pleuritic chest pain with vital signs demonstrating hypoxia, tachycardia, and tachypnea. In this paper, we describe a unique presentation of a critically ill patient who developed a saddle pulmonary embolism despite being on prophylactic anticoagulation.
PubMed: 37266377
DOI: 10.1016/j.radcr.2023.05.015 -
Einstein (Sao Paulo, Brazil) 2023Chest pain is a frequent, potentially life-threatening condition in the emergency department and requires immediate investigation and treatment. This case report...
Chest pain is a frequent, potentially life-threatening condition in the emergency department and requires immediate investigation and treatment. This case report highlights a rare differential diagnosis of pleuritic chest pain: epipericardial fat necrosis. A 29-year-old man presented with normal clinical evaluation, electrocardiography, point-of-care ultrasound, and unremarkable laboratory tests. The initial hypothesis was acute pleuritis. Chest radiography revealed peri-cardiac nonspecific findings, and computed tomography revealed epicardial fat necrosis. Despite the rarity of this condition, accurate diagnosis allows for better practices. An algorithm for a diagnostic approach is proposed.
Topics: Male; Humans; Adult; Fat Necrosis; Diagnosis, Differential; Chest Pain; Ultrasonography; Emergency Service, Hospital
PubMed: 37255060
DOI: 10.31744/einstein_journal/2023RC0183 -
Journal of Medical Case Reports May 2023Vibrio vulnificus is a gram-negative bacterium causing three clinical syndromes namely, gastrointestinal symptoms, skin sepsis and primary sepsis. Primary sepsis... (Review)
Review
BACKGROUND
Vibrio vulnificus is a gram-negative bacterium causing three clinical syndromes namely, gastrointestinal symptoms, skin sepsis and primary sepsis. Primary sepsis exhibits mortality rates exceeding 50%, particularly in the immunocompromised. Vibrio vulnificus is transmitted via consumption of contaminated seafood and contaminated seawater skin exposure. We describe a rare case of an immunocompetent male presenting with an atypical Vibrio vulnificus infection, culminating in severe pneumonia requiring intensive care.
CASE PRESENTATION
A 46 year old Indian male dockyard worker, a non-smoker and teetotaler, of Indian origin presented to the emergency treatment unit of a tertiary care hospital in Sri Lanka, with fever, productive cough with yellow sputum, pleuritic chest pain and tachypnea for five days. He had no gastrointestinal or skin manifestations. His respiratory rate was 38 breaths/min, pulse rate was 120 bpm, blood pressure was 107/75 mmHg and pulse oximetry was 85% on air. Chest X-ray revealed consolidation of the left lung. Empiric intravenous Piperacillin-tazobactam and Clarithromycin were commenced after obtaining blood and sputum cultures. Over the next 24 h, his oxygen requirement rose and as he required vasopressor support, he was admitted to the intensive care unit. He was intubated and bronchoscopy was performed on day two, which demonstrated thick secretions from left upper bronchial segments. His antibiotics were changed to intravenous ceftriaxone and doxycycline following a positive blood culture report of Vibrio vulnificus. He was ventilated for ten days and his intensive care stay was complicated with a non-oliguric acute kidney injury, with serum creatinine rising up to 8.67 mg/dL (0.81-0.44 mg/dL). He developed mild thrombocytopenia with platelets dropping to 115 × 10 /uL (150-450 × 10/uL) which resolved spontaneously. Vasopressors were weaned off by day eight and the patient was extubated on day ten. He was discharged from intensive care on day twelve and made a full recovery.
CONCLUSIONS
Pneumonia itself is an atypical manifestation of Vibrio vulnificus and furthermore, this patient was immunocompetent and did not exhibit the classical gastro-intestinal and skin manifestations. This case highlights the occurrence of atypical Vibrio sp. infections in patients with high exposure risks and the need for early supportive and appropriate antibiotic therapies.
Topics: Humans; Male; Middle Aged; Vibrio vulnificus; Anti-Bacterial Agents; Doxycycline; Sepsis; Multiple Organ Failure; Pneumonia; Vibrio Infections
PubMed: 37202814
DOI: 10.1186/s13256-023-03943-9