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Ebrahimi P, Taheri H, Bahiraie P, Rader F, Siegel RJ, Mandegar MH, Hosseini K, Shahid F. Incidence of secondary pericardial effusions associated with different etiologies: a comprehensive review of literature. J Cardiothorac Surg 2025; 20:141. [PMID: 39987086 PMCID: PMC11846477 DOI: 10.1186/s13019-025-03370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 02/08/2025] [Indexed: 02/24/2025] Open
Abstract
Pericardial effusion is a relatively common complication associated with inflammatory and non-inflammatory diseases. The primary etiology of this condition could be considered when choosing therapeutic options and factors such as effusion size and its hemodynamic consequence. In most cases, small to moderate pericardial effusions can be managed with observation and anti-inflammatory medications unless the effusion develops rapidly. However, in a small proportion of patients, large effusions lead to impaired cardiac filling with hemodynamic compromise and cardiovascular collapse due to cardiac tamponade. The rate at which fluid accumulates is the primary determinant of hemodynamic impact and thus guides the choice of treatment, irrespective of the effusion's size. Severe cases are typically treated with pericardiocentesis with echocardiographic guidance. More aggressive treatments may be necessary for cases due to purulent or malignant etiologies. These cases may require a pericardial window to allow for long-term drainage of the pericardial fluid. This comprehensive review focuses on the epidemiology of pericardial effusion and discusses pathophysiology, diagnostic approaches, and therapeutic options for different causes of secondary pericardial effusions.
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Affiliation(s)
- Pouya Ebrahimi
- Department of Interventional Cardiology, Queen Elizabeth Hospital, Birmingham, UK.
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Homa Taheri
- Department of Cardiology, Smidth Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, US
| | - Pegah Bahiraie
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Florian Rader
- Department of Cardiology, Smidth Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, US
| | - Robert J Siegel
- Department of Cardiology, Smidth Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, US
| | - Mohammad Hosein Mandegar
- Cardiac Surgery Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhan Shahid
- Department of Interventional Cardiology, Queen Elizabeth Hospital, Birmingham, UK
- Department of Interventional Cardiology, School of Medicine, Aston University, Birmingham, UK
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Bagheri A, Sheikhi Nooshabadi M, Ebrahimi P, Nazari R, Ramezani P, Alirezaei T. From thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis case. Int J Emerg Med 2025; 18:4. [PMID: 39754100 PMCID: PMC11697939 DOI: 10.1186/s12245-024-00794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Accepted: 12/20/2024] [Indexed: 01/06/2025] Open
Abstract
BACKGROUND Anticoagulants increase the risk of cardiac tamponade in patients with pericardial effusion (PE). Therefore, inappropriate administration of them in the presence of PE can lead to a catastrophic outcome. This study presents a patient with a provisional misdiagnosis of venous thromboembolism (VTE). CASE PRESENTATION An 83-year-old Iranian female was transferred to the emergency department of a tertiary cardiology hospital complaining of neck swelling concomitant with chest pain and dyspnea. The patient had been diagnosed with jugular vein thrombosis in another local center, and since the chief complaint was neck swelling, she underwent Doppler sonography, and the diagnosis was confirmed. Subsequently, the treatment with unfractionated heparin was started. After 5 h, considering the worsening of symptoms with the suspicious diagnosis of COVID-19 based on her symptoms and laboratory data, a chest computed tomography scan was requested, which showed a massive PE. Subsequently, transthoracic echocardiography confirmed the diagnosis. The patient was immediately transferred to the operating room and underwent pericardiotomy. The post-surgery period was uneventful, and she was discharged 5 days later. CONCLUSION Patients with viral infections, specifically COVID-19, are at risk of undiagnosed severe pericardial effusions. Venous stasis in the jugular veins due to PE can mimic jugular vein thromboembolism, causing a wrong diagnosis. Since treating thrombosis can exacerbate tamponade to hemodynamic instability and collapse, sufficient investigation before starting anticoagulants is necessary. CLINICAL KEY MESSAGE Distinguishing VTE from PE is not always straightforward. Therefore, it is important to ensure physicians have reached an appropriate level of certainty about their diagnosis by performing precise diagnostics before using anticoagulants. Mismanagement with anti-thrombotics can result in catastrophic consequences. Therefore, taking an accurate history, performing a precise physical examination, and using rapid and available diagnostic modalities can avoid delays in definitive management.
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Affiliation(s)
- Amin Bagheri
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Sheikhi Nooshabadi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Autoimmune Disease Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Pouya Ebrahimi
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roozbeh Nazari
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pedram Ramezani
- Faculty of Medicine, Azad University of Medical Sciences, Tehran, Iran
| | - Toktam Alirezaei
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Mangaloiu DV, Tilișcan C, Răriș AD, Negru AR, Molagic V, Vișan CA, Stratan LM, Mihai N, Aramă ȘS, Aramă V. Pericardial and Pleural Effusions in Non-ICU Hospitalized Patients with COVID-19-A Retrospective Single-Center Study. J Clin Med 2024; 13:3749. [PMID: 38999316 PMCID: PMC11242538 DOI: 10.3390/jcm13133749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/03/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Pericardial and pleural effusions are two complications recently described in patients hospitalized with COVID-19 infections. There are several mechanisms that have been proposed and refer to SARS-CoV-2's capacity to bind to cell surfaces via various receptors and its broad tissue tropism that might cause significant complications. The aim of the present study is to evaluate the incidence of pericardial and pleural effusions during COVID-19 infection as well as to determine the risk factors associated with these complications. Methods: We conducted a retrospective single-center study that included 346 patients admitted to the National Institute of Infectious Disease "Prof. Dr. Matei Bals" (Bucharest, Romania), from 1 January to 25 May 2021, during the third wave of the pandemic. Socio-demographic and anthropometric data were collected for each patient. The patients were evaluated clinically, biologically, and radiologically within 48 h of admission. Patients were divided into 3 groups: (1) patients with pericardial effusions-18; (2) patients with pleural effusions-28; (3) patients without pericardial/pleural effusions-294. Results: After exclusion criteria were applied, 337 patients were analyzed. The median age of the participants was 58.26 ± 14.58 years. More than half of the hospitalized patients had associated respiratory failure (61.5%), of which 2.7% had a critical form of the disease and 58.8% had a severe form. The cumulative percentage for pericardial and pleural effusions for the study group was 12.8% (43 patients out of 337). The prevalence of pericardial effusion was 5.3%, twice more frequent among male respondents. Pleural effusion was identified in 8.3% patients. Most patients had unilateral effusion (17), compared to 11 patients who had bilateral involvement. Based on laboratory results, patients with pericardial and pleural effusions exhibited increased levels of C reactive protein, erythrocyte sedimentation rate, NT proBNP, and a higher value of neutrophil/lymphocyte count ratio. In contrast to patients without pleural and pericardial effusions, those with these symptoms experienced a higher frequency of severe or critical illness and longer hospital stays. Conclusions: Pericardial and pleural effusions can complicate COVID-19 infections. In our study, the prevalence of pericardial and pleural effusions in hospitalized patients was low, being associated with the same comorbidities and a number of clinical and biological parameters.
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Affiliation(s)
- David V Mangaloiu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
| | - Cătălin Tilișcan
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
| | - Alexandra D Răriș
- Emergency Clinical Hospital for Children Marie Curie, 041451 Bucharest, Romania
| | - Anca R Negru
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
| | - Violeta Molagic
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
| | - Constanta A Vișan
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
| | - Laurențiu M Stratan
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
| | - Nicoleta Mihai
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
| | - Ștefan S Aramă
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
| | - Victoria Aramă
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balş", 021105 Bucharest, Romania
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Zhu Z, Hu G, Ying Z, Wang J, Han W, Pan Z, Tian X, Song W, Sui X, Song L, Jin Z. Time-dependent CT score-based model for identifying severe/critical COVID-19 at a fever clinic after the emergence of Omicron variant. Heliyon 2024; 10:e27963. [PMID: 38586383 PMCID: PMC10998101 DOI: 10.1016/j.heliyon.2024.e27963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Rationale and objectives The computed tomography (CT) score has been used to evaluate the severity of COVID-19 during the pandemic; however, most studies have overlooked the impact of infection duration on the CT score. This study aimed to determine the optimal cutoff CT score value for identifying severe/critical COVID-19 during different stages of infection and to construct corresponding predictive models using radiological characteristics and clinical factors. Materials and methods This retrospective study collected consecutive baseline chest CT images of confirmed COVID-19 patients from a fever clinic at a tertiary referral hospital from November 28, 2022, to January 8, 2023. Cohorts were divided into three subcohorts according to the time interval from symptom onset to CT examination at the hospital: early phase (0-3 days), intermediate phase (4-7 days), and late phase (8-14 days). The binary endpoints were mild/moderate and severe/critical infection. The CT scores and qualitative CT features were manually evaluated. A logistic regression analysis was performed on the CT score as determined by a visual assessment to predict severe/critical infection. Receiver operating characteristic analysis was performed and the area under the curve (AUC) was calculated. The optimal cutoff value was determined by maximizing the Youden index in each subcohort. A radiology score and integrated models were then constructed by combining the qualitative CT features and clinical features, respectively, using multivariate logistic regression with stepwise elimination. Results A total of 962 patients (aged, 61.7 ± 19.6 years; 490 men) were included; 179 (18.6%) were classified as severe/critical COVID-19, while 344 (35.8%) had a typical Radiological Society of North America (RSNA) COVID-19 appearance. The AUCs of the CT score models reached 0.91 (95% confidence interval (CI) 0.88-0.94), 0.82 (95% CI 0.76-0.87), and 0.83 (95% CI 0.77-0.89) during the early, intermediate, and late phases, respectively. The best cutoff values of the CT scores during each phase were 1.5, 4.5, and 5.5. The predictive accuracies associated with the time-dependent cutoff values reached 88% (vs.78%), 73% (vs. 63%), and 87% (vs. 57%), which were greater than those associated with universal cutoff value (all P < 0.001). The radiology score models reached AUCs of 0.96 (95% CI 0.94-0.98), 0.90 (95% CI 0.87-0.94), and 0.89 (95% CI 0.84-0.94) during the early, intermediate, and late phases, respectively. The integrated models including demographic and clinical risk factors greatly enhanced the AUC during the intermediate and late phases compared with the values obtained with the radiology score models; however, an improvement in accuracy was not observed. Conclusion The time interval between symptom onset and CT examination should be tracked to determine the cutoff value for the CT score for identifying severe/critical COVID-19. The radiology score combining qualitative CT features and the CT score complements clinical factors for identifying severe/critical COVID-19 patients and facilitates timely hierarchical diagnoses and treatment.
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Affiliation(s)
- Zhenchen Zhu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Hu
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhoumeng Ying
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinhua Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengsong Pan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinlun Tian
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Sui
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lan Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Niebauer JH, Iscel A, Schedl S, Capelle C, Kahr M, Schamilow S, Faltas J, Srdits M, Badr-Eslam R, Lichtenauer M, Zoufaly A, Valenta R, Hoffmann S, Charwat-Resl S, Krestan C, Hitzl W, Wenisch C, Bonderman D. Severe COVID-19 and its cardiopulmonary effects 6 and 18 months after hospital discharge. Front Cardiovasc Med 2024; 11:1366269. [PMID: 38504716 PMCID: PMC10948598 DOI: 10.3389/fcvm.2024.1366269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction SARS-CoV-2 infection affects the cardiopulmonary system in the acute as well as long-term phase. The aim of the present study was to comprehensively assess symptoms and possible long-term impairments 6 and 18 months after hospitalization for severe COVID-19 infection. Methods This prospective registry included patients with PCR-confirmed COVID-19 infection requiring hospitalization. Follow-up approximately 6 months post discharge comprised a detailed patient history, clinical examination, transthoracic echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a laboratory panel. At the time of the second follow-up visit at 18 months, patients without pathologic findings during the first study visit were contacted by phone to inquire about the course of their symptoms. In all other patients all initial examinations were repeated. Results Two hundred Patients, who were hospitalized for COVID-19, were contacted by phone and were recruited for the study. Due to dropouts the second study visit was performed in 170 patients. A comparison between the two study visits at 6 and 18 months post discharge showed the following results: Six months after discharge, 73% and 18 months after discharge 52% fulfilled the criteria for Long COVID with fatigue being the most common symptom (49%). Echocardiography at 6 months post discharge showed an impaired left ventricular function in 8% of which 80% returned to normal. Six months post discharge, cMRI revealed pericardial effusion in 17% which resolved in 47% of the 15 patients who underwent a control cMRI. Signs of peri- or myocarditis were present in 5% of the patients and were resolved in all 4 patients who attended control studies. At 6 months, chest CT scans identified post-infectious residues in 24%. In the 25 repeated chest CT scans 20% showed full recovery. Length of in-hospital stay was identified as a significant predictor for persisting Long COVID (95% CI: 1.005-1.12, p = 0.03). Conclusion Comparing 6 to 18 months, the prevalence of Long COVID decreased over time, but a high symptom burden remained. Structural and functional abnormalities were less frequent than the portrayed symptoms, and it thus remains a challenge to substantiate the symptoms.
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Affiliation(s)
- J. H. Niebauer
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - A. Iscel
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - S. Schedl
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - C. Capelle
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - M. Kahr
- Department of Internal Medicine II, Division of Cardiology, AKH Wien, Vienna, Austria
| | - S. Schamilow
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - J. Faltas
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - M. Srdits
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - R. Badr-Eslam
- Department of Internal Medicine II, Division of Cardiology, AKH Wien, Vienna, Austria
| | - M. Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - A. Zoufaly
- Department of Infectious Diseases, Klinik Favoriten, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - R. Valenta
- Department of Radiology, Klinik Favoriten, Vienna, Austria
| | - S. Hoffmann
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - S. Charwat-Resl
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
| | - C. Krestan
- Department of Radiology, Klinik Favoriten, Vienna, Austria
| | - W. Hitzl
- Research and Innovation Management (RIM), Team Biostatistics and Publication of Clinical Trial Study, Paracelsus Private Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - C. Wenisch
- Department of Infectious Diseases, Klinik Favoriten, Vienna, Austria
| | - D. Bonderman
- Department of Cardiology and Emergency Medicine, Klinik Favoriten, Vienna, Austria
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Salimi M, Davoodi L, Jalalian R, Darayee M, Moslemi A, Faeli L, Mirzakhani R, Shokohi T. A fatal Candida albicans pericarditis presenting with cardiac tamponade after COVID-19 infection and cardiothoracic surgery. J Clin Lab Anal 2023; 37:e24968. [PMID: 37803881 PMCID: PMC10681509 DOI: 10.1002/jcla.24968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/08/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Candida pericardial infection is a rare clinical entity usually related to recent cardiothoracic surgery and chronic debilitating conditions. During the COVID-19 pandemic, invasive fungal infections have been on the rise, likely due to a combination of factors such as immunosuppression, underlying conditions like diabetes, and surgical procedures. CASE PRESENTATION Herein, we report a 67-year-old diabetic woman with a history of COVID-19 infection who received a high dose of corticosteroids a few months before admission, and previous myocardial infarction for more than 12 years. The patient had a positive cardiac tamponade with signs of dyspnea, chest pain, and low blood pressure. Echocardiographic data were more in favor of constrictive pericarditis. The patient underwent urgent echocardiography-guided pericardiocentesis and then broad-spectrum antibiotic treatment was prescribed. Repeated echocardiography implied a persistent pericardial effusion 10 days later. Subxiphoid aspirates and biopsied tissues showed budding yeast cells and yeast colonies grew on culture media identified as Candida albicans. CONCLUSION This report should bring to the attention of physicians toward the possibility of Candida pericardial infection presenting with cardiac tamponade after COVID-19 infection and cardiothoracic surgery. Echocardiographic assessment, prompt pericardiotomy, molecular-based identification of causative agent, and early administration of appropriate antifungal treatment should improve the patient's survival.
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Affiliation(s)
- Maryam Salimi
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | - Lotfollah Davoodi
- Department of Infectious Diseases, Antimicrobial Resistance Research Center, Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Rozita Jalalian
- Department of Cardiology, School of Medicine, Cardiovascular Research CenterMazandaran University of Medical SciencesSariIran
| | - Masood Darayee
- Department of Cardiac Surgery, School of Medicine, Cardiovascular Research CenterMazandaran University of Medical SciencesSariIran
| | - Azam Moslemi
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | - Leyla Faeli
- Student Research CommitteeMazandaran University of Medical SciencesSariIran
| | | | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
- Department of Medical Mycology, School of MedicineMazandaran University of Medical SciencesSariIran
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Saraç İ, Aydın SŞ, Özmen M, Doru Hİ, Tonkaz G, Çırçır MN, Akpınar F, Zengin O, Delice O, Aydınyılmaz F. Prevalence, Risk Factors, Prognosis, and Management of Pericardial Effusion in COVID-19. J Cardiovasc Dev Dis 2023; 10:368. [PMID: 37754797 PMCID: PMC10531872 DOI: 10.3390/jcdd10090368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
Background: There is limited data in the literature about the clinical importance and prognosis of pericardial effusion (PE) in patients discharged after recovering from COVID-19, but large-scale studies have yet to be available. This study investigated the prevalence, risk factors, prognosis, late clinical outcomes, and management of PE in COVID-19. Materials and Methods: Between August 2020 and March 2021, 15,689 patients were followed up in our pandemic hospital due to COVID-19. Patients with positive polymerase chain reaction (PCR) test results and PE associated with COVID-19 in computed tomography (CT) were included in the study. The patients were divided into three groups according to PE size (mild, moderate, and large). Transthoracic echocardiography (TTE) records, laboratory data, clinical outcomes, and medical treatments of patients discharged from the hospital were retrospectively reviewed. Results: According to the PE size (mild, moderate, large) of 256 patients with PE at admission or discharge, the mean age was 62.17 ± 16.34, 69.12 ± 12.52, and 72.44 ± 15.26, respectively. The mean follow-up period of the patients was 25.2 ± 5.12 months. Of the patients in the study population, 53.5% were in the mild group, 30.4% in the moderate group, and 16.1% in the large group. PE became chronic in a total of 178 (69.6%) patients at the end of the mean three months, and chronicity increased as PE size increased. Despite the different anti-inflammatory treatments for PE in the acute phase, similar chronicity was observed. In addition, as the PE size increased, the patients' frequency of hospitalization, complications, and mortality rates showed statistical significance between the groups. Conclusions: The clinical prognosis of patients presenting with PE was quite poor; as PE in size increased, cardiac and noncardiac events and mortality rates were significantly higher. Patients with large PE associated with COVID-19 at discharge should be monitored at close intervals due to the chronicity of PE and the increased risk of tamponade.
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Affiliation(s)
- İbrahim Saraç
- Department of Cardiology, Erzurum City Hospital, Erzurum 25010, Turkey; (S.Ş.A.); (M.Ö.); (F.A.)
| | - Sidar Şiyar Aydın
- Department of Cardiology, Erzurum City Hospital, Erzurum 25010, Turkey; (S.Ş.A.); (M.Ö.); (F.A.)
| | - Murat Özmen
- Department of Cardiology, Erzurum City Hospital, Erzurum 25010, Turkey; (S.Ş.A.); (M.Ö.); (F.A.)
| | - Halil İbrahim Doru
- Department of Emergency Medicine, Erzurum City Hospital, Erzurum 25010, Turkey; (H.İ.D.); (M.N.Ç.); (O.Z.); (O.D.)
| | - Gökhan Tonkaz
- Department of Radiology, Giresun University Research Hospital, Giresun 28200, Turkey;
| | - Melike Nur Çırçır
- Department of Emergency Medicine, Erzurum City Hospital, Erzurum 25010, Turkey; (H.İ.D.); (M.N.Ç.); (O.Z.); (O.D.)
| | - Furkan Akpınar
- Department of Emergency Medicine, Erzurum City Hospital, Erzurum 25010, Turkey; (H.İ.D.); (M.N.Ç.); (O.Z.); (O.D.)
| | - Onur Zengin
- Department of Emergency Medicine, Erzurum City Hospital, Erzurum 25010, Turkey; (H.İ.D.); (M.N.Ç.); (O.Z.); (O.D.)
| | - Orhan Delice
- Department of Emergency Medicine, Erzurum City Hospital, Erzurum 25010, Turkey; (H.İ.D.); (M.N.Ç.); (O.Z.); (O.D.)
| | - Faruk Aydınyılmaz
- Department of Cardiology, Erzurum City Hospital, Erzurum 25010, Turkey; (S.Ş.A.); (M.Ö.); (F.A.)
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Mishra R, Jain S, Shaban M, Acosta G, Rodriguez Guerra MA. COVID-19-Induced Cardiac Tamponade: A Case Study and a Literature Review. Cureus 2023; 15:e42427. [PMID: 37637521 PMCID: PMC10448779 DOI: 10.7759/cureus.42427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
COVID-19 presentation is heterogeneous. As a viral illness, it could cause pericardial effusion leading to cardiac tamponade. We present a patient coursing with this viral illness that was found to have cardiac tamponade. We report a case of a 79-year-old female who presented with shortness of breath and dry cough for one week and resulted positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Her initial chest X-ray showed a bottle-shaped heart. Computed chest tomography showed pericardial effusion, and an echocardiogram confirmed moderated pericardial effusion with signs of tamponade. He improved with conservative therapy with colchicine, ibuprofen, cefepime, dexamethasone, dolutegravir, and apixaban for pulmonary emboli. An early approach in cardiac tamponade induced by COVID-19 is crucial to promptly address an aggressive directed therapy, avoiding potential complications or unnecessary procedures.
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Affiliation(s)
- Rishabh Mishra
- Hospital Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, USA
| | - Swati Jain
- Nephrology, Montefiore Medical Center, Wakefield Campus, Bronx, USA
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Pericardial Involvement in Severe COVID-19 Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081093. [PMID: 36013560 PMCID: PMC9415465 DOI: 10.3390/medicina58081093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: SARS-CoV-2 has an extensive tissue tropism due to its ability to attach to the surfaces of cells through different receptors, leading to systemic complications. In this article, we aim to present the prevalence of pericardial effusions in patients with severe COVID-19, to identify the risk factors/predictors for pericardial involvement, and to evaluate its impact on overall mortality. Materials and Methods: We enrolled 100 patients with severe COVID-19 in our observational cohort study and divided them in two groups: Group A (27 patients with pericardial effusion) and Group B (73 patients without pericardial effusion). We recorded demographic and lifestyle parameters, anthropometric parameters, clinical parameters, inflammation markers, respiratory function parameters, complete blood count, coagulation parameters, and biochemical serum parameters. All patients were evaluated by computer tomography scans within 48 h of admission. Results: The median age was 61 years in both groups and the male/female ratio was 3.5 vs. 2.8 in Group A vs. Group B. We identified mild pericardial effusion (3–4 mm) in 62.9% patients and moderate pericardial effusion (5–9 mm) in 37.1% patients, with a median value of 4 [3;6] mm. The patients with pericardial effusion presented with higher percentages of obesity, type-2 diabetes mellitus, arterial hypertension, and congestive heart failure, without statistical significance. Increased values in cardiac enzymes (myoglobin, CK, CK-MB) and LDH were statistically associated with pericardial effusion. The overall mortality among the participants of the study was 24% (24 patients), 33.3% in Group A and 20.8% in Group B. Conclusions: Pericardial effusion has a high prevalence (27%) among patients with severe forms of COVID-19 and was associated with higher mortality. Pericardial effusion in our study was not associated with the presence of comorbidities or the extent of lung involvement. Overall mortality was 60% higher in patients with pericardial effusion.
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