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PubMedDate not supplied

Severe lower limbs lymphedema following breast carcinoma treatment revealing radiation-induced constrictive pericarditis--a case report.

In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors' knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

The role of carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) evaluation in pericardial fluid for the recognition of malignant pericarditis.

This study was designed to assess the value of tumor marker evaluation in pericardial fluid for the recognition of malignant pericarditis. Thirty-six patients with signs and symptoms of large pericardial effusion entered the study. Pericardiocentesis with pericardial fluid drainage was performed in all of them. CEA and NSE levels were evaluated in the pericardial fluid and compared to pericardial fluid cytology. The median CEA value in malignant effusions was 80 ng/ml (range 0-305 ng/ml) and in non-malignant ones 1.26 ng/ml (range 0.2-18.4 ng/ml), p < 0.01. The sensitivity of CEA elevation above 5 ng/ml for the recognition of malignant pericarditis was 73% and the specificity was 90%. Pericardial fluid cytology was positive in 22 of 26 patients with malignant pericarditis (85%). CEA exceeding 5 ng/ml or positive cytology were seen in 96% of the patients with malignant pericarditis. The median NSE value in malignant pericardial effusions was 41.8 micrograms/l (range 2-172 micrograms/l) and in non-malignant ones 5.85 micrograms/l (range 1-83.9 micrograms/l), p < 0.3. For the differential diagnosis of large pericardial effusions we would recommend simultaneous cytologic examination of pericardial fluid and CEA assessment. NSE measurement in hemorrhagic pericardial fluid is of limited value.

Adult↗
PubMed2002

The changing aetiological spectrum of pericarditis in children.

The aetiologies, clinical features and follow-up data of 62 children with pericarditis admitted to a university hospital during a 6-year period were retrospectively assessed. Uraemic pericarditis was the most frequent and infections the second most frequent cause. In this series, the proportion of children with purulent pericarditis is less than in previous reports from developing countries. Familial Mediterranean fever, neoplasias, acute rheumatic fever and post-pericardiotomy syndrome were other important causes of pericarditis.

Acute Disease↗
PubMed1979

Neonatal E. coli pericarditis.

A review of the literature reveals only one case of neonatal Escherichia coli pericarditis. This is a case report of Escherichia coli pericarditis occurring in a two day old infant. The infant initially presented with lethargy and jaundice but this rapidly progressed into shock. Despite vigorous resuscitative efforts, the infant succumbed and at autopsy 30 cc of purulent fluid were obtained. Cultures of the admission blood and post-mortem pericardial effusion grew Escherichia coli. The clinical diagnosis of pericarditis is often difficult because of vague, nonspecific symptoms and signs. The symptoms are usually those of sepsis plus those of impaired circulation due to mechanical embarrassment by accumulating pericardial effusion. It is difficult to differentiate pericarditis with effusion from myocarditis and pericardial effusion secondary to congestive heart failure. The use of pericardiocentesis as a diagnostic tool and echocardiography are the most helpful techniques presently available for diagnosis. Management consists of vigorous supportive efforts, antibiotics, and drainage of the pericardial effusion. Because of the very high mortality associated with this disorder, a high index of suspicion with a vigorous diagnostic and therapeutic approach to the patient is indicated.

Escherichia coli Infections↗
PubMed1991

Acute pericarditis: etiology, treatment and prognosis. A study of 115 patients.

One hundred and 15 hospitalized patients with acute pericarditis were analyzed retrospectively for their etiology, management and long-term prognosis. It was found that most of the patients had either idiopathic or viral etiologies (60%), collagen disease (16.4%) or malignancy (6.9%). Most of the patients were treated with non-steroidal anti-inflammatory drugs (NSAID). Twenty-six patients (22%) required corticosteroids following NSAID treatment failure. Only one patient underwent pericardiocentesis for tuberculous pericarditis. The long-term prognosis was good, although 21.9% of the patients suffered from recurrent episodes of pericarditis. It is concluded that in hospitalized patients with pericarditis, an extensive workup may not reveal the major etiologies, and the disease may be more complicated than previously thought.

Acute Disease↗
PubMed2004

Pericarditis. Series of 84 consecutive cases.

OBJECTIVE: To identify differential clinical, laboratory, and echocardiographic characteristics in persons with diagnosed idiopathic and secondary pericarditis. METHODS: From January 1999 to December 2001, 84 patients with clinically and echocardiographically diagnosed pericarditis were identified in a heart clinic. These patients were analyzed according to age, sex, anthropometric measurements, body habitus, casual blood pressure (BP), signs and symptoms, morbid history, medicines and complications. The individuals were divided into 2 groups: group A comprised 61 patients with known causes of pericarditis and group B comprised 23 patients with idiopathic causes. The groups were compared with chi-square test. P < or = 0.05 was considered statistically significant. RESULTS: The population of these 2 groups was similar in age, sex, anthropometric measures, body habitus, and casual BP. In group B (idiopathic), 23 (100%) cases were diagnosed between April and August versus 24 (39.4%) in the same period for group A (P<0.01). Twenty-three (100%) group B patients received anti-influenza vaccine versus none in group A. Breathlessness (P=0.02) and swelling (P=0.01) were more frequent in group A, but fatigue was more common in group B (P=0.01). For treatment, non-steroidal anti-inflammatory drugs (NSAID) were prescribed to 5 (8.2%) patients in group A and 19 (82.6%) in group B (P=0.01). CONCLUSION: In this series, patients labeled as having idiopathic pericarditis who had previously taken the influenza vaccine had seasonal distribution, a lower prevalence of previous disease, less exuberant signs and symptoms, and clinical regression with NSAID use.

Adult↗
PubMed2002

Possible mesalamine-induced pericarditis: case report and literature review.

Pericarditis should be considered in any patient complaining of chest pain and/or dyspnea who is taking a product that contains mesalamine or sulfasalazine. A 41-year-old woman was taking mesalamine 800 mg 3 times/day for 3 weeks before hospital admission. She complained of sharp, pleuritic chest pain that radiated down both arms and increased in intensity when lying down. She was diagnosed with pericarditis based on clinical presentation and electrocardiogram findings. Differential diagnoses for myocardial infarction, systemic lupus erythematosus, and viral or bacterial causes were ruled out based on subjective and objective data. Mesalamine-induced pericarditis was considered on hospital day 2, and the drug was discontinued at discharge on day 3. Clinicians should be aware of this potential drug-related complication, as the relationship between mesalamine or sulfasalazine and pericarditis has been reported rarely in the literature.

Adult↗
PubMed2002

Primary bacterial pericarditis.

Purulent pericarditis is rarely the primary site of bacterial infection. It is usually a complication of an infection originating elsewhere in the body, arising by contiguous spread or haematogenous dissemination.This paper, however, describes a previously healthy young man, who developed a purulent streptococcal pericarditis with no localizable primary focus. Although many possibilities were investigated, the entry site of the pericarditis remains unknown. The incidence of purulent pericarditis has decreased considerably since the antibiotic era. It is typically an acute and potentially lethal disease, necessitating rapid diagnosis and adequate therapy to improve prognosis. Standard treatment combines appropriate antibiotic therapy with surgical drainage. However, the exact timing and type of surgery is still under discussion. Our patient was treated with antibiotics, subxiphoidal tube drainage of the pericardial fluid and intrapericardial thrombolysis. After three weeks, he developed tamponade, requiring partial pericardiectomy. He recovered completely and resumed his normal activities after a two-month hospitalisation.

Adult↗
PubMed1978

Angiocardiographic differentiation of constrictive pericarditis and restrictive cardiomyopathy due to amyloidosis.

The cineangiocardiograms and coronary angiograms of two cases of amyloidosis of the heart were compared to six cases of constrictive pericarditis. Three angiographic differentiating points were seen: (1) right ventricular free wall motion showed diastolic restriction in both disorders, whereas the crista supraventricularis, which moved normally in constrictive pericarditis, demonstrated restriction in amyloidosis; (2) ventricles in cases of constrictive pericarditis showed subtle further expansion during atrial systole after initial rapid filling (atrial kick), while in both cases of amyloidosis there was no motion during atrial systole; (3) pericardial thickening in constrictive pericarditis was demonstrated by failure of the distal coronary arteries to reach the surface of the cardiac image. In amyloidosis, the distal coronary arteries normally reached the periphery of the image. All three signs may be useful in differentiation, but the first is the easiest to evaluate. The right anterior oblique or posteroanterior view is the recommended projection.

Amyloidosis↗
PubMed1975

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.

Ampicillin↗
PubMed1976

Arthritis and heart lesions. A study of 25 cases with pericarditis or valvular lesions associated to inflammatory joint disease.

Clinical and laboratory data of 25 patients with inflammatory joint disease and pericarditis or valvular heart disease are reviewed. The patients were divided in two groups: 11 presented pericarditis and 14 valvular heart disease. The patients studied presented a spectrum of diseases ranging from classical sero-positive rheumatoid arthritis to ankylosing spondylitis. Acute rheumatic fever was in no case the actual joint disease. In contrast to the patients with valvular heart disease nearly all patients with pericarditis were rheumatoid arthritis factor positive and signs of a generalized systemic disease with vasculitis were also more frequent. In the pericarditis group there was no sex difference in contrast to the valvular group where females were more often affected. The heart lesions were usually detected late in the course of the chronic joint disease. Valvular heart disease occurs not only in ankylosing spondylitis but also in rheumatoid arthritis, usually the sero-negative type. In the light of a survey of the literature, the pertinent findings are discussed.

Adult↗
PubMedDate not supplied

Twelve-lead electrocardiography in tuberculous pericarditis.

OBJECTIVES: This study is part of an ongoing initiative started in 1995 to investigate the therapeutic efficacy of adjuvant corticosteroids in the management of tuberculosis (TB) pericarditis. In this retrospective, descriptive study we describe the changes found on the 12-lead electrocardiogram (ECG) in patients with TB pericarditis, with and without cardiac tamponade. We determined the diagnostic accuracy of ECG parameters for cardiac tamponade. METHODS: All patients referred to our department with echocardiographically confirmed large pericardial effusions underwent a thorough clinical assessment followed by pericardiocentesis and drainage using an indwelling pigtail catheter. The amount of drained effusion was measured, and fluid was sent for diagnostic assessment. Patients were grouped into those with or without cardiac tamponade. The following ECG parameters were assessed: rate, rhythm, microvoltage, electrical alternans, PR segment and ST segment abnormalities. RESULTS: Of the 157 patients assessed, 88 were diagnosed with TB pericarditis All had abnormal ECGs and 83% had changes of chronic pericarditis. Microvoltage in the extremity and/or precordial leads correlated with the presence of large effusions (> 750 ml). None of the studied parameters correlated with the presence of cardiac tamponade. CONCLUSIONS: Twelve-lead ECG is of supportive but not diagnostic value in cardiac tamponade. The presence of microvoltage suggests the presence of a large effusion. The absence of microvoltage makes the presence of cardiac tamponade unlikely.

Cardiac Tamponade↗
PubMed2001

[Two cases of pneumococcal pericarditis].

BACKGROUND: Bacterial pericarditis is often overlooked, partly because symptoms and signs associated with pericarditis are frequently missing, but also because of the rarity of the disease. MATERIAL AND METHODS: Two cases of pneumococcal pericarditis treated at Ullevaal University Hospital are presented. RESULTS: Pneumococcal pericarditis is a rare, but serious complication to infections like pneumonia, pleural empyema, and septicaemia. Patients with an infectious disease who develop signs of elevated central venous pressure, enlarged cardiac silhouette on chest x-ray, or severe hypotension should have an echocardiography performed. If pericardial fluid is present, a diagnostic pericardiocentesis should be considered. INTERPRETATION: Treatment consists of drainage and antibiotics. Pericardiocentesis and subxiphoid catheter drains may be inadequate because of fibrin precipitation resulting in organization of the fluid. In these cases surgical intervention has traditionally been recommended, but intrapericardial fibrinolysis could be an alternative.

Aged↗
PubMed1975

Maximal rate of fall of left ventricular pressure in cardiomyopathy and constrictive pericarditis.

The maximal rate of fall of left ventricular pressure (peak negative dp/dt) was measured in 4 patients with congestive cardiomyopathy (primary myocardial disease), in 5 patients with constrictive pericarditis and in 3 controls. Measurements were made at rest, with leg raising, after a bolus of 6 mug intravenous isoprenaline, and in patients with constrictive pericarditis during pulsus paradoxus. Peak negative dp/dt was 1810 +/- 234 mmHg/sec in controls; it was reduced in patients with constrictive pericarditis (1337 +/- 514 mmHg/sec) and greatly decreased in patients with congestive cardiomyopathy (812 +/- 190 mmHg/sec). There was close linear correlation between resting peak positive and peak negative dp/dt and there was little change with leg raising. Isoprenaline caused an increase in peak positive dp/dt, but there was only a small change in peak negative dp/dt. In patients with constrictive pericarditis, peak negative dp/dt varied during pulsus paradoxus: the linear relationship to peak positive dp/dt was maintained throughout the respiratory cycle. Peak negative dp/dt may be a useful index of myocardial function.

Adolescent↗
PubMedDate not supplied

[Pericarditis caused by coccidioidomycosis. Report of a case].

A 33 year-old man developed coccidioidomycosis which resulted in pericarditis associated with congestive heart failure. A pericardial effusion developed and progressed to constrictive pericarditis. A pericardiectomy was performed and revealed that the pericarditis was due to Coccidioides immitis. The patient died after surgery. This is the second case of coccidioidomycosis with pericarditis reported in Mexico's literature.

Adult↗
PubMedDate not supplied

Constrictive pericarditis presenting as massive ascites in children: report of one case.

Abdominal distension has been described as the most common presenting symptom in children with constrictive pericarditis. This report describes a 13-year-old boy who had abdominal distension with massive ascite and hepatosplenomegaly as an initial presentation. The physical signs of jugular vein engorgement and gallop rhythm as well as the pericardial calcification on the chest roentgenogram lead to the diagnosis of constrictive pericarditis. After ultrafast computed tomography and cardiac catheterization confirmation, the patient received a pericardiectomy with excellent relief of symptoms. Pathology of the pericardium reveals fibrocalcified change, but no acid fast stained bacillus nor granulomatous lesion was observed. The incidence of constrictive pericarditis with evident pericardial calcification in children is extremely low. The diagnostic value of the chest roentgenogram and physical findings for the constrictive pericarditis are addressed.

Adolescent↗
PubMed2003

[Acute haemorrhagic pericarditis following influenza vaccination].

INTRODUCTION: Pericarditis following influenza vaccination is a rare complication. The few cases reported in the literature were all benign. OBSERVATION: An 87 year-old man developed a haemorrhagic pericarditis following an influenza vaccination. The outcome was rapidly favourable after surgical pericardiectomy followed by treatment with colchicine. In the absence of etiology, the hypothesis of post-vaccination pericarditis was proposed. COMMENTS: Despite its low incidence, the hypothesis of post-vaccination pericarditis must be evoked. Diagnosis therefore relies on various arguments. Although usually benign, medical and surgical treatments were required in our patient.

Acute Disease↗
PubMed1992

Idiopathic, aseptic, effusive, fibrinous, nonconstrictive pericarditis with tamponade in a standardbred filly.

A Standardbred filly was admitted for evaluation of pleuritis and pneumonia. Heart rate was 80 to 120 beats/min, and the pulse was barely palpable. Thoracic and abdominal ultrasonography and echocardiography revealed substantial pericardial effusion with cardiac tamponade, fibrinous pericarditis, pleural effusion, and ascites. Initial electrocardiography revealed normal sinus rhythm with decreased amplitude of the QRS complexes consistent with pericardial effusion. Following thoracentesis, echocardiogram-guided pericardiocentesis was performed. Bacterial culture yielded no growth from any of the fluids, and bacteria were not seen on cytologic examination. Initial treatment included broad-spectrum antibiotic treatments, IV fluid therapy, and anti-inflammatory agent administration. On the basis of negative culture results, an immune-mediated cause was considered, and dexamethasone was instituted in a decreasing dosage regimen. Pericardial effusion, ventral edema, and ascites began to resolve within 3 days after beginning dexamethasone treatment. Thirty days following discharge, the filly was reexamined, and at that time, the prognosis for athletic performance was considered good so the horse was returned to race training. The final diagnosis in this case was idiopathic, effusive, nonconstrictive pericarditis with tamponade. Early identification, clinical understanding, and application of knowledge of the pathophysiologic mechanisms of pericarditis in horses, combined with use of diagnostic aids such as ultrasonography and aggressive therapy consisting of effusion drainage, pericardial lavage, antibiotics that penetrate the pericardium, and corticosteroids when indicated are critical for a successful outcome in horses with pericarditis.

Animals↗