1/40. Non-surgical treatment of purulent pericarditis, due to non-encapsulated haemophilus influenzae, in an immunocompromised patient.A 59-year-old woman suffering from rheumatoid arthritis was admitted with pleural empyema and pericarditis due to non-encapsulated H. influenzae, and developed signs of cardiac tamponade. Purulent pericarditis resolved after ultrasound-guided percutaneous aspiration and systemic antimicrobial therapy. Serial echocardiographic examinations showed a slowly vanishing effusion. Long term follow-up revealed no evidence of pericardial constriction. This case illustrates that life-threatening purulent pericarditis in an immunocompromised patient may respond well to non-surgical treatment.- - - - - - - - - - ranking = 1keywords = pericarditis (Clic here for more details about this article) |
2/40. Purulent pericarditis presenting as an extracardiac mass in a patient with untreated diabetes.A 50-year-old man with symptoms of bi-ventricular heart failure was transferred to our hospital with a diagnosis of extracardiac tumor. He had a 10 year history of untreated diabetes. Chest computed tomography (CT) revealed an extracardiac mass in the right atrio-ventricular groove. cardiac catheterization revealed an elevated mean right atrial pressure of 18 mmHg, mean pulmonary wedge pressure of 16 mmHg, and the right ventricular pressure curve demonstrated typical dips and plateaus. At surgery, there was severe adhesion between the pericardium and epicardium, and the pericardium was severely thickened and contained turbid pus. In the left thoracic cavity, there was large amount of pleural effusion and pus. Therefore, the patient was diagnosed with purulent pericarditis caused by left empyema. The thickened pericardium at the anterior portion of the heart was resected, however resection of the remaining portion was abandoned because the adhesion was so tight. After surgery, the patient underwent irrigation of the heart and left thoracic cavity by 1% povidone iodine solution and 0.5 mg/ml of imipenem for 7 days. Bacteriologic culture of the pus from the pericardium revealed anaerobic gram negative bacteria. After 4 months of antibiotics infusion, his C reactive protein became negative and the patient was subsequently discharged from our hospital.- - - - - - - - - - ranking = 0.71428571428571keywords = pericarditis (Clic here for more details about this article) |
3/40. Hemophilus influenzae b pericarditis in children.Recent experience in the diagnosis and management of Hemophilus influenzae b pericarditis is described in five children. Anterior pericardectomy appears to be the preferred method of surgical drainage because it was associated with a shorter hospitalization than pericardiocentesis or closed or open pericardotomy and removed the risk of recurrent cardiac tamponade and constrictive pericarditis. Countercurrent immunoelectrophoresis of sera and pericardial fluid was used to rapidly identify the etiology of pericarditis in four of four patients tested. The observation that three children appeared to develop pericarditis in the absence of a contiguous infectious focus suggests that bacteremic seeding of the pericardium may be important in the pathogenesis of this disease.- - - - - - - - - - ranking = 1.1428571428571keywords = pericarditis (Clic here for more details about this article) |
4/40. life-threatening eosinophilic pleuropericardial effusion related to vitamins B5 and H.OBJECTIVE: To report a case of eosinophilic pleuropericarditis resulting from concomitant use of vitamins B5 and H. CASE SUMMARY: A 76-year-old white woman was admitted to the hospital because of chest pain and dyspnea related to pleurisy and a pericardial tamponade. This patient had no history of allergy and had been taking vitamins B5 and H for two months. Blood tests performed showed an inflammatory syndrome and a high eosinophil concentration (1200-1500 cells/mm3). Pleurocentesis and pericardiotomy yielded a sterile exudative fluid with an eosinophilic infiltrate. There were no nuclear antibodies and no rheumatic factor; screenings for viruses, parasites, bacteria, and malignant tumor were negative. A myelogram, biopsy of the iliac crest bone, and concentration of immunoglobulin e were also normal. After withdrawal of the vitamins, the patient recovered and the eosinophilia disappeared. DISCUSSION: Prolonged hypereosinophilia has marked predilection to damage specific organs, including the heart, but pleuropericardial effusion is uncommon. Drug-related pleuropericarditis usually occurs without an increased eosinophil count. Other drugs responsible for eosinophilic pleuropericarditis are cephalosporins, dantrolene, propylthiouracil, and nitrofurantoin. To our knowledge, this is the first case report of pleuropericarditis related to vitamins B5 and H. CONCLUSIONS: This case suggests that vitamins B5 and H may cause symptomatic, life-threatening, eosinophilic pleuropericarditis. physicians prescribing these commonly used vitamins should be aware of this potential adverse reaction.- - - - - - - - - - ranking = 0.71428571428571keywords = pericarditis (Clic here for more details about this article) |
5/40. Constrictive pericarditis localized to left ventricle presented with left pleural effusion: a case report.An 18-year old woman presented with progressive dyspnea and cough. physical examination revealed decreased breath sounds at the left hemithorax and distant heart sounds with no murmurs or rub. Electrocardiogram revealed low voltage. Chest X-ray showed unilateral left-sided pleural effusion with no cardiomegaly. Transthoracic echocardiogram showed thickened pericardium localized throughout the left ventricle impairing the diastolic filling. Doppler waveforms were suggestive of localized constrictive pericarditis. A computerized tomographic scan of the chest confirmed the presence of unilateral pleural effusion with thickened pericardium surrounding the left ventricle. The patient's symptoms and signs were related to localized constrictive pericarditis and improved following surgery.- - - - - - - - - - ranking = 0.85714285714286keywords = pericarditis (Clic here for more details about this article) |
6/40. Massive right pleural effusion and ascites caused by a primary constrictive pericardial band.A previously healthy 57-year-old woman with peripheral edema and exertional dyspnea had diminished right breath sounds and edema of both legs. Chest radiography showed massive right pleural effusion, and abdominal computed tomography showed ascites. During cardiac catheterization, pressure curves of both ventricles showed "dip-and-plateau" patterns. We diagnosed constrictive pericarditis and conducted pericardiectomy. During surgery, we found a thick fibrous pericardium surrounding the entire heart and a band of calcium in the atrioventricular groove. Histological examination of excised pericardial tissue showed fibrosis, hyalinization, and calcification, with thickening of < or = 18 mm. Cases of localized pericardial thickening, including constricting bands in the atrioventricular groove, are rare and many such complications occur postoperatively. We report a rare case of primary constrictive pericardial band resulting in massive right pleural effusion and ascites.- - - - - - - - - - ranking = 0.14285714285714keywords = pericarditis (Clic here for more details about this article) |
7/40. A case of refractory bilateral pleural effusion due to post-irradiation constrictive pericarditis.A 51-year-old woman suffering from dyspnoea and refractory bilateral pleural effusions is discussed. The effusion was characterized as a transudate and cardiac decompensation and renal insufficiency were initially suspected. Diuretic agents were not effective and the patient required bilateral chest water-sealed drainage tubes for 4 months, after exclusion of neoplastic infiltration, collagen disease and other cardiac disorders. On echocardiogram, cardiac function and other findings were almost normal, except for shortening of deceleration time in transmitral flow velocity. To evaluate the reduced diastolic compliance, cardiac catheterization was performed, and revealed an elevated pressure in the right ventricle with a dip-and-plateau pattern, and constrictive pericarditis was diagnosed. The hydrothorax resolved after pericardiectomy and symptoms were alleviated. Three and a half years after surgery, the patient is well and taking only oral diuretics. The underlying mechanism of cardiac disorder appears to have been mixed restriction and constriction due to irradiation of her chest for breast cancer 13 years ago. Because the echocardiogram was within normal limits, the diagnosis was delayed. radiation-induced constrictive pericarditis should be considered if there is an unexplained transudate effusion with a normal echocardiogram.- - - - - - - - - - ranking = 0.85714285714286keywords = pericarditis (Clic here for more details about this article) |
8/40. Constrictive pericarditis.A patient with constrictive pericarditis following an open-heart operation without sepsis is discussed. In the absence of sepsis, it has been widely held that this complication does not develop following an open-heart procedure. The fatal outcome in this patient could have been avoided had such an association been known.- - - - - - - - - - ranking = 0.71428571428571keywords = pericarditis (Clic here for more details about this article) |
9/40. Acute pericarditis and pleural effusion complicating cytarabine chemotherapy.BACKGROUND: pericarditis is a rare but possibly severe complication of treatment of acute leukemia with cytarabine. CASE REPORT: We report a possibly cytarabine-induced acute pericarditis and pleuritis with a rapid onset. A patient with acute myelomonocytic leukemia developed an isolated pericarditis 3 weeks after the first course of chemotherapy with cytarabine and idarubicin. The second course of chemotherapy with cytarabine and amsacrine was started after clinical improvement; 3 days later an acute pericarditis with a large pericardial effusion accompanied by a left pleural effusion developed. A pericardio- and pleuracentesis was performed and the symptoms improved rapidly without reaccumulation of the fluid. The third course of chemotherapy with mitoxantrone and etoposide was completed without further cardiopulmonary complications. CONCLUSION: The differential diagnosis of pericarditis in the setting of chemotherapy with cytarabine should include cytarabine- induced pericarditis. The pathogenesis remains unclear, directly toxic and immunological mechanisms are suggested. Severe progression with massive pericardial effusion necessitating risky pericardiocentesis can occur and therefore a therapy with high-dose corticosteroids should be considered early.- - - - - - - - - - ranking = 1.2857142857143keywords = pericarditis (Clic here for more details about this article) |
10/40. dantrolene and pleural effusion: case report and review of literature.STUDY DESIGN: Single-subject case (a quadriplegic female, 56 years). OBJECTIVES: To describe a new case of eosinophilic pleural effusion induced by dantrolene chronic administration. SETTING: Physical medicine and rehabilitation unit in a teaching hospital, france. methods: diagnosis of an eosinophilic pleural effusion induced by dantrolene without any respiratory symptoms, except a decrease of breath sounds on the right lung base. RESULTS: Chest radiograph revealed a right-sided pleural effusion, and blood cell count a significant peripheral eosinophilia. Thoracenthesis contained 85% of eosinophils. The other explorations eliminated other causes of pleural effusion. The diagnosis of drug-induced effusion was almost sure and led us to discontinue the dantrolene. After 3 months, she had completely recovered. These characteristics, similar to the eight other cases described in the literature, are essential for the diagnosis of pleural effusion induced by dantrolene. CONCLUSION: dantrolene, a long-acting skeletal muscle relaxant, is well known to induce liver side effects but it can also induce pleural pericarditis. The pathogenesis is still not clearly identified, but similarities of chemical structures of dantrolene and nitrofurantoine make us think that it could be the same mechanism. The association between dantrolene and nitrofurantoine may have contributed to the expression of the pleural effusion.- - - - - - - - - - ranking = 0.14285714285714keywords = pericarditis (Clic here for more details about this article) |
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