An Unusual Cause of Cardiac Tamponade: Primary Pericardial Synovial Sarcoma.
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ABSTRACT:
SUBMITTER: Saba SG
PROVIDER: S-EPMC7847793 | biostudies-literature | 2021 Jan
REPOSITORIES: biostudies-literature
Publications
An Unusual Cause of Cardiac Tamponade: Primary Pericardial Synovial Sarcoma.
Saba Shahryar G SG Ren Qinghu Q Perle Mary Ann MA
Journal of cardiovascular imaging 20210101 1
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Project description:We present a previously healthy young man with cardiac tamponade. He underwent emergency pericardiocentesis. The pericardial fluid was exudative, and Salmonella sp. was grown on both pericardial and blood cultures. Further investigations revealed that this patient had classical Hodgkin lymphoma, which explains his immunocompromised state predisposing him to this infection. (Level of Difficulty: Advanced.).
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Project description:IntroductionSynovial sarcoma is a rare, malignant neoplasm accounting for approximately 5-10% of all soft tissue sarcomas. Synovial sarcomas generally occur in the extremities of adolescent or young adult (AYA)-aged patients; however, they have been reported to affect virtually every organ system. The mediastinum is an exceptionally rare location for synovial sarcoma and malignant pericardial effusions occurring secondary to synovial sarcoma can occur.Case presentationThis case describes a 29-year-old male who presented with 3 weeks of dyspnea and leg swelling. An echocardiogram demonstrated a large pericardial effusion with early tamponade physiology. A subsequent pericardiocentesis returned a lymphocytic predominance with negative flow cytometry and cytology. Cross-sectional imaging with computed tomography (CT) scans of the chest, abdomen, and pelvis was negative for lymphadenopathy or detectable mass. He was discharged where repeat echocardiogram demonstrated recurrence of the effusion, but his symptoms had improved. Ultimately, he was readmitted with refractory dyspnea and edema where cardiac magnetic resonance imaging demonstrated a large mediastinal mass invading the pericardium. The biopsy demonstrated a high-grade spindle cell malignancy positive for a rearrangement of the SS18 gene, a finding diagnostic of synovial sarcoma. He passed away after one round of doxorubicin due to septic and obstructive shock (tamponade).ConclusionMediastinal synovial sarcomas are rare, aggressive, and highly morbid neoplasms. In some cases, they may present insidiously due to their sole presenting clinical manifestation being pericardial effusion. Particular care should be taken to rule out malignancy with MRI or PET-guided imaging in the AYA-aged population when idiopathic, recurrent pericardial effusion is found.
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Project description:Primary cardiac synovial sarcomas are very rare, representing <1% of all primary cardiac tumors. We report the case of a 19-year-old man with syncope and dynamic obstructive shock caused by a large right-sided intracardiac tumor. (Level of Difficulty: Beginner .).
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Project description:BackgroundCardiac trichinellosis is unusual and it is associated with high mortality. We report a case of Trichinella pericarditis complicated by a large pericardial effusion and cardiac tamponade in a setting where the aetiologic diagnosis of pericardial disease is challenging.Case summaryA 27-year-old immune-competent male patient from Cameroon consulted for pleuritic chest pain associated with fever, dry cough, and gradually worsening dyspnoea on exertion of 1-month duration. Upon admission, his blood pressure was 100/73 mmHg, the heart rate was 130/min. The clinical examination revealed a pericardial friction rub, jugular venous distension, and tender hepatomegaly. There was no lower extremity oedema. The diagnosis of pericarditis was made. A two-dimensional transthoracic echocardiogram performed showed a moderate fibrinous circumferential pericardial effusion with echocardiographic signs of tamponade. Pericardiocentesis was performed and analysis of the fluid revealed multiple, motile, roundworms which were identified as Trichinella spiralis, a nematode parasite. There was no eosinophilia on complete blood count. He was treated with Albendazole 800 mg daily per os. His clinical condition improved with resolution of the symptoms and a reduction in the size of the pericardial effusion.DiscussionTrichinella spiralis is a rare cause of pericarditis which can be life-threatening. With the existing challenges in diagnosing the aetiology of pericardial disease in African resource-limited setting, the diagnosis can be missed leading to fatal outcomes.
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