Streptococcus anginosus purulent pericarditis with cardiac tamponade after coronary artery bypass surgery.

Purulent pericarditis caused by Streptococcus anginosus is extremely rare. A 66-year-old man underwent elective coronary artery bypass surgery. This was complicated by sternal wound dehiscence with drainage. Subsequently, he developed fever, progressive dyspnoea and presyncope. Echocardiography showed a large pericardial effusion with evidence of tamponade. He underwent emergent pericardiocentesis. The pericardial fluid culture grew S. anginosus He was treated with 4 weeks of intravenous ceftriaxone with complete clinical recovery. The source of infection was most likely the sternal wound which was overlooked during debridement and rewiring surgery.

Cardiac Tamponade Due to Actinomyces odontolyticus Originating From a Dentigerous Cyst.

This report describes a rare case of pericardial effusion owing to Actinomyces odontolyticus in a 52-year-old woman that originated from a dentigerous cyst, which developed on the distal aspect of a lower left third molar. The cyst had remained asymptomatic for a long period, with no specific functional complications. This is the first case report of a patient with acute pericarditis in which the same strain of A odontolyticus was detected in an asymptomatic dentigerous cyst and in the pericardial fluid.

Cardiac tamponade - unusual clinical manifestation of undiagnosed malignant neoplasm.

Cardiac tamponade may be the first or predominant symptom of some pathologies but its etiology is not uncommonly unknown on admission to hospital. The purpose of this study was to evaluate the predominant causes of cardiac tamponade in previously healthy patients treated emergently in a single cardiac surgical center. The study involved 81 patients with the mean age of 58.1±16.0 years who underwent emergent subxyphoid pericardiotomy due to cardiac tamponade. Pericardial effusion was analyzed macro- and microscopically. Examinations done in the cardiac surgical department revealed pericarditis secondary to infection (n=17) or autoimmunologic processes (n=2) and malignancy in 18 patients (predominantly of the lungs (n=11)). Pericardial effusion obtained from patients with viral and autoimmunologic-induced pericarditis was straw-color and odorless while with bacterial infections dark yellow, iridescent and usually malodorous. Additional workup in the regional hospitals enabled to reveal malignant tumors in 29 patients, leukemia or lymphoma in 5 subjects. In all but one of the neoplastic cases, pericardial fluid was turbid and dark red or plummy. In 10 patients etiology of tamponade remained unknown. In conclusion, cardiac tamponade in previously healthy patients may be occasionally the predominant symptom of cancer, especially of the lungs. Macroscopic intraoperative appearance of pericardial fluid may be helpful in identification of causative condition of cardiac tamponade.

Bacterial Pericarditis Accompanied by Sudden Cardiac Tamponade After Transbronchial Needle Aspiration Cytology.

A 48-year-old man was referred for an abnormal shadow in his chest x-ray. Transbronchial needle aspiration cytology was performed at the mediastinal necrotic lymph node #7, and he was diagnosed as having small cell carcinoma. Fifteen days after bronchoscopy, sudden cardiac tamponade occurred and pericardial drainage suggested a diagnosis of bacterial pericarditis. He was successfully treated by drainage and administration of antibiotics. Complication of bacterial pericarditis associated with bronchoscopy is rare. However, physicians should watch for the appearance of this condition for up to 3 weeks after bronchoscopy, especially in cases with necrotic lymph nodes.

Nontyphoidal cardiac salmonellosis: two case reports and a review of the literature.

Nontyphoidal Salmonella, especially Salmonella enterica, is a rare cause of endocarditis and pericarditis that carries a high mortality rate. Proposed predisposing conditions include immunodeficiency states, congenital heart defects, and cardiac valve diseases. We present 2 cases of cardiovascular salmonellosis. The first case is that of a 73-year-old woman with mechanical mitral and bioprosthetic aortic valves who died from sequelae of nontyphoidal Salmonella mitral valve vegetation, aortic valve abscess, and sepsis. The second case is that of a 62-year-old man with a recent systemic lupus erythematosus exacerbation treated with oral steroids, who presented with obstructive features of tamponade and sepsis secondary to a large S. enteritidis purulent pericardial cyst. He recovered after emergent pericardial drainage and antibiotic therapy. Identifying patients at risk of cardiovascular salmonellosis is important for early diagnosis and treatment to minimize sequelae and death. We reviewed the literature to identify the predisposing risk factors of nontyphoidal Salmonella cardiac infection.

Cardiac tamponade due to group a streptococcus descending necrotizing mediastinitis: case report of an unusual presentation.

BACKGROUND: Cardiac tamponade from necrotizing descending mediastinitis is a rare but life-threatening complication of cervicofacial infections. CASE REPORT: A 49-year-old woman presented in shock with pleuretic chest pain at a small community clinic. She was transferred to our emergency department where cardiac tamponade was diagnosed and drained. Her initial complete blood count and chest radiography suggested a neoplastic process. She, however, was diagnosed with descending necrotizing mediastinitis due to group A Streptococcus. She underwent surgical drainage and recovered uneventfully. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Descending necrotizing mediastinitis can present with cardiac tamponade and a leukemoid reaction mimicking a neoplastic process. Recognizing this entity allows initiation of potentially life-saving treatments.

Infection of a bronchogenic cyst after ultrasonography-guided fine needle aspiration.

Standard recommendation for therapy of benign mediastinal cysts is surgery. Endobronchial ultrasound fine needle aspiration (EBUS-FNA) has been used by some researchers as a diagnostic tool. This approach may be associated with severe life-threatening complications. We describe a case of life-threatening purulent pericardial effusion with tamponade by infection of a bronchogenic cyst after EBUS-FNA.

Cardiac tamponade likely due to candida infection, in an immunocompetent patient.

Candida pericarditis is a rare disease described mainly in immunodepressed patients. Here we report the case of a 76-year-old immunocompetent woman who developed a purulent pericarditis 48 hours after pericardiocentesis. Usual etiologies such as cancer or pericardo-oesophageal fistula, were ruled out. Physical examination revealed a sub-mammary mycosis, which could have led to the infection. The early diagnosis and treatment with a combined medical and surgical approach succeeded in a favorable evolution of this case.

Pericarditis purulenta primaria por Streptococcus pneumoniae, a propósito de un caso clínico / Primary purulent pericarditis by Streptococcus pneumoniae: case report and literature review

Background: Purulent pericarditis has become a rare clinical entity since the onset of antimicrobial therapy and has a poor outcome in the majority of cases. Case-report: A healthy 3 month-old patient admitted with dyspnea, pallor and anorexia, developing cardiogenic shock due to cardiac tamponade. Chest X-ray showed cardiomegaly. He required mechanical ventilation, volume resuscitation and vasoactive drugs. Echocardiogram showed a large pericardial effusion, CT sean ruled out lung and mediastinal infection. Pericardial drainage was performed and Vancomycin plus Ceftriaxone were initiated, with a positive blood culture for Penicillin-sensitive Streptococcus pneumoniae. The evolution was favourable after surgical drainage and controlling the infection. No extraperdicardial infection was found. He received 3 weeks of antibiotic therapy. Immunological studies were normal. Conclusion: Primary purulent pericarditis is uncommon, so early detection and treatment of this life-threatening condition may lead to a good outcome.

Hoy en día la pericarditis purulenta (PP) es una patología poco frecuente, pero de pronóstico grave. Comunicamos el caso clínico de un paciente de 3 meses, sano previamente. Consultó por palidez, rechazo alimentario y dificultad respiratoria de pocas horas de evolución. La radiografía de tórax demostró cardiomegalia. Evolucionó hacia shock cardiogénico por taponamiento cardíaco. Recibió inicialmente expansores de volumen y drogas vasoactivas. Antibioterapia con vancomicina y ceftriaxona. Ecocar-diograma objetivó derrame pericárdico extenso, complementado con TAC que descartó foco infeccioso endotoráxico. Se realizó pericardiocentesis y luego ventana pericárdica. Se aisló en hemocultivo Streptococcus pneumoniae, sensible a penicilina. Luego de drenaje quirúrgico y control de infección presentó evolución favorable. No se encontró sitio infeccioso extrapericárdico. Completó tres semanas de tratamiento antibiótico. Estudio inmunológico fue normal. La PP es observada raramente en individuos sanos. La presentación en este caso fue de horas, por un agente inhabitual y de extrema gravedad. Un diagnóstico precoz, en conjunto con un tratamiento médico-quirúrgico es fundamental, como la mejor forma de evitar secuelas.

Evaluation of children with a large pericardial effusion and cardiac tamponade.

OBJECTIVES: Large pericardial effusions and cardiac tamponade are rare in childhood. The aim of this study was to evaluate the aetiological factors and clinical findings of large pericardial effusion and cardiac tamponade in children. METHODS: We reviewed retrospectively the records of 10 (6 male, 4 female) patients (mean age: 8.05 +/- 4.4 y) with the diagnosis of large pericardial effusion and cardiac tamponade requiring pericardiocentesis and pericardial drainage between 2002 and 2004. RESULTS: After extensive diagnostic investigation we detected that three patients had tuberculosis, one patient had uraemic pericarditis; one patient had bacterial pericarditis; one patient had post-pericardiotomy syndrome; two patients had malignancy and two patients had no identifiable aetiology. Echocardiography-guided percutaneous pericardial puncture and pigtail catheter placement is safe and effective for initial treatment of patients with large pericardial effusion and cardiac tamponade and in most cases, initial assessment with clinical, serologic, and radiologic investigation and careful follow-up can reveal the aetiology. CONCLUSIONS: Although tuberculosis is rare in industrialized countries, in developing countries it remains one of the most important causes of large pericardial effusion and should be investigated and excluded in each patient.

[Tamponade due to Porphyromonas gingivalis]. / Tamponnade a Porphyromonas gingivalis.

A 45 year old man, 10 weeks after angioplasty and endoprosthesis insertion for myocardial infarction, developed tamponade in an infectious context. RNA 16S investigation, using the universal amplification method with ribotyping, detected Porphyromonas gingivalis (a strict anaerobic bacillus associated with peridontitis) in the pericardial fluid. This appears to be the first description of such a clinical scenario, and suggests 5 aetio-pathological mechanisms: fissure syndrome, malignant tamponade, post-infarction pericardial syndrome, endoprosthesis infection and infectious tamponade. We also describe the ribotyping method, which by amplifying DNA coding for RNA 16S allows identification of an increasing number of micro-organisms implicated in infectious pathology.

[A man with Candida pyopneumopericarditis and cardiac tamponade in conjunction with gastric tube infection]. / Een man met candida-pyopneumopericarditis en harttamponnade bij een buismaaginfectie.

A 55-year-old man who had undergone oesophagectomy with retrosternal gastric tube reconstruction for oesophageal carcinoma several years before, presented with retrosternal pain, fever and chills. He appeared to have Candida glabratarelated pyopneumopericarditis and a fungal infection in the gastric tube. Because of cardiac tamponade, the pericardium was surgically drained. The patient was given antibiotics and fluconazole. He left the hospital after one month in relatively good condition. Two months later, he was readmitted for haematemesis. During an emergency surgical procedure a fistula was found between the gastric tube and the left atrium. For these patients is early treatment of the underlying cause lifesaving. Monthly check-ups in an outpatient clinic are needed due to the risk of constrictive pericarditis and recurrent cardiac tamponade.

Effusive-constrictive calcific pericarditis associated with Streptococcus salivarius. Case report and review of the literature.

We report the case of a 40-year-old patient presenting with a 6-month history of dyspnea and edema, with significant worsening of his clinical manifestations for the 2 weeks before admission to our department. During this 14-day preadmission period, continuous positive airway pressure (CPAP) was prescribed elsewhere for management of a working diagnosis of obstructive sleep apnea. The patient presented to us hemodynamically compromised. Management of the patient included emergency cardiac surgery for tamponade caused by effusive-constrictive, calcific pericarditis in addition to antimicrobial treatment as a result of the growth of Streptococcus salivarius from the pericardial fluid. This is the first report in the literature of association of this microorganism with pericarditis. The use of CPAP made the patient's symptoms worse as a result of an increase of the intrathoracic pressure, which was a pathophysiological mechanism, added to the interference of the localized pericardial effusion and the effect of the pericardial constriction. In an era of rapidly increasing use of CPAP systems, clinicians should be aware of their possible detrimental effects on patients with some types of cardiopulmonary diseases.

Tuberculous pericardial effusion: features, tamponade, and computed tomography.

The clinical features with particular reference to tamponade and mediastinal adenopathy were studied in tuberculous pericardial effusion. Tamponade is a frequent complication and the recognition of tuberculous etiology can be difficult. Involvement of the pericardium is mostly from mediastinal lymph nodes that have not been studied. This was a prospective cohort study. All patients had large effusions, and underwent pericardiocentesis and chest computed tomography. Patients with tuberculosis had specific therapy. Others with viral/idiopathic effusion served as controls for the computed tomography studies. There were 26 patients with tuberculosis: 18 had tamponade on echocardiography. All had symptoms. Fever (n = 23) and dyspnea (n = 20) were the most frequent presenting symptoms. Pericardial rub was heard in 14, and 3 had enlarged cervical or axillary nodes. Pulmonary tuberculosis was present in 6. Tuberculin skin test measured 17 +/- 3.3 mm. The biopsy specimen showed a granuloma in 22 of 24. All 26 had mediastinal lymph nodes > 10 mm with a mean size of 19.5 +/- 8.6 mm that disappeared (81%) or regressed (19%) on treatment (p < 0.001). Aortopulmonary nodes were most frequently enlarged (65.4%) and hilar the least. Three required pericardiectomy. At follow-up all were doing well. None with viral/idiopathic effusion had lymph node enlargement. Fever, dyspnea, and tamponade were frequent with tuberculosis. The prognosis was good with specific therapy. Mediastinal nodes were enlarged in all and only with tuberculosis and not with viral/idiopathic effusion. Nodes disappeared or regressed with treatment. In the appropriate clinical context, mediastinal lymph node enlargement on chest computed tomography along with a strongly positive skin test results could help in the diagnosis of a tuberculous etiology of pericardial effusion.

Pericarditis purulenta con taponamiento cardiaco por asociacion de streptococcus agalactiae y salmonella enterica no typhi / Purulent pericarditis with pericardial tamponade caused by streptococcus agalactiae and salmonella enterica no typhi

La pericarditis purulenta (PP) es una condición infrecuente, pero con elevada mortalidad. Previo a la era antibiótica, los agentes etiológicos más comúnmente hallados eran Streptococcus pneumoniae y Staphylococcus aureus. Se presenta el caso de un paciente de sexo masculino de 75 años de edad con un cuadro de shock, PP y taponamiento cardíaco, producto de una sepsis por Streptococcus agalactiae y Salmonella entérica no typhi. No se ha hallado ningún caso similar en la literatuta. Se destaca el antecedente previo inmediato de la realización de una endoscopia digestiva alta con toma de biopsia de esófago como posible causa de bacteriemia e impacto pericárdico. El curso evolutivo fue malo y el paciente falleció a los 34 días. Esta inusual asociaíón bacteriana en un huésped debilitado e inmunodeprimido, debería ser incluida dentro de los diagnósticos etiológicos diferenciales de la pericarditis purulenta.