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PubMed2003

The role of particular strains of Neisseria meningitidis in meningococcal arthritis, pericarditis, and pneumonia.

The clinical presentations of meningococcal diseases other than meningitis or meningococcemia may lead to erroneous diagnosis. Although several reports have described unusual meningococcal diseases, the Neisseria meningitidis strains involved in these forms have been poorly characterized. In this study, meningococcal arthritis and pericarditis were confirmed by isolation of N. meningitidis and/or detection of meningococcal DNA in synovial or pericardial fluid, respectively, and meningococcal pneumonia was detected by isolation of N. meningitidis from blood. From 1999 through 2002, meningococcal disease was bacteriologically confirmed in 26 cases of arthritis, 6 cases of pericarditis, and 33 cases of pneumonia by the National Reference Center for the Meningococci in Paris. We found a statistically significant association between strains of serogroup W135, mostly of the clonal complex ET-37, and arthritis. Pneumonia was most frequently diagnosed in patients aged >70 years, and 54.5% of the strains belonged to serogroup W135, although these strains had heterogeneous phenotypes. Bacteremia is a key step in the pathophysiology of meningococcal disease and precedes any form of invasive infection.

Adolescent↗
PubMed2006

Thoracoscopic pericardiectomy for purulent pericarditis: experience with 21 cases.

PURPOSE: We present our experience in performing thoracoscopic pericardiectomy for purulent pericarditis in 21 children. MATERIALS AND METHODS: Pericardiectomy was carried out using one optical trocar and two operating trocars. Pleural insufflation with carbon dioxide was maintained at 2-4 mm Hg. Anterior pericardiectomy was performed from the left phrenic nerve to the right border of the sternum to free the anterior part of the heart, notably the cardiac apex and the original area of the great vessels. Purulent debris was removed prior to detaching the epicardial peel. RESULTS: This study included 21 patients. Their mean age was 8 years. The time from onset of the disease to surgery ranged from 4 to 34 days (average, 15.2 days). Operative times ranged from 50 to 180 minutes (average, 100 minutes). There were no intraoperative or postoperative complications. All symptoms of cardiac tamponade disappeared immediately postoperatively. Follow-up ranged from 4 to 15 months and showed normal clinical manifestations, echocardiographs, and chest x-rays in all children. CONCLUSION: Thoracoscopic pericardiectomy with removal of a generous amount of the pericardium is feasible and safe for purulent pericarditis.

Adolescent↗
PubMed1979

Chronic pericarditis due to a streptomyces species.

Streptomyces species include a group of aerobic actinomycetes that are generally considered to be saprophytes. Effusoconstrictive pericarditis of mixed etiology developed in a previously healthy patient. The cause of the chronic pericarditis was a Streptomyces species.

Adult↗
PubMed1993

A case of recurrent benign pericarditis treated by colchicine.

After five recurrences of idiopathic pericarditis over a period of 8 months on steroidal anti-inflammatory therapy, a splenectomized patient aged 31 years benefited from treatment with colchicine. He was treated for one year without any recurrence. A relapse occurred 6, 7 and 17 months after having stopped the drug. This observation raises the question whether colchicine might be beneficial in recurrent benign pericarditis with or without corticodependence and have a prophylactic action against recurrences.

Adult↗
PubMed1991

Constrictive pericarditis without typical haemodynamic changes as a cause of oedema formation due to protein-losing enteropathy.

A 41-year-old man presented with physical signs of leg oedema and a laboratory value of decreased serum albumin of 2.4 g.dl-1. Loss of protein via the gastrointestinal tract was demonstrated by an increased faecal excretion of 51-chromium-labelled-albumin and by elevated stool clearance of alpha 1-antitrypsin. No anatomical lesions or intestinal disease were found to explain this protein loss. Constrictive pericarditis was suspected as the cause of protein-losing enteropathy but could not be confirmed by right heart catheterization, in which normal filling pressures and no sign of 'dip and plateau' pressure pattern were found. However, magnetic resonance imaging clearly demonstrated a thickening of the pericardium over the right heart and a tubular-shaped right ventricle as signs of constrictive pericarditis. Peripheral oedema disappeared and serum protein concentration returned to normal after pericardectomy. This demonstrates that moderate pericardial constriction not resulting in discernible pressure abnormalities in the right heart can be associated with protein-losing enteropathy and thus result in hypoproteinaemic peripheral oedema. In this condition a morphological investigation by magnetic resonance imaging is of importance in order not to miss the diagnosis of a potentially treatable disease.

Adult↗
PubMed1992

Pleuritis-pericarditis--an unusual initial manifestation of mixed connective tissue disease.

Cardiac involvement has been reported in mixed connective tissue disease (MCTD). We describe a 16-year-old girl in whom pleuritis and pericarditis occurred as the initial clinical manifestations of MCTD. Although pleuritis and pericarditis form a common clinical entity in MCTD, it is rarely seen as an initial manifestation. If MCTD is suspected, the diagnosis can be made by the clinical findings and the occurrence of a high titre of antibody against ribonuclease-sensitive ribonucleoprotein (RNP). This report emphasizes the importance of screening for connective tissue disease in patients with pericarditis/pleuritis.

Adolescent↗
PubMed1990

Salmonella pericarditis with tamponade in systemic lupus erythematosus.

Despite the high frequency of both pericardial involvement and of infectious complications in SLE, septic pericarditis is uncommon. We report here a patient with SLE who developed tamponade due to Salmonella infection. Most of the other eight recorded cases of septic pericarditis in SLE were due to Staphylococcus aureus and none has been previously attributed to Gram-negative bacteria.

Adult↗
PubMed1997

Rheumatoid constrictive pericarditis.

A 73-yr-old woman with a 4 yr history of rheumatoid arthritis presented with the clinical features of congestive cardiac failure. She had a good early response to standard therapy although she subsequently developed recurrent biventricular failure. The preservation of good ventricular function on echocardiography in the face of clinical evidence of myocardial insufficiency raised the possibility of constrictive pericarditis, which was confirmed on cardiac catheterization. Constrictive pericarditis should be considered in patients with rheumatoid arthritis who develop unexplained cardiac failure. Early diagnosis requires a high index of suspicion and cardiac catheterization may be necessary to confirm the diagnosis. Medical treatment is largely ineffective and pericardiectomy should be considered.

Aged↗
PubMed1995

Case reports: pericarditis and lymphadenitis due to Rhodococcus equi.

Most patients with Rhodococcus equi infection are immunocompromised by either HIV infection, malignancy, or medication. Diagnosis is frequently missed or delayed because the organisms, resembling diphtheroids on smears, may be regarded as contaminants. Their clinical, pathologic, histochemical, and microbiologic resemblance to mycobacteria can result in misdiagnosis. Two cases were seen recently in our institution. R. equi pericarditis developed in a 29-year-old woman with failed renal transplant and R. equi axillary lymphadenitis developed in an asymptomatic 27-year-old man. These patients are important because the former is the first reported case of R. equi pericarditis, and the second case was unusual because of the absence of immunocompromise.

Actinomycetales Infections↗
PubMed1990

Constrictive pericarditis causing a positive TI-201 SPECT stress test for myocardial ischemia.

A case of constritive pericarditis was demonstrated by a positive thallium SPECT stress test for myocardial ischemia. After pericardiectomy, the repeat thallium stress test was normal. The disappearance of the criteria for a positive test suggests that constrictive pericarditis can cause myocardial ischemia, which can be demonstrated by thallium SPECT stress testing.

Coronary Disease↗
PubMed1987

Early pericarditis after acute myocardial infarction: a clinical echocardiographic study.

Clinical and echocardiographic data were evaluated in 46 patients after acute myocardial infarction (AMI). M-mode echocardiogram was performed 24 and 72 h and 5 days after AMI. Early acute pericarditis (EAP) was clinically recognized in 19 (41%) patients. Pericardial effusion (PE) was detected in 29 (63%) patients. In 23 (50%) patients both anterior and posterior PE was observed, while in six (13%) patients PE was only posterior. An echocardiographic pattern consistent with localized fibrinous pericarditis was detected in 11 (24%) patients. Eighteen (95%) of 19 patients with EAP had PE, and only 11 (40%) of the patients without EAP had PE (p less than .001). We conclude that PE is observed frequently after AMI and that the echocardiographic study can help in the diagnosis of EAP after AMI.

Adult↗
PubMed1986

Pericarditis and ulcerative colitis.

We report an 18-year-old man with a pericardial effusion complicating idiopathic ulcerative colitis. Circulating immune complexes were absent. He responded to sulfasalazine and prednisone, with resolution of the pericarditis and improvement in the symptoms of his inflammatory bowel disease (IBD). We recommend looking for pericardial effusion or pericarditis in patients with IBD and chest symptoms, and for IBD in obscure cases of these cardiac disorders.

Adolescent↗
PubMed1992

Acute post-MI pericarditis.

The diagnosis of acute pericarditis may be difficult to establish in patients with recent transmural infarcts as the symptomatology frequently mimics the clinical presentation associated with recurrent ischemia. A careful assessment of the postmyocardial infarction patient may reveal the clinical and electrocardiographic features associated with developing pericarditis. Prompt and accurate recognition of this complication is critical in order to institute definitive therapy, minimize the risk of hemodynamic compromise, and provide psychological support.

Acute Disease↗
PubMed1993

Electrophysiologic effects of a new class III antiarrhythmic agent, E-4031, on atrial flutter, atrial refractoriness, and conduction delay in a canine sterile pericarditis model.

Numerous studies have shown that E-4031 generally prolongs the atrial effective refractory period (AERP) without affecting cardiac conduction. The effects of E-4031 on AERP and cardiac conduction at short cycle lengths (CLs) close to the AERP were measured in 12 dogs with sterile pericarditis. Three pairs of electrodes were sutured at three sites in the atria 4 days after the model was created. We measured AERP and maximum conduction delay (MCD) after 8 beats train at CLs of 400, 300, 200 and 150 ms before and during continuous infusion of E-4031 (0.1 microgram/kg/min) that followed an initial dose of 10 micrograms/kg/min/5 min. E-4031 interrupted sustained atrial flutter (AF) (> or = 10 min) in 4 of 5 episodes and atrial fibrillation (> or = 10 min) in 4 of 4. The CL of AF defined as a rapid atrial rhythm (rate > or = 240 beats/min) in five episodes studied in the sterile pericarditis model was significantly (p < 0.005) prolonged from 120 +/- 8 to 160 +/- 17 ms. There were significant (p < 0.005) increases in AERP at each CL, and prolongation of AERP was 39 +/- 18, 31 +/- 14, 23 +/- 14, and 16 +/- 14 ms at CL 400, 300, 200, and 150 ms, respectively. E-4031 produced less prolongation of AERP at short pacing CLs and had no effect on conduction time during atrial rapid pacing at CLs > 150 ms. E-4031 did not prolong MCD at CL 400 ms, but did prolong MCD at CLs of 300, 200, and 150 ms, despite prolongation of AERP.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1978

Calcific constrictive pericarditis in Degos' disease.

A 31-year-old woman presented with symptoms and signs of constrictive pericarditis. She had a history of Degos' disease, a rare disorder characterized by skin and bowel lesions thought to be secondary to vasculitis. A chest roentgenogram showed extensive calcification of the pericardium. Although pleural and pericardial involvement has been reported in this disease, constrictive pericarditis is most unusual, and radiographically demonstrable calcification of the pericardium has not been reported previously.

Adult↗
PubMed1981

Constrictive pericarditis due to Streptococcus sanguis.

We have described the third case of pericarditis caused by anaerobic streptococci in children. Despite operative drainage and high-dose penicillin therapy, there was rapid progression to constrictive pericarditis. Complete pericardiectomy was life-saving.

Adolescent↗
PubMed1993

Perplexing pericarditis caused by coccidioidomycosis.

In the patient I have described, evaluation of chronic progressive pulmonary coccidioidomycosis presenting itself as cryptogenic pericarditis revealed an unsuspected large endobronchial coccidioidoma. At follow-up after 2 years of fluconazole therapy, the patient was asymptomatic, with a dramatic decrease in infiltrate but no change in CF titers. In endemic areas, coccidioidomycosis should be included in the differential diagnosis of idiopathic pericarditis, especially in high-risk patient populations. Additionally, airway obstruction or compromise might be an early finding in chronic coccidial disease.

Adult↗
PubMedDate not supplied

Diastolic heart failure: restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade: clinical and echocardiographic evaluation.

An understanding of the basic principles of diastolic function is important in order to recognize diseases that may result in diastolic dysfunction and diastolic heart failure. Although uncommon, restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade are among the disorders that may affect primarily diastolic function with preservation of systolic function. Diastolic heart failure may manifest with chronic nonspecific symptoms or may present with acute hemodynamic compromise. Echocardiography plays a vital role in the diagnosis of diastolic dysfunction and differentiation of these disease processes. It also provides a basis for clinical decisions regarding management and surgical referral. This review summarizes the clinical features, pathophysiology, and hemodynamic and echocardiographic signs of restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade.

Cardiac Tamponade↗