MyMedR

Detection of pericardial effusion by echocardiography

Singham KT, Anuar M, Ariffin M

Med J Malaysia, 1978 Jun;32(4):292-3.

PMID: 732624

Matched MeSH terms: Pericardial Effusion/diagnosis*

Fulltext The bug and the big heart --melioidotic pericardial effusion

Yew KL, Ng TH, How SH, Kuan YC

Med J Malaysia, 2011 Mar;66(1):71-2.

PMID: 23765151 MyJurnal

Melioidosis is an infection caused by Gram negative bacterium Burkholderia pseudomallei leading to abscesses in lungs, liver, spleen, musculoskeletal system, prostate and sepsis. We present a rare case of purulent pericardial effusion caused by melioidosis with concomitant pneumonia and splenic abscesses. The patient underwent pericardiocentesis and successfully recovered from cardiogenic and septic shock.

Matched MeSH terms: Pericardial Effusion*

Radionuclide imaging of pericardial effusion

Paramsothy M, Singham KT, Khoo BH

Med J Malaysia, 1979 Jun;33(4):321-5.

PMID: 522743

Matched MeSH terms: Pericardial Effusion/radionuclide imaging*

Radiation-induced pericardial disease: a case report

Doi SA, Azman W, Leong KW, Bosco J

Ann Acad Med Singap, 1995 May;24(3):459-61.

PMID: 7574433

A typical case of chronic pericardial effusion resulting in cardiac tamponade is presented. A pericardiocentesis was done for diagnosis and drainage, followed by a pleuro-pericardial window as definitive therapy. The minimal cumulative dose expected to produce pericardial disease is about 4000 rads, and the disease usually manifests within 12 months of such radiation exposure, as in this patient. It is concluded that for symptomatic pericardial effusions, available evidence justifies a subtotal pericardiectomy, a window procedure being reserved to tide over ill patients as in this patient. No strong evidence exists for the efficacy of steroid therapy; such therapy is reserved for asymptomatic mild effusions, which may also resolve spontaneously.

Matched MeSH terms: Pericardial Effusion/etiology*; Pericardial Effusion/therapy

Case report: A case of pericardial effusion presenting to primary care

Devaraj NK

Med J Malaysia, 2017 08;72(4):252-253.

PMID: 28889141 MyJurnal

This is a rare but interesting case of Mr. MZ who had a lifethreatening pericardial effusion presenting to the primary care clinic. Through great clinical acumen and prudent targeted investigations, diagnosis of this rare condition was reached and urgent referral made to the cardiology team which performed an emergency pericardiocentesis which proved to be life -saving. However, the hovering poor prognosis of Mr. MZ may prompt for a referral to the palliative care team to provide quality end of life care for this unfortunate patient.

Matched MeSH terms: Pericardial Effusion/diagnosis*; Pericardial Effusion/therapy

Fulltext Pericardial cyst: a rare cause of pericardial effusion

Siti Salwa MS, Anas R, Nor Hidayah AB

Med J Malaysia, 2013;68(1):79-80.

PMID: 23466776

Pericardial cysts occur rarely, with an incidence rate of 1 per 100,000. They are usually detected by chance and clinically silent in most cases. Pericardial cysts are the most common benign tumours of the pericardium and presents by the third or fourth decade of life, and equally common in males and females. In principle, they only require follow-up, however, an enlarging or symptomatic cyst requires surgical removal. We report a case of a 32 year-old Malay lady, who presented with history of recurrent pericardial effusion followed by right pleural effusion. Computed tomography (CT) thorax identified a large mediastinal cyst as the cause of her problem, requiring exploratory thoracotomy.

Matched MeSH terms: Pericardial Effusion*

Tuberculous pericardial disease

Chia BL, Yap MH, Goh YS

Med J Malaya, 1970 Jun;24(4):267-72.

PMID: 4248347

Matched MeSH terms: Pericardial Effusion*

Fulltext Massive pericardial effusion in primary hypothyroidism

Hanip MR, Ong SB, Tan TT, Khalid BA

Med J Malaysia, 1989 Dec;44(4):341-3.

PMID: 2520045

A 44 year old lady with primary hypothyroidism presented with massive pericardial effusion without cardiac tamponade. Pericardial tap was done twice and the effusion resolved as the hypothyroid state improved. She remained hypertensive despite the euthyroid state. She was discharged well with L-thyroxine and anti-hypertensive therapy.

Matched MeSH terms: Pericardial Effusion/etiology*

Pericardial decompression syndrome: A complication of pericardiocentesis

Adi O, Fong CP, Ahmad AH, Azil A, Ranga A, Panebianco N

Am J Emerg Med, 2021 07;45:688.e3-688.e7.

PMID: 33514476 DOI: 10.1016/j.ajem.2021.01.022

Pericardial Decompression Syndrome (PDS) is an uncommon but life-threatening complication following pericardiocentesis for cardiac tamponade. We report PDS after pericardiocentesis in two patients that presented to the emergency department with cardiac tamponade. In both cases, pericardiocentesis was performed under ultrasound guidance using the left parasternal approach and approximately 1200-1500 mL of pericardial fluid was removed. Immediately after pericardiocentesis, the haemodynamic status of the patients improved. However, 2-3 h post decompression, both patients developed hypotension and pulmonary edema with reduced left ventricular function, suggestive of PDS. PDS is a condition that is described as paradoxical worsening of vital signs after successful decompression of the pericardium in the setting of acute tamponade. Three possible mechanisms explaining PDS are ischaemic, hemodynamic and autonomic processes. If PDS is unrecognized and untreated, it is associated with a high mortality rate secondary to pulmonary edema and cardiogenic shock. If managed urgently, the cardiopulmonary dysfunction in PDS is usually transient and largely reversible with supportive care.

Matched MeSH terms: Pericardial Effusion/etiology*

Pyopericardium presenting with echocardiographic features of pericardial tamponade in an elderly man

Tan JH, Ng ZQ, Tan HCL, Vendargon S

BMJ Case Rep, 2018 Jun 27;2018.

PMID: 29950501 DOI: 10.1136/bcr-2018-224741

A 72-year-old Chinese man presented with mild symptoms of heart failure. Transthoracic echocardiography showed signs of cardiac tamponade though clinically he was relatively well. The option of pericardiocentesis was not carried out due to a narrow window for aspiration with only a thin layer of effusion seen surrounding the apex and right ventricle on subcostal view.Pericardial window was done via a left anterolateral thoracotomy. Intraoperatively, 500 cm3 of purulent fluid was drained. Microbiology screens were all negative. We present the atypical clinical course of this elderly man presenting with a large pyopericardium.

Matched MeSH terms: Pericardial Effusion/complications; Pericardial Effusion/surgery

Fulltext Case Report: A Patient with Acute Cardiac Tamponade Secondary to Complicated Stanford Type A Intramural Haematoma - the role of CT

Poh F, Chow MB

Med J Malaysia, 2014 Feb;69(1):37-9.

PMID: 24814629

Chest pain is a common presenting complaint in the emergency room of which acute aortic syndrome is a sinister cause associated with high morbidity. A contrastenhanced CT aortogram is often performed for initial evaluation at the first instance of suspicion. We present a patient with Stanford Type A intramural haematoma complicated by haemopericardium and acute cardiac tamponade and highlight the relevant CT signs that would alert the managing physician to urgent echocardiogram correlation and emergent cardiothoracic intervention.

Matched MeSH terms: Pericardial Effusion

Fulltext Disseminated Salmonella infection

Johari MI, Besari AM, Wan Ghazali WS, Yusof Z

BMJ Case Rep, 2019 May 09;12(5).

PMID: 31076489 DOI: 10.1136/bcr-2018-226337

A 47-year-old Malay man who presented with fever, poor oral intake and loss of weight for 1 month duration. Further work-up revealed evidence of disseminated Salmonella infection that was further complicated with pericardial and pleural empyema. Cultures from pericardial and pleural fluids grew Salmonella species with negative serial blood cultures. Contrast enhanced CT thorax showed pleural effusion with large pericardial effusion. The patient was treated with antibiotics and drainage of pericardial and pleural empyema was done and he was discharged well.

Matched MeSH terms: Pericardial Effusion/microbiology*; Pericardial Effusion/physiopathology; Pericardial Effusion/therapy

Fulltext An Unusual Presentation of Tuberculosis

Low, Qin Jian, Cheo, Seng Wee

Borneo Journal of Medical Sciences, 2019;13(2):45-48.

MyJurnal

The normal pericardium is a fibroelastic sac containing a thin layer of fluid that surrounds the heart. Cardiac tamponade, which may be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. Tuberculous pericarditis is a complication of tuberculosis which is often diagnose late due to the difficulty in establishing this diagnosis. We present a case of pericardial tuberculosis diagnosed in a 20-year-old young retroviral disease patient who presented with signs of cardiac tamponade. His clinical condition improved post-pericardial tapping and he was discharged with anti tuberculosis medications. This case highlight the importance of having a high level of suspicion as this condition is easily curable.

Matched MeSH terms: Pericardial Effusion

Massive pericardial effusion - An uncommon initial presentation of systemic lupus erythematosus (SLE)

Cheo SW, Low QJ

Med J Malaysia, 2019 Oct;74(5):439-440.

PMID: 31649224

Systemic lupus erythematosus (SLE) is a common autoimmune disease that we see in our daily clinical practice. It can involve almost every organs in the body. Cardiac manifestations of SLE include pericarditis, myocarditis, heart block, coronary artery disease and others. Here, we report a case of SLE with an uncommon presentation of massive pericardial effusion as initial presentation. Here we also highlight that massive pericardial effusion can also be associated with other complications of SLE such as heart failure and lupus nephritis.

Matched MeSH terms: Pericardial Effusion

Fulltext A Rare Case of Purulent Pericardial TB

Johari MI, Ramli AW, Mat Lawi F, Bin Fouzi MAH, Suardi KPS

Cureus, 2019 Aug 09;11(8):e5356.

PMID: 31608191 DOI: 10.7759/cureus.5356

Pericardial effusion is a common disease and tuberculosis (TB) accounts up to 4% of acute pericarditis with up to 7% of tamponade case. Accurate diagnosis is important while quick intervention can be life-saving. A case was reported involving a 73-year-old man who presented with reduced effort tolerance for one-month duration. During hospitalization, further workup revealed the presence of massive purulent pericardial effusion with evidence of tamponade. TB gene expert was positive in aspirated pericardial fluid and the patient was treated promptly using a combination of anti-TB drugs with the addition of steroid therapy.

Matched MeSH terms: Pericardial Effusion

Murder and robbery by vehicular impact: true vehicular homicide

Nadesan K

Am J Forensic Med Pathol, 2000 Jun;21(2):107-13.

PMID: 10871122

True vehicular homicides are defined as those occurrences in which a motor vehicle is intentionally used as a weapon in taking of a life. A case is presented in which the deceased was traveling in the front passenger seat of a motor car that was deliberately rammed by a heavy jeep that came in the opposite direction, resulting in a serious frontal collision. Immediately after the impact, while the occupants of the car were lying in a dazed condition, the two persons riding in the jeep escaped with a bag containing money that was in the car, leaving the jeep behind. The impact mainly involved the driver's sides of both vehicles. The driver of the car sustained serious injuries but was found to be alive, whereas the front-seat passenger, who did not show any serious external injuries, was found to be in a collapsed state and was pronounced dead on admission to the hospital within 30 minutes of the accident. The autopsy revealed that death was caused by closed hemopericardium from a ruptured right atrium. The evaluation of the external and internal injuries confirmed that the fatal injury and a few serious internal injuries were caused by the seat belt (tertiary-impact injuries). The ruptured right atrium was attributed to blunt abdominal trauma by impacting against the lap belt. The case was a true vehicular homicide in which a motor vehicle had been used as a weapon to kill a person. Various aspects pertaining to road accidents, the safety of the occupants, and the advantage and disadvantage of the safety devices are discussed.

Matched MeSH terms: Pericardial Effusion/pathology

Giant cell myocarditis with cardiac tamponade: a rare combination

Murty OP

Am J Forensic Med Pathol, 2008 Sep;29(3):245-8.

PMID: 18725781 DOI: 10.1097/PAF.0b013e318183d55f

Giant cell myocarditis (GCM) is a rare but fatal disease of idiopathic origin. It results in focal necrosis of myocardium. This is a case report of middle aged Malaysian Indian female who died due to cardiac tamponade due to rupture myocardium and tear in the root of aorta. On naked eye examination, it simply resembled as recent as well as old fibrotic areas of myocardial infarction. She was clinically diagnosed as a case of obstructive cardiomyopathy with atrioventricular block, and was on pace maker. There was subendocardial fibrosis and left ventricular transmural infarction in the left ventricle. On histopathology, this was diagnosed as GCM, there were widespread areas of inflammatory cellular infiltration within the myocardium with multinucleated giant cells and granulomas interspersed with lymphocytes. Microscopic field showed up to 10 multinucleated giant cells. In this case, there were focal areas at multiple locations and caused uneven thickness in the left ventricle wall. Idiopathic GCM is very rare and causation of hemopericardium is the unique feature of this case. In this case the direct link of GCM with aortitis and rupture of left ventricle wall resulting in hemopericardium is shown. This case is documented through macroscopic as well as microscopic photographs in H&E, Ziel-Nelson, and GMS staining.

Matched MeSH terms: Pericardial Effusion/etiology; Pericardial Effusion/pathology

Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Ang PP, Tan GC, Karim N, Wong YP

Acta Cytol., 2020;64(3):248-255.

PMID: 31352449 DOI: 10.1159/000501406

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.

Matched MeSH terms: Pericardial Effusion/diagnosis*; Pericardial Effusion/etiology

Ultrasound findings of plasma leakage as imaging adjunct in clinical management of dengue fever without warning signs

Xin Tian C, Baharuddin KA, Shaik Farid AW, Andey R, Ridzuan MI, Siti-Azrin AH

Med J Malaysia, 2020 11;75(6):635-641.

PMID: 33219170

INTRODUCTION: Plasma leakage is a major cause of morbidity and mortality in dengue fever. Few studies have shown the sensitivity of thoracoabdominal ultrasound in detecting plasma leakage in severe dengue, however its sensitivity in the early presentation of dengue fever without warning signs remains unknown. This study is aimed to determine the role of serial ultrasound in order to detect plasma leakage in dengue fever without warning signs.

METHODS: This prospective cohort study was conducted at Hospital Universiti Sains Malaysia (USM) from 1st October 2016 to 30th November 2017. Serial bedside ultrasound procedures were performed for 83 patients who were diagnosed as having dengue fever without warning signs and were initially treated as outpatients. Ultrasonography evidence of plasma leakage either pleural effusion, thickened gallbladder wall, ascites or pericardial effusion were compared with clinical findings and laboratory parameters for plasma leakage.

RESULTS: Of the 83 dengue patients, eventually 72.3% had dengue fever with warning signs and 6.0% had severe dengue fever. There were 38 patients who had subclinical plasma leakage at initial presentation, 84.2% and 7.9% of them then progressed to dengue fever with warning signs and severe dengue respectively. There was a minimal agreement between serial bedside ultrasound and haematocrit level in the detection of plasma leakage (observed kappa 0.135).

CONCLUSIONS: Serial bedside ultrasound is an adjunct procedure to physical examination and may detect plasma leakage earlier compared to haemoconcentration. The early usage of serial ultrasound is of paramount importance in detecting dengue patients who are at risk of progressing to severe dengue.

Matched MeSH terms: Pericardial Effusion

Fulltext Cardiac A-lines in fast scan as a sign of pneumopericardium

Md Noor J, Eddie EA

Ultrasound J, 2019 Apr 25;11(1):7.

PMID: 31359168 DOI: 10.1186/s13089-019-0123-x

BACKGROUND: Traumatic pneumopericardium is rare and usually results from blunt injury. Diagnosis through clinical and chest X-ray is often difficult. Ultrasound findings of A-line artifacts in the cardiac window may suggest pneumopericardium.

CASE PRESENTATION: A young man involved in a car accident and sustained blunt thoracic injuries, among others. As part of primary survey, FAST scan was performed. Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines. Other cardiac windows showed only A-lines, as well. A suspicion of pneumopericardium was raised and CT scan confirmed the diagnosis.

CONCLUSIONS: Although FAST scan was originally used to look for presence of free fluid, with the knowledge of lung ultrasound for pneumothorax, our findings suggest that FAST scan can also be used to detect pneumopericardium.

Matched MeSH terms: Pericardial Effusion

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