Huge loculated pericardial effusion 2 months after heart surgery.
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ABSTRACT:
SUBMITTER: Gercenshtein V
PROVIDER: S-EPMC7793198 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
Publications
Huge loculated pericardial effusion 2 months after heart surgery.
Gercenshtein Vered V Baluta Natalia N Leitman Marina M
European heart journal. Case reports 20201222 6
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Project description:We report a case of anterior loculated pericardial effusion misinterpreted on point-of-care ultrasound as a dilated right ventricle, and suggesting diagnosis of pulmonary embolism (PE), in a patient with renal failure. The compressed right ventricle from tamponade physiology appeared to be a thickened intraventricular septum. Heparin was given empirically for presumed PE. Later the same day, computed tomography of the chest showed the effusion, as did formal echocardiogram. The patient had drainage of 630 milliliters of fluid and recovered from tamponade. Loculated effusions comprise 15% of all pericardial effusions, and misdiagnosis of PE with heparin therapy could be fatal.
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Project description:A patient with a previous lung transplant and aortic valve replacement had progressive dyspnea. He presented with subacute tamponade secondary to a loculated pericardial effusion that caused impaired left ventricular filling and outflow tract obstruction secondary to distortion of the mitral valve apparatus. We demonstrate the imaging features of this presentation. (Level of Difficulty: Intermediate.).
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Project description:Pericardial effusions can occur as either circumferential or loculated when referencing their anatomic distribution in the pericardium. These effusions can result from multiple different etiologies, including malignancy, infection, trauma, connective tissue disease, acute pericarditis drug induced, or idiopathic. Loculated pericardial effusions can be difficult to manage. Even small loculated effusions can result in hemodynamic compromise. Oftentimes in the acute setting, point of care ultrasound can be used to evaluate pericardial effusions directly at the bedside. We present a case of a malignant loculated pericardial effusion and offer insight into management and clinical evaluation using point of care ultrasound.
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Project description:Pericardial effusion (PE) after pediatric cardiac surgery is common. Because of the lack of a uniform classification of the presence and severity of PE, we evaluated PE altering clinical management: clinically relevant PE. Risk factors for clinically relevant PE were studied. After cardiac surgery, children were followed until 1 month after surgery. Preoperative variables were studied in the complete cohort. Perioperative and postoperative variables were studied in a case-control manner. Patients with and without clinically relevant PE were matched on age, gender, and diagnosis severity in a 1:1 ratio. Multivariate analysis was conducted using important preoperative variables from the complete cohort combined with perioperative and postoperative variables from the case-control data. 1241 surgical episodes in 1031 patients were included. Clinically relevant PE developed in 136 episodes (11.0%). Multivariate correlation with the outcome was present for age, BSA (adjusted odds ratio: 1.6, 95% CI 0.9-2.8), right-sided heart defect (adjusted odds ratio: 1.3, 95% CI 0.9-1.9), history of previous operation (adjusted odds ratio: 0.5, 95% CI 0.3-0.7), cardiopulmonary bypass use (adjusted odds ratio: 2.1, 95% CI 0.9-4.5), duration of CPAP postoperatively, and an inotropic score (adjusted odds ratio: 1.01, 95% CI 0.998-1.03). In this large patient cohort, 11.0% of postoperative periods of pediatric cardiac surgery were complicated by PE requiring alteration of treatment. Secondly, we newly identified cardiopulmonary bypass use and right-sided heart defects as risk factors for clinically relevant PE and confirmed previously described risk factors: age, CPAP duration, BSA, and inotropic score and a previously described risk reductor: history of previous operation.
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Project description:BackgroundMalignant pericardial effusions are often linked to metastases from solid tumours, such as those in the lung or breast, or haematological diseases. Primary cardiac tumours are rare, occurring in only 0.02% of cases, with pericardial tumours comprising 6.7%-12.8% of all primary cardiac tumours.Case summaryIn Case 1, a 49-year-old Black African male presented with chest pain and breathlessness after a COVID-19 vaccine. Initially treated for pericarditis, he returned with worsening symptoms. Echocardiography revealed pericardial effusion and cardiac tamponade. Imaging confirmed a right atrial mass diagnosed as malignant biphasic mesothelioma. He died 4 months after diagnosis. In Case 2, a 43-year-old Caucasian male developed breathlessness and fever post-COVID-19 vaccine. Imaging identified a large posterior pericardial mass, later diagnosed as synovial sarcoma. Chemotherapy yielded minor tumour reduction, but he succumbed to his illness, spending his final days in a hospice.DiscussionInitial clinical signs are critical in determining the origin of pericardial effusion. Malignancy should be suspected in cases with cardiac tamponade, unexplained haemorrhagic pericardial fluid, or recurrent symptoms. Negative cytology warrants further investigation with advanced imaging or biopsy to improve diagnostic sensitivity. Diagnosing rare tumours involves multiple imaging modalities, fluid analysis, biopsies, and an interdisciplinary approach, with pathological analysis being the gold standard. Treatment remains challenging due to the rapid progression of these tumours, with surgery often not feasible. A multi-pronged diagnostic approach is crucial, and clinicians must maintain suspicion for malignancy in persistent pericardial effusion cases, even in the context of other potential confounding factors.
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| S-EPMC11831025 | biostudies-literature
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| S-EPMC4374243 | biostudies-literature
Project description:BackgroundMalignant pericardial effusion (Eff) is often asymptomatic and has an unknown prevalence, due to its occult presentation. The condition often is identified postmortem on autopsy, and it is associated with a poor prognosis. Given the late presentation of malignant pericardial Effs, a minimal volume of literature has examined the epidemiology, clinical characteristics, and outcomes of these complex patients. We conducted a systematic review to advance present understanding of this condition.MethodsA search of 4 databases resulted in 41 case reports meeting criteria. Inclusion criteria were being a patient aged > 18 years who presented with pericardial Eff in the setting of malignancy. Intervention was medical and/or surgical therapy, and the outcome was mortality.ResultsFor the 41 patients included, the median age was 54 years, and the majority were male patients (58%). Dyspnea was the leading symptom (90%), and cardiac tamponade was present in 78% of cases. Common cancers included lung, gastrointestinal, and renal neoplasms (59%). Pericardiocentesis occurred in 98% of cases, with a median fluid extraction volume of 1000 mL. Death occurred in 44%, primarily due to disease progression and/or metastasis.ConclusionsThis study presents the largest systematic review on malignancy-induced pericardial Effs to date. Notably, solid tumours, and specifically lung adenocarcinomas, are common culprits. Malignant pericardial Effs are often severe, with a majority of patients presenting with cardiac tamponade. Overall, treatment options are limited, and the associated mortality rate is high.
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