RESUMEN
To further define the nature of Lyme carditis, electrophysiologic study and endomyocardial biopsy were performed in a patient with Lyme disease, whose principal cardiac manifestation was high-degree atrioventricular block. Intracardiac recording demonstrated supra-Hisian block and complete absence of an escape mechanism. Gallium 67 scanning demonstrated myocardial uptake, and right ventricular endomyocardial biopsy revealed active lymphocytic myocarditis. A structure compatible with a spirochetal organism was demonstrated in one biopsy specimen. It is concluded that Lyme disease can produce active myocarditis, as suggested by gallium 67 imaging and confirmed by endomyocardial biopsy. Furthermore, the presence of high-grade atrioventricular block in this disease requires aggressive management with temporary pacemaker and corticosteroid therapy.
Asunto(s)
Enfermedad de Lyme/diagnóstico , Adulto , Biopsia , Electrofisiología , Radioisótopos de Galio , Bloqueo Cardíaco/diagnóstico , Humanos , Enfermedad de Lyme/etiología , Enfermedad de Lyme/patología , Masculino , Miocarditis/diagnóstico por imagen , Miocarditis/patología , Miocardio/patología , Cintigrafía , Spirochaetales/aislamiento & purificaciónRESUMEN
Pericardial cysts are rare mediastinal cysts occurring with an incidence of 1 in 100, 000. Characteristically, they occur along the right border of the heart. Their size varies from 1.0 cm to 15 cm, and they are often asymptomatic. Patients with symptoms usually have atypical chest pain. In the case reported here, a 37-year-old man complained of nonproductive cough. Chest x-ray film revealed a pericardial cyst that appeared as a large echolucent unilocular mass along the left border of the heart. Diagnosis was confirmed with the use of both computed tomography and transthoracic echocardiography.