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1.
Medicine (Baltimore) ; 99(37): e22093, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925751

RESUMO

RATIONALE: Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers infection and inflammation. As a result, pericarditis and pericardial effusion may occur with or without COVID-19 related respiratory signs. Due to limitations in sensitivity and specificity of current COVID-19 diagnostic studies, cases that trigger high clinical intuition, even with negative serologic and polymerase chain reaction testing results, may necessitate further diagnostic workup to discover the underlying etiology. PATIENT CONCERNS: Here we present a rare case of pericardial effusion in the setting of asymptomatic COVID-19 infection manifesting with the chief complaint of chest pain. DIAGNOSIS: While undergoing diagnostic workup, the patients first 2 sets of COVID 19 reverse transcription-polymerase chain reaction (RT-PCR) were negative while a latter RT-PCR test, as well as serology, were positive, leading to the diagnosis of COVID-19 reinfection or subacute presentation of viral infection with pericardial effusion. Echocardiogram depicted large circumferential pericardial effusion with mildly thickened pericardium. INTERVENTIONS: The patient underwent pericardial window placement followed by ibuprofen administration and discharged from the hospital. OUTCOMES: During the follow-up visit patient had no symptoms and echocardiogram demonstrated complete resolution of the effusion. LESSONS: Due to the possible establishment of pericardial effusions and consecutively tamponade even without any COVID-19 related clinical presentation, it is crucial for clinicians to trust their intuition, conduct the appropriate diagnostic tests, find the underlying diagnosis and prevent the devastating consequences.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Ecocardiografia/métodos , Pandemias , Derrame Pericárdico , Pericardiocentese/métodos , Pneumonia Viral , Infecções Assintomáticas , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/fisiopatologia , Derrame Pericárdico/cirurgia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Resultado do Tratamento
2.
Am J Cardiol ; 132: 140-146, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32773224

RESUMO

Pericardial disease is a recognized manifestation of cardiovascular disease in the end-stage renal disease (ESRD) population, and can manifest as pericardial effusion, though the prognosis of pericardial disease in ESRD patients is unclear. In the modern era of renal replacement therapy, little is known about the prevalence and the implications of pericardial effusion in ESRD patients, its echocardiographic characteristics, and risk factors. We conducted a retrospective chart review on subjects > than 18 years of age with known ESRD who were undergoing outpatient evaluation for renal transplantation at Mayo Clinic Arizona between January 2001 and December 2015 and had baseline echocardiogram completed within 3 months of their initial evaluation. Patients with moderate sized pericardial effusions or larger were identified. The pericardial effusion cohort was age and gender matched with a cohort of patients with ESRD without pericardial effusion in a 1:2 fashion. 54 patients with moderate or greater sized pericardial effusion out of 2,820 patients that fit our inclusion criteria, corresponding to a prevalence of 1.9%. A total of 41 patients or 75.9%, had a moderate sized effusion. A total of 13 patients, or 24.1% had a large sized effusion, 7 of whom had tamponade physiology on echocardiography. The presence and size of the effusion was not predictive for worse outcomes. Hemodialysis duration was protective, but no other factors were predictive or protective in the development of moderate sized or larger pericardial effusions, including echocardiographic parameters.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim , Derrame Pericárdico/epidemiologia , Arizona/epidemiologia , Ecocardiografia , Feminino , Seguimentos , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Prevalência , Prognóstico , Estudos Retrospectivos
3.
J Card Surg ; 35(10): 2583-2588, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32668050

RESUMO

INTRODUCTION: Pericardial effusion develops due to different etiologies. The main goals of our study are to understand the etiology and determine whether the amount of pericardial effusion is significant in terms of malignancy. MATERIAL AND METHODS: 142 patients with pericardial effusion, who met the criteria between 1 January 2014 and 1 January 2019, were retrospectively analyzed. All of these patients underwent operation with the subxiphoidal approach. The fluid samples were sent to the microbiology and pathology laboratories for evaluation. Patients underwent follow-up after 1 month. RESULTS: Of the patients included in this study, 72 (61%) of 118 patients were operated on under general anesthesia with a laryngeal mask, and 46 (39%) underwent sedation and local anesthesia. The etiologies found in patients were as follows: effusions resulting from malignancy in 27 (22.9%), idiopathic in 24 (20.3%), cardiac causes (depending on the use of anticoagulants or postoperation) in 22 (18.6%), uremia in 20 (16.9%), infection in 18 (15.3%), and heart failure in 7 patients. The amount of fluid drained from the patients was 661.61 ± 458.34 mL. Out of 27 patients with malignancy, 21 (77.8%) had drainage over 500 mL of effusion fluid, and 6 (22.2%) had drainage under 500 mL. Patients who had positive results tended to have drainage over 500 mL compared with patients who had negative results in terms of malignancy (P = .033). CONCLUSION: The subxiphoidal approach to pericardial effusion is an easily applicable operation, whether therapeutic or diagnostic. The advantages of the subxiphoidal approach include drainage of all of the fluid and ease of sampling the pericardial fluid. We believe that the amount of fluid drained can lead us to consider malignancy as an etiology.


Assuntos
Neoplasias/complicações , Neoplasias/diagnóstico , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Drenagem/métodos , Feminino , Humanos , Masculino , Derrame Pericárdico/patologia , Derrame Pericárdico/cirurgia , Técnicas de Janela Pericárdica , Estudos Retrospectivos
4.
Am J Case Rep ; 21: e925554, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32606285

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness. However, with rising numbers of cases, multiple reports of cardiovascular manifestations have emerged. We present a case of COVID-19 infection complicated by myopericarditis and tamponade requiring drainage. CASE REPORT An 82-year-old woman with multiple comorbidities presented with five days of productive cough, fever with chills, and intermittent diarrhea. She tested positive for COVID-19. Index EKG revealed new diffuse T-wave inversions and a prolonged QT interval (>500 ms). Troponin was mildly elevated without any anginal symptoms. Hydroxychloroquine and azithromycin were not initiated due to concerns about QT prolongation. The echocardiogram revealed preserved left ventricular (LV) function, a small global pericardial effusion, and apical hypokinesis. Serial echocardiograms revealed an enlarging circumferential pericardial effusion with pacemaker wire reported as 'piercing' the right ventricular (RV) apex alongside early diastolic collapse of the right ventricle, suggesting echocardiographic tamponade. Chest CT revealed extension of the RV pacemaker lead into the pericardial fat. Interestingly, on comparison with a previous chest CT from 2019, similar lead positions were confirmed. Pericardiocentesis was performed with removal of 400 cc exudate. CONCLUSIONS Acute myopericarditis and pericardial effusion can occur in COVID-19 infection, even in the absence of severe pulmonary disease. This case highlights the importance of awareness of rare cardiac manifestations of COVID-19 in the form of acute myopericarditis and cardiac tamponade and their early diagnosis and management.


Assuntos
Betacoronavirus , Tamponamento Cardíaco/etiologia , Diagnóstico Precoce , Miocardite/complicações , Derrame Pericárdico/etiologia , Pericardiocentese/métodos , Pericardite/complicações , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Ecocardiografia , Feminino , Humanos , Miocardite/diagnóstico , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/cirurgia , Pericardite/diagnóstico , Função Ventricular Esquerda/fisiologia
6.
Eur J Intern Med ; 76: 100-101, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-183001
7.
Eur J Intern Med ; 76: 100-101, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32359887
9.
Curr Cardiol Rep ; 22(1): 2, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31940097

RESUMO

PURPOSE OF REVIEW: This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of anti-tuberculous therapy (ATT), and recent efficacy trials. RECENT FINDINGS: A profibrotic immune response characterizes TBP, with low levels of AcSDKP, high levels of γ-interferon and IL-10 in the pericardium, and high levels of TGF-ß and IL-10 in the blood. These findings may have implications for future therapeutic targets. Despite advances in nucleic acid amplification approaches, these tests remain disappointing for TBP. Trials of corticosteroids and colchicine have had mixed results, with no impact on mortality, evidence of a reduction in rates of constrictive pericarditis and potential harm in those with advanced HIV. Small studies suggest that ATT penetrates the pericardium poorly. Given that there is a close association between high bacillary burden and mortality, a rethink about the optimal drug doses and duration may be required. The high mortality and morbidity from TBP despite use of anti-tuberculous drugs call for researches targeting host-directed immunological determinants of treatment outcome. There is also a need for the identification of steps in clinical management where interventions are needed to improve outcomes.


Assuntos
Antituberculosos/uso terapêutico , Pericardite Tuberculosa/diagnóstico , Pericardite Tuberculosa/tratamento farmacológico , Gerenciamento Clínico , Humanos , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/tratamento farmacológico , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/tratamento farmacológico , Pericardite Tuberculosa/etiologia , Pericárdio
10.
BMC Cancer ; 20(1): 13, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906980

RESUMO

BACKGROUND: Primary angiosarcomas of the right atrium are extremely rare, often resulted in missed diagnosis or misdiagnosis with routine examination tools. These malignant cardiac tumors are highly aggressive with generally poor prognosis. Surgical excision is the mainstay of treatment as it is essentially not responsive to current regimens of chemoradiotherapy. CASE PRESENTATION: Herein, we describe a patient who initially presented with paroxysmal atrial fibrillation and was subsequently treated with radiofrequency catheter ablation (RFCA). Prior to RFCA, an initial transesophageal echocardiography revealed a local thickening of the intratrial septum. Three months later, she was hospitalized with progressive dyspnea and massive pericardial effusion. A large immobile, non-pedunculated mass, occupying almost half of the right atrium was detected by transthoracic and transesophageal echocardiogram. Multimodality cardiac imaging was useful in further characterizing this mass, which was ultimately diagnosed as an angiosarcoma based upon biopsy results. The growth rate was extremely rapid following RFCA, and patient underwent surgical excision. After discharge, the angiosarcoma recurred and patient survived for 7 months from the first episode of tamponade. CONCLUSIONS: Primary cardiac angiosarcoma of the right atrium can easily be mistaken for structural anomalies in its early stages, losing the opportunity for initiating earlier treatments to improve potential patient outcomes. The correct diagnosis of this rare case relied on the comprehensive utilization of multimodal imaging techniques including biopsy.


Assuntos
Ablação por Cateter , Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Hemangiossarcoma/diagnóstico , Diagnóstico Ausente , Fibrilação Atrial/diagnóstico , Dispneia/diagnóstico , Dispneia/etiologia , Evolução Fatal , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Derrame Pericárdico/diagnóstico , Tomografia por Emissão de Pósitrons
11.
Acta Cytol ; 64(3): 248-255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31352449

RESUMO

BACKGROUND: Differentiating reactive mesothelial cells from metastatic carcinoma in effusion cytology is a challenging task. The application of at least 4 monoclonal antibodies including 2 epithelial markers (Ber-EP4, MOC-31, CEA, or B72.3) and 2 mesothelial markers (calretinin, WT-1, CK5/6, or HBME-1) are often useful in this distinction; however, it is not readily available in many resource-limited developing countries. Aberrant immunoexpression of enhancer of zeste homolog 2 (EZH2), a transcriptional repressor involved in cancer progression, is observed widely in various malignancy. In this study, we evaluate the diagnostic value of EZH2 as a single reliable immunomarker for malignancy in effusion samples. METHODS: A total of 108 pleural, peritoneal, and pericardial effusions/washings diagnosed as unequivocally reactive (n = 41) and metastatic carcinoma (n = 67) by cytomorphology over 18 months were reviewed. Among the metastatic carcinoma cases, 54 were adenocarcinoma and others were squamous cell carcinoma (n = 1), carcinosarcoma (n = 1), and carcinoma of undefined histological subtypes (n = 11). Cell block sections were immunostained by EZH2 (Cell Marque, USA). The percentages of EZH2-immunolabeled cells over the total cells of interest were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off score to define EZH2 immunopositivity. RESULTS: A threshold of 8% EZH2-immunolabeled cells allows distinction between malignant and reactive mesothelial cells, with 95.5% sensitivity, 100% specificity, 100% positive predictive value, and 93.2% negative predictive value (p < 0.0001). The area under the curve was 0.988. CONCLUSION: EZH2 is a promising diagnostic biomarker for malignancy in effusion cytology which is inexpensive yet trustworthy and could potentially be used routinely in countries under considerable economic constraints.


Assuntos
Líquido Ascítico/patologia , Biomarcadores Tumorais/análise , Carcinoma/diagnóstico , Proteína Potenciadora do Homólogo 2 de Zeste/análise , Derrame Pericárdico/diagnóstico , Derrame Pleural Maligno/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Líquido Ascítico/química , Carcinoma/complicações , Citodiagnóstico/métodos , Feminino , Humanos , Imuno-Histoquímica/métodos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Derrame Pleural Maligno/etiologia , Estudos Retrospectivos , Adulto Jovem
12.
Acta Cytol ; 64(3): 256-264, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31466063

RESUMO

BACKGROUND: Effusion cytology is a major diagnostic tool in medicine and has both therapeutic and prognostic implications. One of the dilemmas encountered is the differentiation between atypical cells and reactive mesothelial cells. The use of ancillary tools can reduce this grey zone and help to achieve a definitive diagnosis. OBJECTIVES: The main objective of this study was to evaluate the role of flow cytometry (FCM) and cell block with immunohistochemistry (IHC), along with the clinicoradiological investigations, to achieve a final diagnosis in effusion cytology to the maximum extent possible. METHOD: A prospective study was conducted. Effusion fluids, showing adequate amount and cellularity, were processed for conventional cytology, ploidy analysis by FCM, and cell block analysis, followed by IHC wherever required. Conventional cytological analysis was done by 2 independent pathologists, to look for interobserver variation, if any. The final result was achieved on the basis of integration of the results of the aforementioned studies, cytological details, clinicoradiological information, tissue biopsy findings, and follow-up. RESULT: A total of 90 samples were analyzed. On cytological examination, observer I categorized 60% samples as benign and 18.8% (n = 17) as malignant versus 58% categorized as benign and 23.3% (n = 21) as malignant by observer II. Observer I reported 19 (21.1%) equivocal cases and observer II reported 16 (17.7%). When both pathologists were considered together, the number of equivocal cases increased to 20. Sensitivity and specificity of FCM were 96.67 and 100%, respectively, and 100% for the cell block. On combining all techniques, the equivocal cases were resolved and a total of 33 cases were reported as malignant. However, 3 cases could still not be categorized and were labeled inconclusive. CONCLUSION: Conventional cytology combined with cell block IHC and FCM has the potential to minimize the requirement of tissue biopsy for confirmation. If the first sample is used judiciously for all the techniques, this may reduce the requirement for a second sample and possibly also the time required for a definite diagnosis and the initiation of therapy.


Assuntos
Líquido Ascítico/patologia , Citodiagnóstico/métodos , DNA de Neoplasias/análise , Neoplasias/diagnóstico , Ploidias , Citometria de Fluxo , Humanos , Imuno-Histoquímica/métodos , Neoplasias/genética , Derrame Pericárdico/diagnóstico , Derrame Pleural Maligno/diagnóstico , Sensibilidade e Especificidade
13.
Medicine (Baltimore) ; 98(42): e17584, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626128

RESUMO

RATIONALE: High-stage endometrial carcinoma is an aggressive tumor with a high propensity for distant spread. However, metastases to the pericardium are rare in gynecological cancer, and are usually fatal. PATIENT CONCERNS: A 69-year-old woman was diagnosed with endometrial carcinoma with pericardium metastasis. The symptoms at presentation were panic and shortness of breath. DIAGNOSES: The cytologic examination of pericardial fluid obtained by pericardiocentesis confirmed metastasis. INTERVENTIONS: In addition to cisplatin instilled into the pericardial space, for systemic chemotherapy, we chose that gemcitabine and lobaplatin regimen be preferred. OUTCOMES: The patient has been participating in telephone follow-up for 8 months and has generally remained in a good condition. LESSONS: Endometrial carcinoma can have pericardial metastases. When this happens, we recommend ultrasound-guided pericardial puncture and the pericardial injection of cisplatin, in combination with systemic chemotherapy that consists of gemcitabine and lobaplatin.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias do Endométrio/secundário , Neoplasias Cardíacas/complicações , Derrame Pericárdico/etiologia , Pericardiocentese/métodos , Idoso , Terapia Combinada , Diagnóstico Diferencial , Ecocardiografia , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/terapia , Feminino , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/terapia , Humanos , Imagem por Ressonância Magnética , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapia , Pericárdio , Tomografia Computadorizada por Raios X
14.
Cardiol Young ; 29(10): 1278-1281, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475645

RESUMO

We report a case of a 13-year-old male with trisomy 21 in Southwestern Ontario, Canada, who presented with bilateral pneumonia, pericardial effusion, and peripheral oedema. The pericardial effusion did not respond to standard treatment options. Evaluation revealed severe dietary restriction, consistent with kwashiorkor. Hospital course was complicated by severe hypoalbuminaemia, hypocalcaemia, hypomagnesaemia, and hypophosphataemia. The pericardial effusion and other findings resolved gradually upon slow introduction of a well-balanced diet and adequate caloric and protein intake. Kwashiorkor is an unusual cause of pericardial effusion and can be overlooked especially in developed countries. It is a type of protein-calorie malnutrition often seen in children of impoverished countries and famine. It is a result of insufficient protein intake in the context of adequate caloric intake. Pericardial effusion not responding to usual treatment is a challenge, and other aetiologies must be considered. Malnutrition is often underdiagnosed or misdiagnosed in developed countries with devastating outcomes if unrecognised. This makes it imperative to consider this diagnosis, recognise potential risk factors, and be prepared to accurately assess overall nutritional status.


Assuntos
Ecocardiografia/métodos , Kwashiorkor/complicações , Derrame Pericárdico/diagnóstico , Pericárdio/diagnóstico por imagem , Adolescente , Diagnóstico Diferencial , Humanos , Kwashiorkor/diagnóstico , Masculino , Derrame Pericárdico/etiologia
15.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511262

RESUMO

A 12-year-old boy presented with central chest pain, shortness of breath and type 1 respiratory failure. He had a background of graft versus host disease (GvHD), which was currently managed with imatinib therapy. A focused bedside ultrasound scan was performed revealing a large pericardial effusion. The child was referred to a tertiary paediatric cardiology centre where he underwent emergency pericardiocentesis, draining a total of 800 mL of pericardial fluid. Fluid analysis excluded infection, and with no other concerns for a GvHD flare the diagnosis of an imatinib-induced pericardial effusion was made. On terminating the therapy, the pericardial collection did not reaccumulate. Tyrosine kinase inhibitor-induced pericardial and/or pleural effusion should be considered as a differential diagnosis in paediatric patients on this therapy presenting in a similar manner.


Assuntos
Mesilato de Imatinib/efeitos adversos , Derrame Pericárdico/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Criança , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Masculino , Derrame Pericárdico/diagnóstico
16.
Clin Lung Cancer ; 20(6): 435-441, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31303452

RESUMO

BACKGROUND: Higher cardiac radiotherapy (RT) doses when treating lung cancer are associated with worse overall survival (OS), although the direct association between cardiac dose and early cardiotoxicity is poorly understood. We hypothesized that RT doses to the heart and cardiac substructures are associated with under-reported early cardiotoxicity and worse OS. PATIENTS AND METHODS: We conducted an institutional retrospective review of lung cancer patients treated with conventionally fractionated RT from 2010 to 2015. Collected data included pre-RT cardiac risk factors, post-RT cardiotoxicities, and dose-volume parameters for cardiac substructures. Univariate and multivariate analyses were performed to identify predictors of cardiotoxicity and OS. RESULTS: Seventy-six cases were evaluated with 1.2 years median follow-up. Cardiotoxicities included atrial arrhythmia (n = 5), pericardial effusion (n = 16), and valvular disease (n = 1). In univariate analysis, significant dose-volume predictors for cardiotoxicity included mean RT dose to structure of interest, volume of structure of interest receiving ≥30 Gy RT dose, and volume of structure of interest receiving ≥45 Gy RT dose (V45) to the atria, ventricles, and pericardium. Higher ventricular V45 was associated with post-RT cardiotoxicity in multivariate analysis (hazard ratio [HR], 1.50; P = .027). Cardiotoxicity occurrence was a highly significant predictor of OS in multivariate analysis (HR, 12.7; P < .001), but higher ventricular V45 alone was not (HR, 0.78; P = .450). CONCLUSION: Early cardiac events were relatively common after lung cancer RT and associated with multiple cardiac dose-volume parameters. Occurrence of early cardiotoxicity was strongly associated with worse OS. In practice, early cardiotoxicity is under-reported, supporting the need for more detailed cardiac evaluations in high-risk patients to detect and address early cardiotoxicity.


Assuntos
Arritmias Cardíacas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Cardiotoxicidade/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Neoplasias Pulmonares/radioterapia , Derrame Pericárdico/diagnóstico , Radioterapia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/etiologia , Carcinoma Pulmonar de Células não Pequenas/complicações , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Doenças das Valvas Cardíacas/etiologia , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Derrame Pericárdico/etiologia , Prognóstico , Radiometria , Estudos Retrospectivos , Risco
18.
ABC., imagem cardiovasc ; 32(3): 214-216, jul.-set. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1006712

RESUMO

Relatamos o caso de um paciente jovem admitido no pronto-socorro com quadro de dor precordial. O eletrocardiograma de admissão identificou supradesnivelamento do segmento ST localizado em parede lateral associado à imagem em "espelho", com enzimas cardíacas altamente elevadas, o que sugere diagnóstico de síndrome coronariana com supradesnivelamento de ST. O ecocardiograma evidenciou derrame pericárdico com fração de ejeção preservada e ausência de alterações segmentares, sugerindo, assim, pericardite aguda, com comprometimento do miocárdio. Desta forma, foi realizada ressonância magnética cardíaca, que evidenciou presença de realce tardio não isquêmico, confirmando o diagnóstico de perimiocardite. Trata-se de situação pouco frequente na prática clínica e que merece maior compreensão e atenção por parte dos médicos que trabalham em prontos-socorros


Assuntos
Humanos , Masculino , Adolescente , Eletrocardiografia/métodos , Miocardite , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico , Infecções/complicações , Infarto do Miocárdio
19.
Clin Lab ; 65(5)2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31115232

RESUMO

BACKGROUND: Elevated adenosine deaminase (ADA) and normal tumor markers in pericardial or pleural effusion are usually considered to be a specific manifestation of benign pericardial or pleural effusion. Here we report a case of lung adenocarcinoma with pericardial metastasis with elevated ADA and normal tumor markers in pericardial effusion. METHODS: Pericardiocentesis and lung puncture combined laboratory indexes and pathology were performed for diagnosis. RESULTS: Analysis of pericardial fluid revealed a white blood cell (WBC) count of 2,000 x 106/L (70% for lymphocytes) with an ADA level of 72.8 U/mL. Pathology of pericardial effusion found no malignant cells. Histopathology of percutaneous lung puncture showed adenocarcinoma. CONCLUSIONS: ADA and tumor markers were not a specific index in differential diagnosis between tuberculosis and metastasis in pericardial effusion.


Assuntos
Adenocarcinoma/diagnóstico , Adenosina Desaminase/metabolismo , Neoplasias Pulmonares/diagnóstico , Derrame Pericárdico/diagnóstico , Pericardite Tuberculosa/diagnóstico , Pericárdio/patologia , Biomarcadores Tumorais/análise , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pericárdico/metabolismo , Derrame Pleural/diagnóstico , Derrame Pleural/metabolismo
20.
Ir Med J ; 3(112): 902, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-31124350

RESUMO

Aim To report the first case of cardiac tamponade related to Infliximab induction therapy in an Ulcerative Colitis patient. Methods Review of published case reports. Results This complication was likely due to a type 3 hypersensitivity immune-complex reaction resulting in a reactive pericardial effusion Discussion Though rare, this case demonstrates how autoimmune reaction to anti-TNF𝛼 therapy can initially mimic infection, as our patient presented with tachycardia, hypotension, raised inflammatory and infective markers and fever.


Assuntos
Tamponamento Cardíaco/induzido quimicamente , Colite Ulcerativa/tratamento farmacológico , Fármacos Gastrointestinais/efeitos adversos , Infliximab/efeitos adversos , Autoimunidade , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/imunologia , Tamponamento Cardíaco/terapia , Colite Ulcerativa/imunologia , Feminino , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/imunologia , Humanos , Infliximab/administração & dosagem , Infliximab/imunologia , Pessoa de Meia-Idade , Derrame Pericárdico/induzido quimicamente , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/imunologia , Derrame Pericárdico/terapia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/imunologia
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