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Chen X, Zhao C, Zheng Z, Bian C, Zhang Y, Zhang P, Li Y, Zhao M, Li J. A case of cardiac tamponade caused by T4N2M1 lung squamous cell carcinoma invading the aorta. Forensic Sci Med Pathol 2023; 19:393-397. [PMID: 36180659 DOI: 10.1007/s12024-022-00532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
In patients with known lung squamous cell carcinoma, it is necessary to be alert to the presence of cancer cell infiltration in the large blood vessels and the heart. In this report, we report a case of a 49-year-old man who was previously diagnosed with squamous cell carcinoma of the lung, underwent autoimmune cell therapy, and was diagnosed posthumously with lung cancer invading the aorta and heart, resulting in severe cardiac tamponade. This case illustrates the value and key points of autopsy in evaluating sudden deaths.
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Affiliation(s)
- Xiankun Chen
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China
| | - Congcong Zhao
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China
| | - Zhe Zheng
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China
| | - Cunhao Bian
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China
| | - Yongtai Zhang
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China
| | - Peng Zhang
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China
| | - Yongguo Li
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China
| | - Minzhu Zhao
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China.
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China.
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China.
| | - Jianbo Li
- Department of Forensic Medicine, Chongqing Medical University, Chongqing, 400010, China.
- Chongqing Engineering Research Center for Criminal Investigation Technology, Chongqing, 400010, China.
- Chongqing Key Laboratory of Forensic Medicine, Chongqing, 400010, China.
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Tsai YH, Ko KH, Yen H, Huang TW. Intrapericardial Thymoma Presented as Pericardial Tamponade with Post-Operative Myasthenia Gravis. Medicina (B Aires) 2022; 58:medicina58050609. [PMID: 35630026 PMCID: PMC9147635 DOI: 10.3390/medicina58050609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Thymoma is an epithelial mass arising from the thymus. Most thymomas are located in the anterior mediastinum. Ectopic intrapericardial thymoma is very unusual; to date, only eight cases of pericardial thymoma have been reported. Among thymoma patients, 20% to 25% are associated with myasthenia gravis. However, postoperative myasthenia gravis occurs in less than 1% of cases. Here, we share a rare case of ectopic intrapericardial thymoma that developed postoperative myasthenia gravis six months after surgery. Case presentation: A 66-year-old woman visited the outpatient department due to productive cough and chest pain. Chest radiography showed increased soft tissue opacity over the mediastinum. A soft tissue mass in the pericardium and a ground glass nodule in right upper lung were noted using chest computed tomography. The diagnosis of thymoma, type B2, pT3N0M0, and stage IIIA and synchronous adenocarcinoma in situ of the right upper lung was confirmed after surgical removal. Six months later, the patient developed postoperative myasthenia gravis. Conclusions: Thymoma is rarely considered a differential diagnosis in pericardial tumors. Surgical removal with adjuvant radiation therapy should be performed considering the malignancy potential of thymomas and cardiac complications. In patients without myasthenia gravis, a small chance of postoperative myasthenia gravis remains. Patients should be carefully monitored for myasthenia gravis after surgery.
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Affiliation(s)
- Yueh-Hsun Tsai
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Kai-Hsiung Ko
- Department of Radiology, National Defense Medical Center, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Hao Yen
- Department of Pathology, National Defense Medical Center, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, Taipei 11490, Taiwan
- Correspondence:
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Deana C, Vetrugno L, Fabris M, Curcio F, Sozio E, Tascini C, Bassi F. Pericardial Cytokine "Storm" in a COVID-19 Patient: the Confirmation of a Hypothesis. Inflammation 2022; 45:1-5. [PMID: 34533672 PMCID: PMC8446479 DOI: 10.1007/s10753-021-01563-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/22/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022]
Abstract
Novel Coronavirus Disease in most cases produces mild symptoms which resolve after a few days. Some authors hypothesized that SARS-CoV-2 infection could trigger excessive cytokine production leading to a severe multi-organ disease requiring intensive care admission. Respiratory and neurological symptoms are the most frequently reported manifestation of the disease. Indeed, cardiac involvement is reported mostly as a part of a systemic disease. Few isolated cardiac manifestations of COVID-19 infection have been described. We report herein a case of SARS-CoV-2 related severe isolated pericardial involvement requiring ICU admission due to cardiac tamponade needing urgent drainage. Analysis of pericardial fluid from drainage demonstrated a higher cytokine concentration than blood values. Other causes of pericardial disease, such as autoimmunity, bacterial or other than COVID-19 infection, neoplasms or acute myocardial infarction were also evaluated, but all tests confirmed negative results. The suspicion of isolated involvement of the pericardium was therefore demonstrated by the analysis of cytokines which strongly support our hypothesis.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Martina Fabris
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Clinical Pathology, Department of Laboratory Medicine, Academic Hospital of Udine, Udine, Italy
| | - Francesco Curcio
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Clinical Pathology, Department of Laboratory Medicine, Academic Hospital of Udine, Udine, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy
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Key P, Qiryaqoz Z, Prahlow J, Fisher-Hubbard A. Tuberous Sclerosis Complex Diagnosed After Fatal Aortic Dissection. Am J Forensic Med Pathol 2021; 42:e1-e4. [PMID: 33074837 DOI: 10.1097/paf.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Phillip Key
- From the Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
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Affiliation(s)
- A Agarwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Soni
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Chaudhary
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kalogeraki A, Lazopoulos G, Papadakis GZ, Tamiolakis D, Karvela-Kalogeraki I, Karvelas-Kalogerakis M, Segredakis J, Chalkiadakis GE. Cytology of Pericardial Effusion due to Malignancy. ACTA ACUST UNITED AC 2017; 54:179-183. [PMID: 27658166 DOI: 10.1515/rjim-2016-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant pericardial effusion occurs in one tenth of all cancers. It is a very serious disorder that is mainly a secondary process due to metastasis because primary neoplasms of the pericardium such as mesotheliomas, sarcomas being exceedingly rare [corrected]. Pericardial effusion specimens are uncommon and to the best of our knowledge the current study is the largest systematic evaluation of pericardial fluid cytology performed to date. MATERIAL AND METHODS Pericardial effusion specimens from 145 patients collected over a 25 [corrected] year period were studied by cytology [corrected]. The minimum pericardial fluid volume used for adequate cytologic diagnosis in these patients was more than 60 mL. RESULTS Cytological diagnosis revealed malignant pericardial exudates in 100% of the studied patients [corrected]. CONCLUSIONS Cytology provides an immediate and accurate means of diagnosis. Immunocytology is very important
in the diagnostic evaluation.
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Stockhausen S, Kernbach-Wighton G, Madea B, Doberentz E. [Rare causes of iatrogenic pericardial tamponade - 2 case reports]. Arch Kriminol 2017; 239:36-44. [PMID: 29791113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Two rare causes of iatrogenic pericardial effusions are presented. In the first case, a 61-year-old woman who had undergone laparoscopic surgery for a diaphragmatic hernia was resuscitated without success the next day. As cause of death circulatory failure as a result of post-operative pulmonary embolism was reported. Autopsy results showed that the pericardium and the heart had been sewn to the diaphragm. The suture was torn from the tissue, which caused a hemorrhage into the pericardium and the chest cavity, so that death was diagnosed to be due to cardiac tamponade and hemothorax after an iatrogenic heart injury. In the second case, a 62-year-old man who had developed a massive incisional hernia after treatment of an abdominal gunshot wound underwent open herniotomy with mesh repair. Postoperatively, the man complained about increasing pain and shortness of breath. He was transferred to another hospital for further assessment, where a cardiac tamponade was diagnosed. Autopsy results showed that three of the plastic staples used to fix the mesh had perforated the diaphragm and the pericardium thus injuring the adjacent right ventricle with subsequent perforation and development of a hemopericardium.
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Nikolić S, Živković V. Subendocardial hemorrhages in a case of extrapercardial cardiac tamponade – A possible mechanism of appearance. SRP ARK CELOK LEK 2016; 144:440-442. [PMID: 29652455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Subendocardial hemorrhages are grossly visible bleedings in the inner surface of the left ventricle, the interventricular septum, and the opposing papillary muscles and adjacent columnae carneae of the free wall of the ventricle. These are commonly seen in sudden profound hypotension either from severe blood loss from “shock” in the widest sense and, even more often, in combination with brain injuries. CASE OUTLINE We present a case of a 38-year-old man, injured as a car driver in a frontal collision, who died c. 45 minutes after the accident. The autopsy revealed severe chest trauma, including multiple right-sided direct rib fractures with the torn parietal pleura and right-sided pneumothorax, several right lung ruptures, and a rupture of one of the lobar bronchi with pneumomediastinum, and prominent subcutaneous emphysema of the trunk, shoulders, neck and face. The patchy subendocardial hemorrhage of the left ventricle was observed. The cause of death is attributed to severe blunt force chest trauma. CONCLUSION We postulate pneumomediastinum leading to extrapericardial tamponade as the underlying mechanism of this subendocardial hemorrhage.
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Huang L, Liu SG, Huang C, Yu DY, Zheng L, Cheng JD, Tang SB. [Sudden death caused by aortic dissection: 63 cases of forensic pathological analysis]. Fa Yi Xue Za Zhi 2013; 29:273-275. [PMID: 24350543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the cause of death, clinical manifestations and forensic pathological features of death cases caused by aortic dissection. METHODS Sixty-three cases of aortic dissection were selected from forensic medical center, Sun Yat-sen University from 2001 to 2011 and retrospectively analyzed. RESULTS The patients were mostly young and middle-aged male, aged from 30 to 49 years old. The DeBakey type II was the most common pathological type and the main cause of death was pericardial tamponade. The most common symptom was abdominal pain. However, the location of aorta dissection did not always correlate with the location of pain. Some cases showed no obvious clinical symptoms. The rupture was usually located in ascending aorta with atherosclerosis and pathological changes of hypertension. CONCLUSION It is significant for diagnosis and evaluation the cause of death of aortic dissection by knowing the clinical symptoms and forensic pathological features.
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Affiliation(s)
- Lei Huang
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.
| | - Shuang-Gao Liu
- Clinical Department, 157th Hospital Affiliated to Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510510, China
| | - Cui Huang
- Department of Acupuncture, Traditional Chinese Medical Hospital of Huangshan, Huangshan 245000, China
| | - Dan-Yuan Yu
- Forensic Science Centre, Public Security Department of Qingyuan, Qingyuan 511500, China
| | - Li Zheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jian-Ding Cheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Shuang-Bo Tang
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
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Gromadziński L, Przelaskowski P, Januszko-Giergielewicz B, Górny J, Stankiewicz A, Każarnowicz A, Pruszczyk P. [Cardiac tamponade as the first symptom of lung cancer]. Pneumonol Alergol Pol 2013; 81:149-153. [PMID: 23420432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Pericardial effusion is a relatively common clinical problem. It is, however, rarely the first symptom of cancer. Cardiac tamponade testifies to an advanced stage of cancer and is a negative prognostic factor. This paper presents a patient in whom cardiac tamponade was the first symptom of lung cancer. A 63-year-old male, habitual smoker, was admitted to hospital due to progressive symptoms of exertional dyspnoea lasting for a few days and chest pain. Echocardiographic examination revealed a large amount of fluid in the pericardium with echocardiographic signs of a life-threatening cardiac tamponade. The patient underwent pericardial puncture and additional imaging examinations. Lung adenocarcinoma was recognized as the underlying disease. Due to the recurrence of the life-threatening cardiac tamponade, video-assisted thoracoscopic pericardial fenestration was performed and systemic chemotherapy was introduced with good results.
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Affiliation(s)
- Leszek Gromadziński
- Klinika Chorób Wewnętrznych, Gastroenterologii i Hepatologii, Szpital Uniwersytecki Uniwersytetu Warmińsko-Mazurskiego w Olsztynie, ul. Al. Warszawska 30, Olsztyn.
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Warren M, Thompson KS, Popek EJ, Vogel H, Hicks J. Pericardial effusion and cardiac tamponade in neonates: sudden unexpected death associated with total parenteral nutrition via central venous catheterization. Ann Clin Lab Sci 2013; 43:163-171. [PMID: 23694791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Total parenteral nutrition (TPN) via central venous catheter (CVC) is used routinely to provide adequate nutrition for neonates, especially those with very low birth weights (VLBWN). Pericardial effusion and cardiac tamponade (PCE/CT) is a potentially life-threatening CVC complication. DESIGN This autopsy study presents the gross and histopathologic findings in 5 neonates receiving continuous TPN via CVCs, who suddenly and unexpectedly died from PCECT. RESULTS The study population included five neonates (age 4-29 days, 3 males, 2 females, 4 VLBWN neonates, 1 full-term neonate). Chemical analysis of the milky-white PCE fluid showed high triglyceride levels (717-777 mg/dL) consistent with intralipid. Right atrial microscopic examination with the four VLBWNs showed interstitial edema and dilated lymphatics (n=4), atrial thrombus (n=1), and focal fibrinous epicardial exudate (n=1). The full-term neonate RA revealed focal myocyte coagulative necrosis, acute organizing hemorrhage, focal collagen deposition, myocardial hypertrophy, and endocardial thickening. CONCLUSIONS Right atria in PCE/CT demonstrated marked interstitial edema and dilated fine vascular channels. Endocardial injury with permeation of hyperosmotic TPN fluid into the interstitium and egress into the pericardial sac is hypothesized as the etiology of PCE/CT. Recognition of PCE and impending CT in neonates with CVCs for TPN with expedient intervention may avoid sudden unexpected deaths.
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Affiliation(s)
- Mikako Warren
- Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA
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Carles D, Boucard C, Baudoin B, Pelluard F, André G, Naudion S, Legendre M. [Cardiac tamponade with anterior interventricular vein thrombosis complicating central venous catheter insertion in a neonate]. Ann Pathol 2012; 32:217-9. [PMID: 22748341 DOI: 10.1016/j.annpat.2011.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 06/14/2011] [Accepted: 10/24/2011] [Indexed: 11/17/2022]
Abstract
Tamponade is a rare but particularly serious complication of central venous catheters in the newborn. Tamponade can be due to the endocardic aggression caused by the continuous flow of a hyperosmotic solution or by a mechanical injury that can result in perforation of the atrial wall. The risk of tamponade is present whatever is the position of the tip of the catheter, although it has been shown that this risk is increased when this tip is in the right auricle. The originality of our observation is the discovery at the post-mortem examination of an anterior interventricular vein thrombosis, without any lesion of the atrial wall. In the event of the diagnosis of tamponade in living newborn, this etiology must be required because of its therapeutic implications.
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Affiliation(s)
- Dominique Carles
- Unité de pathologie fœtoplacentaire, université Bordeaux-Segalen, 146 rue Léo-Saignat, Bordeaux cedex, France.
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Radojevic RN, Bjelogrlic TB, Savic NS, Soc VM. Heart rupture and tamponade with a short review of cause of death in Ebstein anomaly. J Heart Valve Dis 2012; 21:549-550. [PMID: 22953686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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14
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Affiliation(s)
- Li Hou
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan
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15
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Kodama M, Tateno H, Tasak S, Soejima K, Asano K, Hayashi Y. [An autopsied case of primary malignant pericardial mesothelioma diagnosed antemortally]. Nihon Kokyuki Gakkai Zasshi 2011; 49:964-969. [PMID: 22352060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 40-year-old man was admitted to our hospital with a 1-month history of dyspnea and appetite loss. Chest computed tomography and echocardiography showed moderate pericardial effusion and pericardial thickening. The patient had no history of exposure to asbestos. We created a pericardial window in order to make a diagnosis and to relieve the symptoms using video-assisted thoracoscopic surgery and performed biopsies of the pericardium and the pleura. Immunohistologic analysis of the pericardium confirmed a diagnosis of biphasic pericardial mesothelioma. We gave the patient two cycles of chemotherapy, including pemetrexed and platinum, but his condition did not improve and he died 3 months after onset.
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Vega J, Cisternas M, Bergoeing M, Espinosa R, Zapico A, Chadid P, Santamarina M. [Erdhei-Chester disease: report of one case]. Rev Med Chil 2011; 139:1054-1059. [PMID: 22215336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a 76-year-old male who was admitted due to progressive congestive heart failure lasting several months. An echocardiogram showed a large pericardial effusion with early signs of pericardial tamponade and an irregular surface suggestive of cancer infiltration. The patient was operated, creating a pericardial window and draining 1,200 ml of a brownish yellow fluid with abundant cellularity. Pericardial biopsy showed infiltration by CD68 (+), CD1a (-) and S100 (-) cells. Twenty-eight months earlier, due to fatigue, dyspnea, and a non-specific inflammatory process, an enhanced-contrast-scan showed that aorta was coated with a hypodense tissue that began near the aortic valve and extended until the inferior mesenteric artery, with stenosis of the left subclavian, celiac axis, renal and upper mesenteric arteries. An angioplasty and stent placing was carried out in the last two arteries. Both kidneys had the appearance of "hairy kidneys". A bone scan showed increased uptake in femurs and tibiae and X-ray examination showed osteosclerosis in metaphysis and diaphysis. The diagnosis of Erdheim-Chester disease (non-Langerhans-cell histiocytosis) was made and the patient was treated with steroids and methotrexate.
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Affiliation(s)
- Jorge Vega
- Servicio de Medicina Interna, Sección de Nefrología, Hospital Naval A. Nef, Viña del Mar, Chile.
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Puchalski B, Starczewska M, Koperski Ł, Żyłkowski J, Majstrak F, Górnicka B, Filipiak K. [Cardiac tamponade as the initial symptom of lung cancer]. Kardiol Pol 2011; 69:482-486. [PMID: 21594839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report a case of a 55 year-old woman in whom cardiac tamponade was first symptom of lung cancer. The pericardium is involved in about 12% of patients with malignant disease. Cardiac tamponade is life-threatening situation. In our case diagnosis was made on clinical symptoms and echocardiography. Only urgent pericardiocentesis performed under echocardiograhic guidance can save patient's life. In described case final diagnosis was made on histological examination. We should take into the consideration lung cancer in differentiation causes of cardiac tamponade.
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Affiliation(s)
- Bartosz Puchalski
- I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa.
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Abstract
The anesthetic management of patients with pericardial tamponade is challenging, as they present with not only the cardiovascular compromise that defines pericardial tamponade, but often have comorbid conditions that increase the complexity of their management. This review describes the pathophysiology, etiology, clinical presentation, and anesthetic management of patients with pericardial tamponade, with an emphasis on the intraoperative period and the management of pericardial window procedures, the most common clinical scenario where anesthesiologists will encounter pericardial tamponade.
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Affiliation(s)
- Christopher J O'Connor
- Department of Anesthesiology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Rautji R, Behera C, Dogra TD. An unusual fatal construction site injury in India: a case report. Med Sci Law 2009; 49:222-223. [PMID: 19787996 DOI: 10.1258/rsmmsl.49.3.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 35-year-old male, employed at a construction site, accidentally injured himself when an iron rod, which he was handing up from the ground floor to a fellow worker standing on the first floor, fell backwards. It pierced his suprascapular fossa on the right side, damaging great vessels and the tricuspid valve, and entered the pericardial cavity after puncturing the posterior wall of the right ventricle. The iron rod was taken out by fellow workers at the site and the injured man was immediately taken to a nearby clinic where he was resuscitated and the wound was stitched. He was later transferred to a tertiary care hospital where he died about an hour after admission. Though many bizarre injuries have been reported at construction sites, a fatal injury of this nature deserves a mention in the forensic literature.
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Affiliation(s)
- Ravi Rautji
- Department of Forensic Medicine, Armed Forces Medical College, Pune, India.
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20
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Basu D, Siddaraju N, Murugan P, Badhe BA, Akkarappatty C, Dutta TK. Cytologic aspects of T-cell acute lymphoblastic leukemia presenting as a massive pericardial effusion: a case report. Acta Cytol 2009; 53:337-40. [PMID: 19534280 DOI: 10.1159/000325321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) with a clinical presentation of cardiac tamponade and the presence of blasts in the pericardial fluid is an uncommon event. A cytopathologist needs to adopt a cautious interpretive approach while dealing with a lymphoid-rich pericardial effusion in order to prevent a false negative diagnosis. CASE A 27-year-old male presented with breathlessness, ascites, bilateral pedal edema and fever. He had mild hepatomegaly. On detailed clinical examination, a diagnosis of anemia with cardiac tamponade was made. Cytology of pericardial fluid revealed a large number of lymphoid cells in a hemorrhagic background that, under low magnification, closely resembled mature lymphocytes. However, a careful examination of May-Grünwald-Giemsa-stained cytologic smears, under an oil immersion objective (x 1,000), showed atypical lymphoid cells having blastoid morphology. Rare lymphoid cells displayed a "hand mirror" appearance. A hematologic workup was carried out to exclude leukemia/lymphoma. Complete blood count revealed pancytopenia with abnormal lymphoid cells. Bone marrow showed replacement by 90% lymphoblasts exhibiting periodic acid-Schiff stain, CD3 and terminal deoxynucleotidyl transferase positivity. A diagnosis of T-cell acute lymphoblastic leukemia (FAB L1) was offered, and the patient was started on a remission and induction regimen. However, he had a rapid downhill course and died of cardiorespiratory arrest. CONCLUSION Both clinicians and cytopathologists need to be aware of rare instances in which ALL may present with a pericardial effusion as an initial manifestation. The abnormal lymphoid cells found in the pericardial fluid in such situations need to be interpreted cautiously, as their presence is of clinical significance.
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Affiliation(s)
- Debdatta Basu
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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21
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Petcu DP, Petcu C, Popescu CF, Bătăiosu C, Alexandru D. Clinical and cytological correlations in pericardial effusions with cardiac tamponade. Rom J Morphol Embryol 2009; 50:251-256. [PMID: 19434319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We studied 27 patients diagnosed with pericardial effusion with cardiac tamponade on which pericardiocentesis was performed. The purpose of the study was to evaluate the benefits and limits of the cytological examination of the pericardial liquid in the etiological diagnosis and the treatment of patients with cardiac tamponade. The pericardial liquid taken was examined macroscopically, biochemically (content of proteins, glucose, cholesterol, and LDH), cytologically (MGG stained smears from pericardial liquid) and bacteriologically. The obtained results were compared to the clinical data, the laboratory and paraclinical tests, to differentiate the cause and therapeutically procedure. The cardiac tamponade remitted after pericardiocentesis in all patients. The pericardial liquid was exudate (Ligth criteria) in 82% of all patients. The cytological examination of the pericardial liquid showed malignant smear in 40.74% of the patients, smear of the TBC specific inflammation type in 7.40% patients, smear of non-specific inflammation type in 25.94% of patients, reactive type smear in 25.9% of patients.
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Affiliation(s)
- D P Petcu
- University of Medicine and Pharmacy of Craiova, Craiova, Romania.
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22
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Calvo E, Becerra E, López-Longo FJ, Cabrera FJ, Carreño L, Paravisini A, Cebollero M, Pinilla B, Muiño A. Pericardial tamponade in a patient with polymyalgia rheumatica. Clin Exp Rheumatol 2009; 27:S83-S85. [PMID: 19646352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a patient who developed pericarditis and pericardial tamponade coinciding with polymyalgia rheumatica onset. Our patient did not show any clinical sign of vasculitis; temporal artery biopsies were negative for giant cell arteritis. Pericardial biopsy in our case shows inflammatory perivascular lymphocytary infiltrates thus we believe pericardial effusion has an inflammatory-immunologic origin. Cardiac manifestations are exceptional in polymyalgia rheumatica, though it should be considered in the differential diagnosis in patients with pericarditis over 50 years. The recognition of this uncommon manifestation is very important due to the good response to corticosteroid treatment.
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Affiliation(s)
- E Calvo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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23
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Ashraf T, Pathan A, Memon A, Rasool I, Kundi A. Percutaneous balloon pericardiotomy in a patient with advanced case of malignant pericardial effusion and tamponade. J PAK MED ASSOC 2008; 58:334-336. [PMID: 18988395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Surgical creation of a pericardial window has been a standard procedure for relieving symptoms of patients presenting with recurrent pericardial effusion. In this report we describe the application of Multitrack balloon catheter for creating a pericardial window in a patient who had recurrent pericardial effusion with tamponade as a result of advance malignant disease of breast.
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Affiliation(s)
- Tariq Ashraf
- National Institute of Cardiovascular Diseases, Karachi
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24
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Hayes CR, Lewis D. Spontaneous coronary artery dissection of the left circumflex artery causing cardiac tamponade and presenting with atrial fibrillation: a case report and review of the literature. Angiology 2007; 58:630-5. [PMID: 17901453 DOI: 10.1177/0003319707304532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spontaneous coronary artery dissection is rare. When it does occur, it can present in a myriad of ways and can mimic more common clinical scenarios. Undiagnosed it can be fatal. In this article, the authors present a case of coronary artery dissection in a middle aged man presenting as fast atrial fibrillation with hemodynamic compromise. He was unsuccessfully cardioverted and later arrested and died. Postmortem showed a ruptured dissection of the left circumflex artery causing cardiac tamponade and death. Incidence, associations, pathophysiology, investigations, and treatment options are reviewed.
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25
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Doğan U, Ozeke O, Duksal F, Unlü M. Unusual late cardiac complication of left pneumonectomy: left atrial compression. Anadolu Kardiyol Derg 2007; 7:354. [PMID: 17785253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Umuttan Doğan
- Department of Cardiology, Diyarbakir Military Hospital, Diyarbakir, Turkey
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26
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Fujii T, Sumiyoshi S, Koga T, Nishizaka M, Matsukawa R, Kuwano H, Sueishi K. An autopsy case report of annuloaortic ectasia with cardiac tamponade ruptured from an aneurysm of the right Valsalva sinus. Pathol Res Pract 2007; 203:671-5. [PMID: 17646055 DOI: 10.1016/j.prp.2007.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 04/26/2007] [Accepted: 05/02/2007] [Indexed: 11/20/2022]
Abstract
Annuloaortic ectasia (AAE) is a clinicopathologic condition with primary or secondary dilatation of the aortic annulus and aneurysm of the proximal thoracic aorta, leading to aortic regurgitation. We herein report an autopsy case of a Japanese 57-year-old male with AAE who died of a cardiac tamponade rupture from the sinus of the right coronary. The wall of the aortic root, particularly that of the sinus of the right coronary Valsalva, underwent extensive fibrosis with loss or fragmentation of the elastic lamina in the medial layer and perforation directly into the pericardial space. The adventitia of the proximal aorta to the aortic arch was diffusely fibrotic with both acute and chronic hemorrhage and chronic inflammatory infiltrate. However, the ascending aortic media was largely intact, except for focal laminar necrosis at the center of the medial layer; no medial cystic necrosis, laminar necrosis, or mesoaortitis/panaortitis was present in the thoracic or abdominal aorta, nor in the main aortic branches, which was suggestive of Takayasu disease and giant cell arteritis. Thus, this patient was diagnosed to have idiopathic AAE with sustained peri-aortic hemorrhage, and he finally died of a cardiac tamponade resulting from an aneurysmal rupture.
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Affiliation(s)
- Takaaki Fujii
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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27
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Nandeesh BN, Mahadevan A, Santosh V, Yasha TC, Shankar SK. Acute aortic dissection presenting as painful paraplegia. Clin Neurol Neurosurg 2007; 109:531-4. [PMID: 17475398 DOI: 10.1016/j.clineuro.2007.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 03/23/2007] [Indexed: 10/23/2022]
Abstract
Aortic dissection is a rare potentially life threatening condition. Neurological complications such as paraplegia as presenting manifestation of aortic dissection are exceedingly rare. We describe a 60-year-old man who presented with acute onset paraplegia with bladder involvement, constricting pain in the lower abdomen, bradycardia and succumbed rapidly within 14h of onset of symptoms. Autopsy revealed an unexpected cause of paraplegia with extensive aortic dissection extending from origin to iliac bifurcation (DeBakey type I). The aorta showed extensive atherosclerosis causing medial destruction and dissection. The spinal cord in the vulnerable watershed zone of T12-L1 downwards revealed ischemic softening. No infarcts were seen in other organs as he succumbed rapidly to cardiac tamponade. Acute aortic dissection presenting as paraplegia though rare, should be considered in patients presenting with sudden onset paraplegia with associated severe pain and absent pulses. Prompt diagnosis and timely intervention may help save life and limb.
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Affiliation(s)
- B N Nandeesh
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India
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28
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Affiliation(s)
- William C Little
- Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA.
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29
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Aydin B, Püschel K, Schulz F. [Delayed pericardial tamponade following a stab wound to a branch of the right coronary artery]. Arch Kriminol 2006; 217:101-7. [PMID: 16696233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A 45-year-old man was attacked with a knife and suffered multiple stab wounds to the chest and abdomen. After surgical treatment and hospitalization for 9 days he was discharged in a stable condition. The following day he was found dead in his apartment. The autopsy revealed a pericardial tamponade caused by acute bleeding from an injured branch of the right coronary artery. This case shows that life-threatening late complications in patients with penetrating cardiac wounds may occur despite an initially uneventful course.
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Affiliation(s)
- Birol Aydin
- Aus dem Institut für Rechtsmedizin der Universität Hamburg
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30
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Abstract
BACKGROUND Patients with blunt or penetrating cardiac injury usually present with cardiac tamponade and hemorrhagic shock upon hospital arrival. Many victims die before they reach hospital. In this study, we present a detailed analysis of hemopericardium-related fatalities. METHODS We retrospectively reviewed the medicolegal autopsy records of hemopericardium-related fatalities that occurred from 1994 to 2003. The parameters investigated were demographic characteristics, hospitalization before death, the cause of death, the manner of death, the mechanism of death, the location of the entrance wound, the number of wounds reaching the target and the site of target perforation. RESULTS Seven women (mean age: 45 +/- 23 years) and 33 men (mean age: 34 +/- 12 years) were included in the study. Only 5 patients (12.5%) with cardiac activity reached the hospital. Twenty individuals (50%) were victims of stabbings, which was the most common cause of death. The most commonly encountered manner of death was homicide (79%). Thirty-one (77.5%) victims died of hemorrhagic shock and 9 (22.5%) of cardiac tamponade. Entrance wounds were frequently located on the left chest (n = 26). The perforated cardiac chambers were the left atrium (n = 1), the left ventricle (n = 12), the right atrium (n = 2) and the right ventricle (n = 15). One victim had coronary artery perforation. Nine victims had perforations on the intrapericardial part of the aorta. CONCLUSIONS In our series, the hemopericardium-related deaths occurred predominantly in men. Stabbing was the most common cause of death. Entrance wounds were most commonly located on the left chest, and perforated sites were ventricles. Death at the scene was also frequent, and the mechanism of death was hemorrhagic shock.
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MESH Headings
- Accidents, Aviation
- Adolescent
- Adult
- Aged
- Autopsy
- Cardiac Tamponade/etiology
- Cardiac Tamponade/mortality
- Cardiac Tamponade/pathology
- Cause of Death
- Child
- Coronary Vessels/injuries
- Female
- Heart Injuries/etiology
- Heart Injuries/mortality
- Heart Injuries/pathology
- Homicide
- Humans
- Male
- Middle Aged
- Pericardial Effusion/etiology
- Pericardial Effusion/mortality
- Pericardial Effusion/pathology
- Retrospective Studies
- Sex Factors
- Shock, Hemorrhagic/etiology
- Shock, Hemorrhagic/mortality
- Shock, Hemorrhagic/pathology
- Suicide
- Wounds, Gunshot/complications
- Wounds, Gunshot/mortality
- Wounds, Gunshot/pathology
- Wounds, Stab/complications
- Wounds, Stab/mortality
- Wounds, Stab/pathology
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Affiliation(s)
- Gurcan Altun
- Department of Forensic Medicine, Cardiology, Faculty of Medicine, Trakya University, Edirne, Turkey.
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Abstract
Four cases of serious cardiac attacks by autochthonous Trypanosoma cruzi infection from the Brazilian Amazon are reported; three of them occurred in micro-epidemic episodes. The manifestations included sudden fever, myalgia, dyspnea and signs of heart failure. Diagnosis was confirmed by specific exams, especially QBC (Quantitative Buffy Coat) and natural xenodiagnosis. Despite treatment with benznidazol, three patients died with serious myocarditis, renal failure and cardiac tamponade. The authors call attention to the emergence of this disease and reveal a previously unknown pathogenicity of T. cruzi strains in this area, added to a non-usual transmission form.
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Affiliation(s)
- Ana Yecê das Neves Pinto
- Parasitology Department, Evandro Chagas Institute, BR 316 Highway, Ananindeua City, Pará, Brazil.
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Matoh F, Hayashi H, Terada H, Satoh H, Katoh H, Urushida T, Shiraki K, Asai M, Sakahara H, Takehara Y. Usefulness of Delayed Enhancement Magnetic Resonance Imaging for Detecting Cardiac Rupture Caused by Small Myocardial Infarction in a Case of Cardiac Tamponade. Circ J 2005; 69:1556-9. [PMID: 16308508 DOI: 10.1253/circj.69.1556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Delayed enhancement magnetic resonance imaging (DE-MRI) has excellent spatial resolution and compared with other cardiac imaging techniques it can detect a small myocardial infarction (MI) or a subendocardial infarction. A 76-year-old man was admitted for loss of consciousness because of cardiac tamponade. The cause of tamponade was unknown, but electrocardiography and blood test suggested a recent MI. The removal of 100 ml bloody fluid by immediate pericardiocentesis normalized his hemodynamics, and he regained consciousness. Neither echocardiography nor scintigraphy could determine the location of the MI or rupture, but DE-MRI clearly demonstrated a transmural enhancement in a very narrow range of the lateral wall of the left ventricle. Coronary angiography revealed a severely stenotic lesion in the obtuse marginal branch of the left circumflex artery. DE-MRI is a powerful tool for diagnosing small MI that are undetectable with other imaging. Therefore, DE-MRI should be applied in cases with cardiac tamponade by unknown causes.
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Affiliation(s)
- Fumitaka Matoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Japan.
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Abstract
Adult T-cell leukemia/lymphoma (ATLL) has a wide variety of clinical presentations. The most common ones include leukemia, hypercalcemia, lymphadenopathy, hepatosplenomegaly, and skin lesions. We report a case of ATLL in a 73-year-old woman who presented initially with chest discomfort and shortness of breath. The patient had no peripheral lymphadenopathy, circulating lymphoma cells, hepatosplenomegaly, or skin lesions. CT scan showed small mediastinal lymph nodes and pericardial effusion. Diagnosis was established by cytomorphologic evaluation and flow cytometric analysis of the pericardial fluid. Cardiac involvement is a rare event in ATLL and, when present, usually is a late finding in the setting of disseminated disease. This case was unusual because the patient lacked all common clinical features of ATLL. We present this case so as to increase awareness that ATLL could initially present with pericardial effusion. The pathophysiologic mechanisms of cardiac involvement are also discussed.
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Affiliation(s)
- Fernando P Chaves
- Boston Medical Center, Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA.
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Eroles Vega G, Rondón Fernández P, Ferreiro López D, Romero Pérez C, Salcedo Pérez S, Lacambra Calvet C, Solis Villa J. [Tumor-associated significant pericardiac effusions: analysis of 18 cases]. Rev Clin Esp 2004; 204:260-3. [PMID: 15142494 DOI: 10.1157/13061412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Metastatic infiltration is most frequent than primary pericardiac tumors. Most frequent tumors are adenocarcinoma and lymphomas. A retrospective analysis of 18 oncological patients with significant pericardiac effusion (SPE) is carried out. The conclusions of the study are: SPE can be the first manifestation of a neoplasm; frequently, pericardiac tamponade (PT) has a neoplastic origin; thorax is the most frequent localization of the primary tumor; pericardiac fluid (PF) cytology analysis has low diagnostic yield; most useful diagnostic tests are thoracocentesis, thorax computerized tomography (CT) and bronchoscopy; SPE in a neoplasm suggest poor short-term prognosis; poor prognosis variables in this series were primary tumor unfavorable histology, advanced tumor disease and (probably) presentation as PT.
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Affiliation(s)
- G Eroles Vega
- Servicio de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, Spain
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35
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Derk CT, Sandorfi N, Curtis MT. A case of anti-Jo1 myositis with pleural effusions and pericardial tamponade developing after exposure to a fermented Kombucha beverage. Clin Rheumatol 2004; 23:355-7. [PMID: 15293100 DOI: 10.1007/s10067-004-0890-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Accepted: 01/30/2004] [Indexed: 10/26/2022]
Abstract
The pathogenesis of the idiopathic inflammatory myopathies has been postulated to be an environmental trigger causing the expression of the disease in a genetically predisposed patient. We report a case of anti-Jo1 antibody-positive myositis which was associated with pleural effusions, pericardial effusion with tamponade, and 'mechanic's hands', probably related to the consumption of a fermented Kombucha beverage. Kombucha 'mushroom', a symbiosis of yeast and bacteria, is postulated to be the trigger for our patient's disease owing to the proximity of his symptoms to the consumption of the Kombucha beverage.
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Affiliation(s)
- Chris T Derk
- Division of Rheumatology, Thomas Jefferson University Hospital, Philadelphia, PA 1910, USA.
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36
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Martínez A, Vilá LM, Ríos-Olivares E. Predominance of CD4+ T cells and Th2 cytokines in the pericardial fluid of a dermatomyositis patient with cardiac tamponade. Clin Exp Rheumatol 2004; 22:135. [PMID: 15005021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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37
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Kabukcu M, Demircioglu F, Yanik E, Basarici I, Ersel F. Pericardial tamponade and large pericardial effusions: causal factors and efficacy of percutaneous catheter drainage in 50 patients. Tex Heart Inst J 2004; 31:398-403. [PMID: 15745292 PMCID: PMC548241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In 50 patients treated from January 1998 through March 2002 for pericardial effusion and tamponade, we retrospectively investigated the efficacy of percutaneous placement of an indwelling pericardial catheter guided by 2-dimensional echocardiography and fluoroscopy. We also investigated causation. In 80% of the patients, we were able to determine specific causes through clinical, serologic, and cytologic investigation: cancer in 15 patients, chronic renal failure in 11, systemic lupus erythematosus in 2 rheumatoid arthritis in 2, Dressler syndrome in 2, tuberculosis in 1, blunt chest trauma in 1, purulent pericarditis in 1, and probably viral pericarditis in 5. No specific cause could be determined in 10 patients (20%). We did not observe any complication due to the procedure. Two patients died during hospitalization. After hospitalization, 9 patients with metastatic cancer died within 3 months. A 2nd percutaneous drainage procedure was required in 2 cancer patients. Recurrence of pericardial effusion and tamponade and the requirement of pericardiectomy occurred in 2 patients with perfusion of unknown cause and in 1 patient with perfusion due to rheumatoid arthritis. Histologic examination of pericardial tissue in patients with idiopathic disease showed fibrinous pericarditis but no causal factor. In the group with idiopathic pericardial effusion, 2 patients with multiple mediastinal lymphadenopathy underwent mediastinal exploration; biopsy revealed nonspecific lymphadenitis and fibrinous pericarditis. In patients with large pericardial effusions and tamponade, the specific cause was in most cases already known or obtained by initial clinical and laboratory investigation. Sufficient cardiac decompression was achieved by percutaneous pigtail catheter drainage.
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Affiliation(s)
- Mehmet Kabukcu
- Department of Cardiology, Akdeniz University, School of Medicine, 07070-Antalya, Turkey.
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38
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Corso RB, Kraychete N, Nardeli S, Moitinho R, Ourives C, Silva RMD, Pereira RE. Spontaneous rupture of a right atrial angiosarcoma and cardiac tamponade. Arq Bras Cardiol 2003; 81:611-3, 608-10. [PMID: 14963611 DOI: 10.1590/s0066-782x2003001400008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Primary cardiac angiosarcoma is a rare disease of difficult diagnosis and poor prognosis frequently associated with recurring hemopericardium. We report the case of a 30-year-old female with a right atrial angiosarcoma and spontaneous rupture to the pericardial cavity, who was diagnosed during an emergency exploratory thoracotomy, whose indication was cardiac tamponade. This is the 8th case reported in the literature. Clinical findings are discussed and a literature review is provided.
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Affiliation(s)
- Ricardo Barros Corso
- Serviço de Cirurgia Cardíaca Cardiocirúrgica, Serviço de Cardiologia Clínica Cardiointensiva, Hospital Santa Izabel, Santa Casa de Misericórdia, Salvador, BA, Brazil
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39
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Gopez EV, Carey M, Klatt E. Cardiac tamponade as the initial manifestation of primary pericardial malignant mesothelioma. Acta Cytol 2002; 46:1171-3. [PMID: 12462105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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40
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Perdekamp MG, Serr A, Hench J, Mattern D, Bohnert M. [Hemopericardium caused by endocarditis ulcerosa: an unusual cause of sudden death in adolescence]. Arch Kriminol 2002; 210:158-66. [PMID: 12532678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The authors report on the case of a 18-year-old student who died suddenly and unexpectedly of a pericardial tamponade after perforated ulcer-polypous endocarditis of the aortic valve. The detection of aerococcus urinae--which usually causes urinary tract infection--on the inflamed aortic valve demonstrates an unusual pathogenetic chain linking complexes of findings in the urogenital system and the heart.
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41
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Averbeck T, Hemmanouil I, Bredt M, Stover T. [Therapy refractory throat pain. Dissecting aneurysm of the aorta with cardiac tamponade]. HNO 2002; 50:946-7. [PMID: 12575724 DOI: 10.1007/s00106-002-0688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- T Averbeck
- Klinik und Poliklinik fur Hals,- Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover
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Winter WE, Seidman J, Krivak TC, Pujari SG, Boice CR, Carlson JW. Papillary serous adenocarcinoma of the ovary diagnosed after malignant pericardial tamponade and embolic stroke. Gynecol Oncol 2002; 84:453-5. [PMID: 11855887 DOI: 10.1006/gyno.2001.6505] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Epithelial carcinomas of the ovary are predominantly an intraperitoneal disease. Reports of epithelial ovarian carcinomas metastatic to the pericardium are rare. CASE A 43-year-old woman was admitted with symptoms of a pericardial tamponade, as well as an embolic cerebrovascular accident, and transferred to the ICU where a pericardiocentesis was performed. Cytology revealed malignant cells in the pericardial fluid. CT scan of the abdomen and pelvis revealed bilateral pelvic masses. A laparotomy revealed a papillary serous adenocarcinoma of ovarian primary and an infarcted spleen with capsular tumor metastases. The malignant cells in the pericardial fluid were consistent with the ovarian primary. CONCLUSION Ovarian cancer metastasis to the heart and pericardium presented an aggressive variant of tumor spread with significant morbidity and subsequent mortality.
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Affiliation(s)
- William E Winter
- Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307, USA
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43
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Arat M, Ulusoy V, Demirer T, Uysal AV, Ozcan M, Dinçer S, Ilhan O, Koç H. An unusual presentation of plasma cell dyscrasias: cardiac tamponade due to myelomatous infiltration. Leuk Lymphoma 2002; 43:145-8. [PMID: 11908719 DOI: 10.1080/10428190210182] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pericardial involvement, a rare complication of multiple myeloma (MM), is caused by amyloidosis, infections, bleeding abnormalities or plasma cell infiltration, usually at a late or terminal stage of the disease. Three cases of MM with pericardial involvement are reported here and discussed in the light of current literature. In a retrospective review of all patients with MM at two institutions, three cases of pericardial involvement were identified. In one case, we were able to obtain cytospin preparations of the pericardiocentesis fluid. In the remaining two patients, the pericardial biopsy specimen was obtained via a pericardial window. All patients had progressive dyspnea and signs of pericardial tamponade. The pericardiocentesis fluid showed infiltration with plasma cells in one of the three patients, who had a progressive and fatal course. In the second patient pericardial invasion was proven by biopsy and the third was diagnosed with a plasma cell leukemia but developed a pericardial effusion demonstrated by pericardial biopsy. All these three patients died of progressive disease without any response to chemotherapy and supportive measures. In conclusion, optimal treatment for malignant involvement of the pericardium by myeloma cells has not yet been established and is often fatal.
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Affiliation(s)
- Mutlu Arat
- Department of Hematology, Ankara University Medical School, Ibni Sina Hospital, Turkey.
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44
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MESH Headings
- Cardiac Tamponade/pathology
- Cell Transformation, Neoplastic/pathology
- Diagnosis, Differential
- Fatal Outcome
- Heart Neoplasms/pathology
- Heart Neoplasms/secondary
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/pathology
- Male
- Middle Aged
- Pericardium/pathology
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45
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Abstract
BACKGROUND Malignant pericardial effusion as a complication of gynecological cancers is a rare occurrence. A review of the literature revealed only two cases of pericardial effusion secondary to endometrial adenocarcinoma. We describe another patient with FIGO stage IIIA endometrial cancer who developed malignant pericardial effusion with cardiac tamponade. CASE A 57-year-old woman with a history of endometrial carcinoma presented with pericardial effusion and cardiac tamponade. The patient had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by three cycles of radiotherapy postoperatively. Chest X ray and echocardiogram confirmed the presence of pericardial effusion with impending cardiac tamponade. Pericardial biopsy revealed adenocarcinoma. The treatment consisted of emergency pericardial window and subsequent therapy with tamoxifen. A follow-up after 6 months revealed the patient to be asymptomatic. CONCLUSION Patients with cancer may develop a pericardial effusion for different reasons. Early diagnosis of the specific cause is not only useful but also essential in determination of the mode of therapy and estimation of prognosis.
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Affiliation(s)
- P Kheterpal
- Department of Medicine, Lincoln Mental and Medical Health Center, 234 East 149th Street, Bronx, New York 10451, USA.
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46
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Nour-Eddine M, Bensaid A, Tahiri A, Chraibi N. [Malignant non-Hodgkin's lymphoma presenting with cardiac tamponade]. Arch Mal Coeur Vaiss 2001; 94:1112-6. [PMID: 11725718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Malignant non-Hodgkin's lymphoma rarely involves the heart. However, all cardiac structures may be invaded, although the myocardium and pericardium are affected more often than the valvular structures. Diagnosis is important because treatment must be adapted. The cardiac signs are usually non-specific and lymphomas presenting in this way have only occasionally been reported. The authors report two cases in which malignant non-Hodgkin's lymphoma presented with cardiac tamponade.
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Affiliation(s)
- M Nour-Eddine
- Service de cardiologie, CHU Ibn-Rochd, Casablanca, Maroc
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47
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Gonzalez-Ojeda A, de Luna Vargas MA, Nazara-Cazorla Z, Anaya-Prado R, Radillo LG. Esophagopericardial fistula attributed to a barogenic rupture of the esophagus. Report of a case and review of the literature. Hepatogastroenterology 2001; 48:1375-8. [PMID: 11677968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
In this case we describe a fatal condition of esophagopericardial fistula secondary to barogenic rupture of the esophagus. The review of the literature disclosed only one fatal case (reported in 1968) of esophagopericardial fistula attributed to barogenic rupture of the esophagus. Early diagnosis and adequate treatment including pericardiocentesis along with intermittent drainage of the pericardium, full-course antibiotic therapy and a timely, well-planned surgical intervention will substantially improve the prognosis in this type of pathology. Patients similar to our case should be treated with either surgical bipolar esophageal exclusion (conservative disconnection) or esophagectomy combined with large drainage of the pericardial and mediastinal spaces. This case report reinforces the complexity of the diagnosis, and perhaps the need for clinical awareness and the inclusion of this entity in a differential diagnosis.
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Affiliation(s)
- A Gonzalez-Ojeda
- Medical Research Unit of Clinical Epidemiology, Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México.
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48
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Affiliation(s)
- J Chiu
- Cardiac Non-Invasive Laboratory, Department of Medicine, Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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49
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Veinot JP, Acharya V. Post-traumatic left ventricular false aneurysm. J Forensic Sci 2001; 46:396-8. [PMID: 11305450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Most false aneurysms of the heart represent contained ventricular free wall ruptures after myocardial infarction. Post-traumatic aneurysms also may follow penetrating or non-penetrating trauma to the chest. Regardless of the origin of the false aneurysm there is a propensity for aneurysm rupture. We report a patient who developed a false aneurysm of her left ventricle that developed post-motor vehicle accident. Her orthopedic problems were the clinical problems identified and after a hospital admission of 10 days she was discharged home. Four weeks later she died suddenly from anterior left ventricle false aneurysm rupture and tamponaide. Patients with significant chest wall trauma should be assessed for cardiac pathology prior to discharge. Presentation may be delayed and be overshadowed by more evident pathology. Trauma-related aneurysms may cause sudden death, and this may occur some later time after the trauma. Attributing the cause of death to the trauma, which may be remote, is important for the forensic investigator to remember.
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Affiliation(s)
- J P Veinot
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ontario, Canada.
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50
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Gorski AG, Guiterrez PS. A 73-year-old woman with retrosternal pain but no obstructive coronary artery lesion on coronary angiography. Arq Bras Cardiol 2000; 75:329-8. [PMID: 11058930 DOI: 10.1590/s0066-782x2000001000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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