Four years of experience in endomyocardial biopsy--an immunohistologic approach

Left ventricular biopsies from 376 patients (including 78 patients undergoing bypass surgery) were analyzed by light microscopy (necrosis, infiltration with or without fibrosis) and by immunohistology (bound antibodies). Circulating antisarcolemmal antibodies (ASA) were determined at the time of biopsy using a double-sandwich technique. Circulating antimyolemmal antibodies were assessed in intact rat and human cardiocytes. Histologic findings, heart catheterization, and echocardiography together with the patient's history established the diagnosis of perimyocarditis, myocarditis, postmyocarditic dilated cardiomyopathy, healed myocarditis, and healed perimyocarditis. Both bound and circulating ASA were found in up to 100% of cases in acute inflammatory heart disease and postmyocarditic cardiomyopathy, indicating a secondary immunopathogenesis of the myocardial disease. Analysis of immunoglobulin subclasses revealed: IgG-binding does not discriminate between acute/healing/healed carditis and postmyocarditic dilated heart disease (61.1%-91.7% positive); IgM binding is diagnostic for acute or healing perimyocarditis but has a relatively low incidence (33.3%); IgA binding occurs in acute or healing myocarditis (45.5%), perimyocarditis (33.3%), and in postmyocarditic heart disease (39.4%), but not in controls; complement fixation was never seen in controls, but was seen in acute myocarditis (45.4%), perimyocarditis (25%), and postmyocarditic heart disease (46%). Pretreatment of cryostat sections with collagenase to avoid "nonspecific" binding of antibodies to collagen considerably reduced the sensitivity but increased the specificity. Thus, endomyocardial biopsy proved a safe and valuable method for the further analysis of patients with carditis and myocardial disease of unknown origin.

Severe Pericarditis as a Presenting Sign of Bronchogenic Carcinoma

An exudative pericarditis was the only sign of an adenocarcinoma arising from the right main bronchus of the lung for two and a half months. No metastases were found at the time of diagnosis. Pericarditis relapsed quickly after repeated pericardiocenteses, and systemic chemotherapy did not influence its course. Cardiac tamponade caused the death of the patient.

Pericardial effusion in advanced ovarian carcinoma. A literature review and report of two cases

The incidence of all categories of metastatic cancer to the heart is rising, as antineoplastic treatment results in longer survival. Malignant pericardial effusion in ovarian carcinoma has only been described at autopsy. In this report two cases of this condition diagnosed in vivo are presented, together with a review of the diagnosis and treatment of this complication of neoplastic disease.

Idiopathic hemorrhagic pericardial effusion in eight dogs

Idiopathic hemorrhagic pericardial effusion was diagnosed in 8 dogs. The patients were typically males of large or giant breeds and a wide age range was represented. In all dogs clinical features of acute or chronic cardiac tamponade and right-sided heart failure were present. The pericardial effusion in each case was identified by thoracic radiography, electrocardiography, and echocardiography. Cytologic examination of the fluid did not allow differentiation from hemorrhagic effusions caused by neoplasia. Bacterial and fungal cultures were negative in 5 dogs. In 6 cases, a presumptive diagnosis was based on the absence of cardiac masses on 2-dimensional echocardiography, contrast pericardiography, or both. The condition was managed successfully by partial pericardiectomy in 5 cases. The definitive diagnosis in each case was established by gross cardiac examination at surgery or necropsy and by histologic examination of tissues. Blood vessels and lymphatics of the parietal and visceral pericardia appeared to be the primary targets of the disease process.

Hemorrhagic cardiac tamponade: a clinicopathologic correlation

Staphylococcus aureus pericarditis and recurrent episodes of hemorrhagic cardiac tamponade developed in a 31-year-old man. He later died of exsanguination and at autopsy was found to have a ruptured infective pseudoaneurysm of the aortic arch. When hemorrhagic pericardial effusions of undetermined cause are encountered, the heart and great vessels should be evaluated as potential sources of the hemorrhage.

Clinical echocardiography in acquired heart disease

Echocardiography directly reflects cardiac anatomy and pathology. A normal two-dimensional and M-mode study rules out a multitude of cardiac pathologies. Echocardiography serves the clinician well in differentiating cardiac from noncardiac symptoms and in providing bedside quantitative assessment of regional and global left ventricular function. It is also invaluable in evaluating valvular disease, pericardial effusion, and intracardiac masses.

Solitary tumour metastasis: a rare cause of right ventricular outflow tract obstruction and sudden death

The clinical features of a patient presenting with recent breathlessness indicated right ventricular outflow tract obstruction, while echocardiography suggested the presence of tumour in the right ventricle. Before further investigations could be instituted, she died suddenly. Autopsy revealed a haemopericardium secondary to rupture of the right atrium while the right ventricle was found to contain a tumour arising from most of its endocardial surface. Histology showed this to be a poorly differentiated mucous secreting carcinoma similar in appearance to her colonic carcinoma excised 8 years previously. There was no other evidence of metastatic disease.

[Echocardiography in pericardial effusion and tamponade (author's transl)]

The role of echocardiography in the diagnosis and quantitative assessment of pericardial effusion was demonstrated in 57 cases, 10 of which were confirmed by surgery. With this highly sensitive method all effusions equal or superior to 50 ml could be detected and their volume measured with accuracy. There were no false positive results. Two specific signs of tamponade came out very clearly: a decrease in EF slope, which was less than 50 mm/sec, and a notch in the anterior wall of the right ventricle which occurred 0.04 +/- 0.01 sec after QRS.

The epicardial fat pad sign: analysis of frontal and lateral chest radiographs in patients with pericardial effusion

The epicardial fat pad sign (EFPS) has been useful in the diagnosis of pericardial effusion on plain frontal and lateral chest radiographs. In this series of 100 cases, including patients with small pericardial effusions, it was positive in 52% of cases, being seen on the lateral view in 41%, on the frontal view in 23%, and on both views in 12%. The authors consider this sign to be the most reliable plain-radiograph finding in the diagnosis of pericardial effusion.

Irradiation-induced pericarditis

Three patients with pericarditis following therapeutic irradiation for malignant tumors were studied at autopsy. In one subject, death occurred five days after the last dose of radiation. The pericardial involvement was characterized by fibrinous exudation. This was more marked in degree over the right side of the heart than the left and corresponded with the field of irradiation. In the remaining two patients, two and four courses of radiation had been applied, the interval between the last dose and death being seven weeks in one patiet and 1 1/2 years in the other. The lesions were those of organizing pericarditis.

B-cell nature malignant lymphoma probably caused by EB-virus infection

In cells in a haemopericardium associated with a B-cell malignant lymphoma, immature herpes type virus particles were found by electron microscopy. Epstein-Barr virus associated nuclear antigen (EBNA) and virus capsid antigen (VCA) were also found, both in the tumor cells, in the bloody pericardial fluid and in cultivated cells. Serological studies revealed high anti-toxoplasma antibody levels both in the pericardial fluid and in serum. Both EB virus and toxoplasma infections are assumed to have played an important role on the pathogenesis of the present case.

A clinicopathological study on pericardial heart disease in the aged

A total of 87 cases of pericardial heart disease (73 of pericarditis and 14 of hemopericardium) among 870 consecutive autopsies of aged patients was studied. Fibrinofibrouspericarditis was found in 80.8% of pericarditis, neoplastic in 13.7% and purulent in 5.5%. Representative cases of each type of pericarditis were illustrated. Among fibrinofibrous pericarditis, idiopathic was the most common and the other causes included irradiation, myocardial infarction, renal failure, rheumatoid arthritis and hypothyroidism. Frequent association of congestive heart failure or anasarca with mild to moderate fibrinofibrous pericarditis was noted. Clinical and morphologic evidences of pulmonary tuberculosis were present in nearly one third of cases with fibrinofibrious pericarditis, but actual incidence of tuberculous pericarditis could not be determined. Incidence of clinical signs and symptoms of acute pericarditis was evaluated with the stress on the relatively high incidence of supraventricular tachyarrhythmias, especially in cases with histological evidence of sinus node involvement in aged cases.

[Idiopathic edema, capillaropathy, pericardial and pleural effusions with high protein content (author's transl)]

Clinical and electron microscopic studies of two female patients are reported who, in addition to the symptoms and signs of idiopathic edema, had pericardial (and pleural) effusions. In one patient pericardiectomy had to be performed, in the other patient pharmacotherapy with spironolactone was effective. In these patients the protein-concentrations of edema fluid (25 and 12 g/l) and pericardial fluid (55-61 and 48 g/l) were relatively high; the distribution space of labelled protein was increased; blood volumes were low-normal or decreased. Electronmicroscopy of the microvasculature showed identical alterations in both cases. In the cutaneous vessels the endothelium developed numerous abnormal cytoplasmic processes and intercellular "gaps". In the capillaries of skeletal muscle our findings indicate an increase in vesicular transport. We suggest the electron microscopic alterations to be the morphologic correlate for the increased transport and extravascular accumulation of protein. Changes as they are described here in humans with idiopathic edema have been documented before in animals with experimental edema.

Renal failure associated with pericardial effusion in a dog

Signs of heart failure due to cardiac tamponade developed in a young dog with previously unrecognized renal disease. The uremic syndrome was considered the likely cause of the effusive pericarditis found at necropsy. In a review of necropsy records from 150 dogs with renal disease, 11 had pericardial lesions.

True and false left ventricular aneurysms. Propensity for the altter to rupture

Two cases are described of sudden death resulting from rupture of small chronic false aneurysm of the left ventricle with secondary hemopericardium. The cases support the point that rupture of chronic false left ventricular aneurysm tends to occur. This appears to be contrary to the potential for chronic true aneurysms of the left ventricle which tend not to rupture. Rupture of true left ventriuclar aneurysm in its deveoping stahe may, however, occur.

Leiomyosarcoma of the pulmonary trunk associated with pericardial effusion

Thijs, L. G., Kroon, T. A. J., and van Leeuwen, Th. M. (1974).Thorax, 29, 490-494. Leiomyosarcoma of the pulmonary trunk associated with pericardial effusion. The case history of a patient with a leiomyosarcoma of the pulmonary trunk is presented. The clinical picture was dominated by unexplained shortness of breath, episodes of cough and haemoptysis, general weakness, and weight loss. Signs of a pericardial effusion and pulmonary stenosis developed a few weeks before death. Thoracotomy revealed an inoperable tumour arising from the pulmonary trunk and a large pericardial effusion. Microscopy of the tumour removed at necropsy showed a leiomyosarcoma.

Aortic body tumor in a duck

A chemodectoma of the aortic body was found at the base of heart of a Brahminy duck (Tadorna ferruginea). It incorporated aorta and pulmonary artery at their emergence, part of vagus nerve, sympathetic ganglion, and thyroid gland. The tumor cells had infiltrated the local lymphatics only.