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Sahiti F, Cejka V, Schmidbauer L, Albert J, Kerwagen F, Frantz S, Gelbrich G, Heuschmann PU, Störk S, Morbach C. Prognostic Utility of Pericardial Effusion in the General Population: Findings From the STAAB Cohort Study. J Am Heart Assoc 2024; 13:e035549. [PMID: 38879452 PMCID: PMC11255739 DOI: 10.1161/jaha.124.035549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/14/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND The incidental finding of a pericardial effusion (PE) poses a challenge in clinical care. PE is associated with malignant conditions or severe cardiac disease but may also be observed in healthy individuals. This study explored the prevalence, determinants, course, and prognostic relevance of PE in a population-based cohort. METHODS AND RESULTS The STAAB (Characteristics and Course of Heart Failure Stages A/B and Determinants of Progression) cohort study recruited a representative sample of the population of Würzburg, aged 30 to 79 years. Participants underwent quality-controlled transthoracic echocardiography including the dedicated evaluation of the pericardial space. Of 4965 individuals included at baseline (mean age, 55±12 years; 52% women), 134 (2.7%) exhibited an incidentally diagnosed PE (median diameter, 2.7 mm; quartiles, 2.0-4.1 mm). In multivariable logistic regression, lower body mass index and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels were associated with PE at baseline, whereas inflammation, malignancy, and rheumatoid disease were not. Among the 3901 participants attending the follow-up examination after a median time of 34 (30-41) months, PE was found in 60 individuals (1.5%; n=18 new PE, n=42 persistent PE). Within the follow-up period, 37 participants died and 93 participants reported a newly diagnosed malignancy. The presence of PE did not predict all-cause death or the development of new malignancy. CONCLUSIONS Incidental PE was detected in about 3% of individuals, with the vast majority measuring <10 mm and completely resolving. PE was not associated with inflammation markers, death, incident heart failure, or malignancy. Our findings corroborate the view of current guidelines that a small PE in asymptomatic individuals can be considered an innocent phenomenon and does not require extensive short-term monitoring.
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Affiliation(s)
- Floran Sahiti
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Vladimir Cejka
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
| | - Lena Schmidbauer
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
| | - Judith Albert
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Fabian Kerwagen
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Stefan Frantz
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Götz Gelbrich
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
| | - Peter U. Heuschmann
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
- Institute of Medical Data ScienceUniversity Hospital WurzburgGermany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Caroline Morbach
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
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Gan T, Chen J, Wang H, Shang C, Xi S, Fan Z, He B, Zhang M, Zhao L. Impact of sequential (first- to third-generation) EGFR-TKI treatment on corrected QT interval in NSCLC patients. Front Oncol 2024; 14:1330165. [PMID: 38774407 PMCID: PMC11106428 DOI: 10.3389/fonc.2024.1330165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/18/2024] [Indexed: 05/24/2024] Open
Abstract
Objective To evaluate the impact of sequential (first- to third-generation) epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment on top-corrected QT interval (top-QTc) in non-small cell lung cancer (NSCLC) patients. Methods We retrospectively reviewed the medical records of NSCLC patients undergoing sequential EGFR-TKI treatment at Shanghai Chest Hospital between October 2016 and August 2021. The heart rate (HR), top-QT interval, and top-QTc of their ECGs were extracted from the institutional database and analyzed. Logistic regression was performed to identify predictors for top-QTc prolongation. Results Overall, 228 patients were enrolled. Compared with baseline (median, 368 ms, same below), both first-generation (376 ms vs. 368 ms, p < 0.001) and sequential third-generation EGFR-TKIs (376 ms vs. 368 ms, p = 0.002) prolonged top-QT interval to a similar extent (p = 0.635). Top-QTc (438 ms vs. 423 ms, p < 0.001) and HR (81 bpm vs.79 bpm, p = 0.008) increased after first-generation EGFR-TKI treatment. Further top-QTc prolongation (453 ms vs. 438 ms, p < 0.001) and HR increase (88 bpm vs. 81 bpm, p < 0.001) occurred after treatment advanced. Notably, as HR elevated during treatment, top-QT interval paradoxically increased rather than decreased, and the top-QTc increased rather than slightly fluctuated. Moreover, such phenomena were more significant after treatment advanced. After adjusting for confounding factors, pericardial effusion and lower serum potassium levels were independent predictors of additional QTc prolongation during sequential third-generation EGFR-TKI treatment. Conclusion First-generation EGFR-TKI could prolong top-QTc, and sequential third-generation EGFR-TKI induced further prolongation. Top-QT interval paradoxically increased and top-QTc significantly increased as HR elevated, which was more significant after sequential EGFR-TKI treatment. Pericardial effusion and lower serum potassium levels were independent predictors of additional QTc prolongation after sequential EGFR-TKI treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Min Zhang
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liang Zhao
- Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Vaghela NN, Jadav NB, Shah YR, Parmar AT, Munnangi PR, Madhupalli RN. The thyroid-pericardium connection: Unveiling the influence of hypothyroidism severity on pericardial effusion in South Gujarat's patient population-A cross-sectional study. J Family Med Prim Care 2024; 13:1049-1054. [PMID: 38736801 PMCID: PMC11086790 DOI: 10.4103/jfmpc.jfmpc_1236_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 05/14/2024] Open
Abstract
Context Hypothyroidism and pericardial effusion are two conditions that are associated with previous research. Nevertheless, the correlation between the severity of hypothyroidism and the occurrence of pericardial effusion remains uncertain. Aims 1. To explore and examine the association between the severity of hypothyroidism and the occurrence of pericardial effusion. 2. To compare clinical characteristics and demographic factors with varying degrees of hypothyroidism severity and pericardial effusion. Settings and Design Tertiary care hospital and cross-sectional study using a pretested, semistructured questionnaire and echocardiography. Method and Material The cross-sectional study encompassed a cohort of 60 patients diagnosed with hypothyroidism. Statistical Analysis Used Epi-info version 7.0 and Open epi version 3.1, Chi-square, mean, and standard deviation were used. Results There were 16 male participants, accounting for 26.7% of the total, and 44 female participants, constituting 73.3% of the cohort. The participants' average age was 35.5 years. Based on TSH levels, the severity of hypothyroidism in the study was classified into three categories: mild (33.4%), moderate (43.3%), and severe (23.3%). The most common symptoms were lethargy, weight gain, and cold intolerance. Also, an association between the severity of hypothyroidism and pericardial effusion was noted. Conclusion This research established a noteworthy correlation between hypothyroidism severity and pericardial effusion incidence that is statistically significant. Nevertheless, no significant associations were detected with demographic factors or pulse rate. These results underscore the significance of monitoring and addressing pericardial effusion in patients with moderate-to-severe hypothyroidism. Further investigations are warranted to extend these findings.
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Affiliation(s)
- Nital N. Vaghela
- Department of Medicine, Government Medical College, Surat, Gujarat, India
| | - Naresh B. Jadav
- Department of Medicine, Government Medical College, Surat, Gujarat, India
| | - Yash R. Shah
- Department of Medicine, Government Medical College, Surat, Gujarat, India
| | - Ajay T. Parmar
- Department of Medicine, Government Medical College, Surat, Gujarat, India
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Hasbini J, Safawi N, Mneimneh S, Rajab M, Berjaoui C, Naous A. Pericardial effusion complicated by umbilical vein catheter in a preterm infant with respiratory distress syndrome: A case report. Radiol Case Rep 2024; 19:741-744. [PMID: 38074435 PMCID: PMC10701350 DOI: 10.1016/j.radcr.2023.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 04/04/2024] Open
Abstract
Respiratory distress syndrome (RDS) is the most common respiratory illness in premature infants. This syndrome is characterized by a deficiency in surfactant, necessary for proper lung function. Serious complications of RDS include pericardial effusion and pulmonary hypertension. Although pericardial effusion is a rare complication of RDS, it is potentially fatal if not treated. The most common cause of pericardial effusion (PCE) is the placement of a central venous catheter (CVC), a widely used procedure in neonatal intensive care unit to support premature infants. In this paper, we report a case of a 36 + 4 weeks preterm male infant presenting for RDS. During his hospital stay, at 24 hours of life, the patient started to develop bradycardia where he was intubated. After 48 hours of birth, a central venous catheter was inserted, and on echocardiography results showed pericardial effusion, and pulmonary hypertension.
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Affiliation(s)
- Jida Hasbini
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Nour Safawi
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Sirine Mneimneh
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Mariam Rajab
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | | | - Amal Naous
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
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Shmueli H, Shah M, Patel Y, Nguyen LC, Hardy H, Rader F, Siegel RJ. Effects of pericardiocentesis on renal function and cardiac hemodynamics. Echocardiography 2024; 41:e15764. [PMID: 38345414 DOI: 10.1111/echo.15764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Previous case studies have reported reversal of acute renal failure after pericardiocentesis in pericardial effusion. This study examines the effects of pericardiocentesis on preprocedural low cardiac output and acute renal dysfunction in patients with pericardial effusion. METHODS This is a retrospective study of 95 patients undergoing pericardiocentesis between 2015 and 2020. Pre- and post-procedure transthoracic echocardiograms (TTE) were reviewed for evidence of cardiac tamponade, resolution of pericardial effusion, and for estimation of right atrial (RA) pressure and cardiac output. Laboratory values were compared at presentation and post-procedure. Patients on active renal replacement therapy were excluded. RESULTS Ninety-five patients were included for analysis (mean age 62.2 ± 17.8 years, 58% male). There was a significant increase in glomerular filtration rate pre- and post-procedure. Fifty-six patients (58.9%) had an improvement in glomerular filtration rate after pericardiocentesis (termed "responders"), and these patients had a lower pre-procedure glomerular filtration rate than "non-responders." There was a significant improvement in estimated cardiac output and right atrial pressure for patients in both groups. Patients who had an improvement in renal function had significantly lower pre-procedural diastolic blood pressure and mean arterial pressure. CONCLUSIONS Pericardial drainage may improve effusion-mediated acute renal dysfunction by reducing right atrial pressure and thus systemic venous congestion, and by increasing forward stroke volume and perfusion pressure.
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Affiliation(s)
- Hezzy Shmueli
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
| | - Maulin Shah
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Yatindra Patel
- Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Long-Co Nguyen
- Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Hannah Hardy
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
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Tong K, Meng Y, Zhang L, Lei X, Guan X, Xiao L, Yu J, Dou Y. Retrospective study of risk factors for pericardial effusion after haematopoietic stem cell transplantation in children. Hematology 2023; 28:2245259. [PMID: 37551721 DOI: 10.1080/16078454.2023.2245259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES The clinical characteristics, risk factors and survival prognosis of pericardial effusion (PE) after haematopoietic stem cell transplantation (HSCT) in children were investigated. METHODS Clinical data of children who underwent HSCT at the Children's Hospital Affiliated with Chongqing Medical University from January 2016 to December 2022 were analysed retrospectively. Cox proportional hazards regression and the Kaplan-Meier method were used to analyse the risk factors for post-HSCT PE and its impact on outcomes, respectively. RESULTS We enrolled 452 patients with HSCT: 307 males and 145 females, with a median age of 3.4 (1.8 to 6.5) years at transplantation. Forty-five patients (10%) had PE within a median time of 25 (10.5 to 44) days, 42 (93%) within 100 days. Three patients with large PE were treated with pericardiocentesis and drainage, while the others were treated conservatively. Of the 45 patients with PE, 24 survived, and their PE disappeared after treatment. Graft-versus-host disease (GVHD) grade, abnormal pre-HSCT electrocardiogram, hepatic veno-occlusive disease (HVOD), pulmonary infection and Epstein-Barr virus (EBV) infection were risk factors for PE. The overall survival (OS) rates at 1, 3, and 5 years were 86.0%, 84.2%, and 82.3%, respectively. PE had a significant negative effect on OS after HSCT (P < 0.0001). Particularly, one patient with large PE died of pericardial tamponade. CONCLUSIONS Post-HSCT PE usually occurred within 100 days. GVHD grade, abnormal pre-HSCT electrocardiogram, HVOD, pulmonary infection and EBV infection were closely related to PE. PE had a significant negative effect on OS rate.
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Affiliation(s)
- Ke Tong
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Yan Meng
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Luying Zhang
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xiaoying Lei
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xianmin Guan
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Li Xiao
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jie Yu
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Ying Dou
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
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Ingber RB, Lodhi U, Mootz J, Siegel A, Al-Roubaie M, Greben C. Comparing Outcomes of CT-Guided Percutaneous Pericardial Drainage with Surgical Pericardial Window in Patients with Symptomatic Pericardial Effusions. Acad Radiol 2023; 30:2533-2540. [PMID: 36925336 DOI: 10.1016/j.acra.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/15/2023]
Abstract
RATIONALE AND OBJECTIVES To compare short-term outcomes of CT-guided percutaneous pericardial drainage (PPD) versus subxiphoid surgical pericardial window (PW) drainage and analyze the risk factors associated with their outcomes. MATERIALS AND METHODS A retrospective chart review of patients who underwent either percutaneous drainage with drainage catheter placement or PW with surgical drain placement for symptomatic pericardial effusion between January 1, 2006 and August 31, 2016 was performed after institutional review board approval (decision number 16-783). The primary objective was to test for associations between the short-term (≤30 days post procedure) complication and recurrence rates in patients with symptomatic pericardial effusions. The secondary objectives were to test for associations between short-term complications with changes in vital signs. RESULTS Of the 257 procedures included in the final analysis, 142 were in the percutaneous drainage group. Short-term complication rate was significantly greater (p < 0.001) in patients undergoing PW, 17% (19/114), as compared with PPD, 2% (3/142). The estimated odds of having complications in the PW cohort was 9 times greater than the percutaneous drainage cohort (OR = 9.3, 95% CI: 2.7-32.3). No significant difference was observed between whether or not a patient experienced a short-term recurrence and any of the explanatory variables (patient demographics, imaging, and vital signs). CONCLUSION CT-guided PPD is a safer alternative to surgical PW as it leads to fewer complications without a significant difference in recurrence rate of pericardial effusion.
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Affiliation(s)
- Ross B Ingber
- Department of Radiology, Division of Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset NY 11030.
| | | | - Joseph Mootz
- Department of Radiology, Division of Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset NY 11030
| | - Adam Siegel
- Department of Radiology, Division of Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset NY 11030
| | - Mustafa Al-Roubaie
- Moffit Cancer Center, University of South Florida Morsani School of Medicine
| | - Craig Greben
- Department of Radiology, Division of Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset NY 11030
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Matos Sousa R, Nogueira C, Vilela MJ, Neves Correia F, Silva Araújo C, Ribeiro M, Capela C. A Rare First Presentation of Hodgkin's Lymphoma: Symptomatic Pericardial Effusion. Cureus 2023; 15:e46731. [PMID: 38022304 PMCID: PMC10631307 DOI: 10.7759/cureus.46731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Symptomatic pericardial effusion occurring as the initial manifestation of Hodgkin's lymphoma is exceedingly uncommon, and there are limited documented instances in the available literature. Pericardial effusion can present various differential diagnoses, and among these, malignancy is an important yet less frequently encountered cause. A heightened level of suspicion is crucial for establishing an accurate diagnosis, particularly when the patient's clinical course deviates from the anticipated trajectory. Through this case, we aim to emphasize the significance of considering lymphoproliferative diseases as a pertinent possibility in the differential diagnosis of pericardial effusion. Additionally, we underscore the importance of promptly reaching a diagnosis, as it can help prevent severe complications and enhance the patient's prognosis.
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Affiliation(s)
- Rita Matos Sousa
- Internal Medicine, Hospital de Braga, Braga, PRT
- Clinical Sciences, Escola de Medicina da Universidade do Minho, Braga, PRT
| | | | | | | | | | | | - Carlos Capela
- Internal Medicine, Hospital de Braga, Braga, PRT
- Clinical Sciences, Escola de Medicina da Universidade do Minho, Braga, PRT
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Yıldız Potter İ, Leo MM, Vaziri A, Feldman JA. Automated detection and localization of pericardial effusion from point-of-care cardiac ultrasound examination. Med Biol Eng Comput 2023; 61:1947-1959. [PMID: 37243852 PMCID: PMC11194944 DOI: 10.1007/s11517-023-02855-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
Focused Assessment with Sonography in Trauma (FAST) exam is the standard of care for pericardial and abdominal free fluid detection in emergency medicine. Despite its life saving potential, FAST is underutilized due to requiring clinicians with appropriate training and practice. To aid ultrasound interpretation, the role of artificial intelligence has been studied, while leaving room for improvement in localization information and computation time. The purpose of this study was to develop and test a deep learning approach to rapidly and accurately identify both the presence and location of pericardial effusion on point-of-care ultrasound (POCUS) exams. Each cardiac POCUS exam is analyzed image-by-image via the state-of-the-art YoloV3 algorithm and pericardial effusion presence is determined from the most confident detection. We evaluate our approach over a dataset of POCUS exams (cardiac component of FAST and ultrasound), comprising 37 cases with pericardial effusion and 39 negative controls. Our algorithm attains 92% specificity and 89% sensitivity in pericardial effusion identification, outperforming existing deep learning approaches, and localizes pericardial effusion by 51% Intersection Over Union with ground-truth annotations. Moreover, image processing demonstrates only 57 ms latency. Experimental results demonstrate the feasibility of rapid and accurate pericardial effusion detection from POCUS exams for physician overread.
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Affiliation(s)
| | - Megan M Leo
- School of Medicine, Boston University (BU), Chobanian & Avedisian, Boston, MA, USA
- Department of Emergency Medicine, Boston Medical Center (BMC), Boston, MA, USA
| | | | - James A Feldman
- School of Medicine, Boston University (BU), Chobanian & Avedisian, Boston, MA, USA
- Department of Emergency Medicine, Boston Medical Center (BMC), Boston, MA, USA
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10
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Karasu BB, Akin B. Can Asthma Cause Pericardial Effusion? Insights Into an Intriguing Association. Tex Heart Inst J 2023; 50:491986. [PMID: 37011363 PMCID: PMC10178645 DOI: 10.14503/thij-22-7867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Pericardial effusion (PE) is a commonly encountered condition in clinical practice, but its etiology can be difficult to identify, with many cases remaining classified as idiopathic. This study aimed to investigate whether an association exists between asthma and idiopathic PE (IPE). METHODS Patients who had been diagnosed with PE in the authors' outpatient cardiology clinics between March 2015 and November 2018 were retrospectively analyzed. The study population was divided into 2 groups-non-IPE (NIPE) and IPE-based on whether a cause had been identified. Demographic, laboratory, and clinical data for the 2 groups were examined statistically. RESULTS A total of 714 patients were enrolled in the study after exclusion of 40 cases. Of these 714 patients, 558 were allocated to the NIPE group and 156 to the IPE group (NIPE group median [IQR] age, 50 [41-58] years vs IPE group median [IQR] age, 47 [39-56] years; P = .03). Asthma was significantly more prevalent among patients in the IPE group than among those in the NIPE group (n = 54 [34.6%] vs n = 82 [14.7%]; P < .001). In multivariate logistic regression analysis, asthma (odds ratio, 2.67 [95% CI, 1.53-4.67]; P = .001) was found to be an independent predictor of IPE. In the IPE group, patients with asthma had either mild or moderate PE, with the right atrium being the most common location in these patients. CONCLUSION Asthma was an independent predictor of mild to moderate IPE. The right atrium was the most frequently encountered location for PE in patients with asthma.
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Affiliation(s)
- Betul Banu Karasu
- Department of Cardiology, Etimesgut Sehit Sait Erturk State Hospital, Ankara, Turkey
| | - Berna Akin
- Department of Chest Diseases, Ankara Pursaklar State Hospital, Ankara, Turkey
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Liu H, Li X, Song L, Zhang W. Hemorrhage of internal mammary vessels in percutaneous perventricular device closure: A rare case report. Asian J Surg 2023; 46:1114-1115. [PMID: 35995717 DOI: 10.1016/j.asjsur.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Haibei Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu City, Sichuan Province, China
| | - Xuejie Li
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu City, Sichuan Province, China
| | - Li Song
- Department of Pain, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu City, Sichuan Province, China
| | - Wensheng Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu City, Sichuan Province, China; Laboratory of Anesthesia and Critical Care Medicine,Chengdu City, Sichuan Province, China.
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12
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Issani A. An updated narrative review on the management of the most common oncological and hematological emergencies. Dis Mon 2023; 69:101355. [PMID: 35379468 DOI: 10.1016/j.disamonth.2022.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oncological emergencies are defined as an acute life-threatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to end-stage disease. These oncological emergencies are broadly classified into four major categories; metabolic, structural, hematological and treatment-related causes; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. This study aims to cover an in-depth review of the underlying pathogenesis, clinical presentation, and updated management protocol of most common emergencies belonging to the above-mentioned categories. An all-language literature search was conducted on 15th October 2021 and 10th March 2022, limited to 5 years on PubMed database using the following search strings: oncological emergencies, malignant spinal cord compression, febrile neutropenia, hyperviscosity syndrome, superior vena cava syndrome, immune related adverse events, tumor lysis syndrome, hypercalcemia of malignancy, corrected calcium, malignant pericardial effusion and chemotherapy extravasation.
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Affiliation(s)
- Ali Issani
- Baqai Medical University, Karachi, Pakistan.
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13
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Ortega Bonilla B, Vidán Astiz MT. [Pericardial effusion as an extra-articular manifestation of rheumatoid arthritis: A case report]. Rev Esp Geriatr Gerontol 2023; 58:43-45. [PMID: 36631336 DOI: 10.1016/j.regg.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/20/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023]
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Muacevic A, Adler JR, Conde I, Pereira VH, Azevedo P. A Case of a Large Malignant Pericardial Effusion on Computed Tomography Without Electrocardiographic Gating. Cureus 2023; 15:e34176. [PMID: 36843767 PMCID: PMC9957554 DOI: 10.7759/cureus.34176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/27/2023] Open
Abstract
A 67-year-old female was admitted due to dyspnea. A computed tomography (CT) disclosed a suspicious pulmonary mass and a pericardial effusion. A transthoracic echocardiogram confirmed a large-volume circumferential pericardial effusion. A pericardiocentesis was performed, and the cytological and histochemical studies later confirmed the diagnosis of pulmonary adenocarcinoma. This case report highlights the casualty of having found a cardiac tamponade through a CT not synchronized with an electrocardiogram.
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15
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Muacevic A, Adler JR, Altshuler E, Seifert RP, Al-Mansour ZA. Pericardial Effusion: A Novel Presentation of Aplastic Anemia. Cureus 2023; 15:e33276. [PMID: 36741642 PMCID: PMC9894639 DOI: 10.7759/cureus.33276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
Pericardial effusion is defined as the accumulation of fluid between the visceral and parietal pericardium. The underlying etiology varies as any pathology that causes pericarditis or involves the pericardium can cause effusion. In practice, the majority of pericarditis cases are idiopathic, although these are assumed to be secondary to occult viral infection or inflammatory phenomena. Malignancy, particularly the metastatic spread of noncardiac primary tumors, has been implicated as a differential in the diagnosis of pericardial effusion. Though commonly seen in solid malignancies, effusion has been reported in hematologic malignancies such as myelodysplastic syndrome (MDS), acute leukemia, and lymphoma. Nonetheless, pericardial effusions associated with hematologic conditions are extremely rare with only one case report published describing pericardial effusion secondary to immune thrombocytopenia (ITP). We herein report the first documented case, to our knowledge, of pericardial effusion as an initial clinical manifestation of aplastic anemia in a middle-aged male presenting with pancytopenia.
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16
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Jin YF, Ye YQ, Jin YJ, Zhu XY, Sha M, Liu R, Chen C. Risk Factors and Impact on Outcomes of Lung Cancer Patients Concurrent with Deep Vein Thrombosis. Cancer Control 2022; 29:10732748221145074. [PMID: 36520061 PMCID: PMC9761800 DOI: 10.1177/10732748221145074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Many investigations on prognostic factors in lung cancer have been conducted; however, little is known regarding the outcomes of lung cancer cases complicated by deep vein thrombosis (DVT). This study aimed to determine the risk factors and impact on outcomes of lung cancer patients concurrent with DVT. METHODS Lung cancer patients who underwent lower-extremity venous ultrasound were enrolled in this study. The patients were divided into a DVT group and a non-DVT group. Demographic information, clinical characteristics, and survival were analyzed by t-test, Wilcoxon test, chi-squared test, and logistic regression analysis. RESULTS Of the 160 enrolled lung cancer patients, DVT was detected in 30 patients. Among the DVT group, adenocarcinoma was the most common histological type (27/30, 90.00%). Lung cancer complicated with DVT was associated with advanced stage, more severe myocardial injury, and a hypercoagulable state (P < .05). Differences in driver genes between the two groups were not significant. Radiologically, lung cancer patients with DVT were more likely to present with pericardial effusion and pleural effusion than patients without DVT (P < .05). Following multivariable logistic regression analysis, advanced stage (OR 5.368, [95%CI 1.871-18.165], P = .021), NT-proBNP >300 pg/ml (OR 5.575, [95%CI 1.733-3.722], P = .018), D-dimer >5 mg/L (OR 8.449, [95%CI 4.323-18.536], P = .004), CRP >12 mg/L (OR 6.687, [95%CI 1.967-13.617], P = .010), and serum CEA >25 ng/ml (OR 4.755, [95%CI 1.358-3.123], P = .029) were independent risk factors for adenocarcinoma complicated with DVT. Finally, survival analysis revealed that the occurrence of DVT resulted in a poorer prognosis despite anticoagulant therapy (P < .05). CONCLUSION DVT is a potential complication in patients with lung adenocarcinoma and could represent a prognostic marker for unfavorable outcome. It is essential to screen for DVT in high-risk adenocarcinoma patients.
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Affiliation(s)
- Yi-fan Jin
- Cheng Chen, Department of Respiratory and
Critical Medicine, The First Affiliated Hospital of Soochow University, 899
Pinghai Road, Suzhou 215000, China.
| | | | | | | | | | | | - Cheng Chen
- Cheng Chen, Department of Respiratory and
Critical Medicine, The First Affiliated Hospital of Soochow University, 899
Pinghai Road, Suzhou 215000, China.
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17
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Weisnicht AM, Byrne R, Henkel EB, Harding SA, Kostelyna SP, Schady D, Lai J, Stubbs LA. Recurrent Rash in an 11-Year-Old Boy With Pericardial and Pleural Effusions. Pediatrics 2022; 150:189805. [PMID: 36305212 DOI: 10.1542/peds.2021-055524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/06/2022] Open
Abstract
An 11-year-old, previously healthy boy presented to the emergency center (EC) for acute respiratory distress in the setting of 5 months of recurrent and worsening rash with progressive fatigue, shortness of breath, chest pain, and cough. At the onset of his rash, he and his younger brothers were diagnosed with roseola. Although his brothers' symptoms resolved, the patient's rash recurred, prompting his primary care provider to prescribe amoxicillin. The rash subsequently worsened, so amoxicillin was stopped; a prednisone course was prescribed which alleviated the rash. Upon completion of the prednisone course, the rash returned more diffusely with associated symptoms of shortness of breath, chest pain, and cough. Because of these symptoms, his mother brought him to the EC, where his vitals were notable for tachypnea and tachycardia. His initial EC imaging workup was remarkable for an echocardiogram with a mild to moderate circumferential pericardial effusion, chest x-ray (CXR) with a large right pleural effusion, and chest computerized tomography significant for prominent and diffuse mediastinal and hilar lymphadenopathy with numerous enlarged axillary lymph nodes. Laboratory results were notable for elevated liver enzymes, inflammatory markers, d-dimer, and brain natriuretic peptide. Differential diagnosis remained broad, including infectious, oncologic, and rheumatologic etiologies. Our panel of experts reviews the evaluation, hospital course, and treatment of this patient presenting with an unusual rash and serositis.
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Affiliation(s)
| | | | | | | | | | | | - Jamie Lai
- Pediatric Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Leigh A Stubbs
- Pediatric Rheumatology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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18
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Del Portillo-Navarrete JH, Pizano A, Benavides J, Palacio AM, Moreno-Medina K, Cabrales J, Echeverri D. Unveiling the causes of pericardial effusion in a contemporary case series of pericardiocentesis in Latin America. Sci Rep 2022; 12:16010. [PMID: 36163473 PMCID: PMC9512803 DOI: 10.1038/s41598-022-19339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/29/2022] [Indexed: 12/01/2022] Open
Abstract
Pericardial effusions requiring pericardiocentesis have multiple causes that vary among geographical regions and health contexts. This procedure can be performed for diagnostic or therapeutic indications. The purpose of this study was to identify the principal causes of pericardial effusions and indications for pericardiocentesis, exploring differences among groups. This was a retrospective case series of patients who underwent pericardiocentesis for pericardial effusion in a single center in Latin America. Demographic, clinical, echocardiographic, and procedural variables were recorded and analyzed. The primary outcome was to determine the causes of pericardial effusions in these patients and the indication (diagnostic, therapeutic, or both). The results are presented in two groups (inflammatory and noninflammatory) according to the cause of the pericardial effusion. One hundred sixteen patients with pericardial effusion underwent pericardiocentesis. The median age was 58 years (IQR 46.2–70.7), and 50% were male. In the noninflammatory pericardial effusion group, there were 61 cases (53%), among which neoplastic pericardial effusion was the most frequent cause (n = 25, 40.9%). In the inflammatory group, there were 55 cases (47%), and the main cause was postpericardiectomy syndrome after cardiac surgery (n = 31, 56.4%). The principal indication for pericardiocentesis was therapeutic (n = 66, 56.8%). Large pericardial effusion without hemodynamic effect of cardiac tamponade was significantly more frequent in the inflammatory group (p = 0.03). In conclusion, the principal cause of pericardial effusion in patients who underwent pericardiocentesis was postpericardiectomy syndrome after cardiac surgery, followed by neoplastic pericardial effusion. Pericardiocentesis is mainly a therapeutic procedure.
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Affiliation(s)
- Juan Hernando Del Portillo-Navarrete
- Department of Interventional Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163A # 13B-60, 110131, Bogotá, Colombia. .,School of Medicine, Universidad el Bosque, Bogotá, Colombia. .,School of Medicine, Universidad del Rosario, Bogotá, Colombia.
| | - Alejandro Pizano
- Department of Interventional Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163A # 13B-60, 110131, Bogotá, Colombia
| | | | | | - Karen Moreno-Medina
- Research Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Jaime Cabrales
- Department of Interventional Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163A # 13B-60, 110131, Bogotá, Colombia.,School of Medicine, Universidad el Bosque, Bogotá, Colombia.,School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Darío Echeverri
- Department of Interventional Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163A # 13B-60, 110131, Bogotá, Colombia.,School of Medicine, Universidad el Bosque, Bogotá, Colombia.,School of Medicine, Universidad del Rosario, Bogotá, Colombia
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19
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Yamani N, Abbasi A, Almas T, Mookadam F, Unzek S. Diagnosis, treatment, and management of pericardial effusion- review. Ann Med Surg (Lond) 2022; 80:104142. [PMID: 35846853 PMCID: PMC9283797 DOI: 10.1016/j.amsu.2022.104142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
The hemodynamic stability of the heart and pericardium are maintained by the pericardial fluid of volume ∼10–50 ml. Pericardial effusion is associated with the abnormal accumulation of pericardial fluid in the pericardial cavity. Numerous imaging techniques are utilized to evaluate pericardial effusion including chest X-ray, electrocardiogram, transthoracic echocardiography, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis. Once diagnosed, there are numerous treatment options available for the management of patients with pericardial effusion. These include various invasive and non-invasive strategies such as pericardiocentesis, pericardial window, and sclerosing therapies. In recent times, few studies have been conducted to evaluate the safety and efficacy of each approach in routine clinical practice. In this review, we review the role of different modalities in the diagnosis of pericardial effusion while highlighting existing therapies aimed at the management and treatment of pericardial effusion. Numerous imaging techniques are utilized to evaluate pericardial effusion (PE) including chest X-ray, electrocardiogram, transthoracic echocardiography, CT scan, cardiac MRI, and pericardiocentesis. Multiple treatment options are available for the management of patients with PE including pericardiocentesis, pericardial window, and sclerosing therapies. Recent studies have evaluated the safety and efficacy of various diagnostic and management techniques in routine clinical practice. Further research is needed to investigate the optimal diagnostic and treatment options for patients with PE.
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Affiliation(s)
- Naser Yamani
- Department of Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL, 60612, USA
| | - Ayesha Abbasi
- Department of Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL, 60612, USA
| | - Talal Almas
- Department of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Corresponding author. RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Farouk Mookadam
- Department of Cardiovascular Medicine, Banner University Medical Center, Phoenix, AZ, USA
| | - Samuel Unzek
- Department of Cardiovascular Medicine, Banner University Medical Center, Phoenix, AZ, USA
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20
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Piccioni A, Franza L, Rosa F, Manca F, Pignataro G, Salvatore L, Simeoni B, Candelli M, Covino M, Franceschi F. Use of POCUS in Chest Pain and Dyspnea in Emergency Department: What Role Could It Have? Diagnostics (Basel) 2022; 12:diagnostics12071620. [PMID: 35885525 PMCID: PMC9325275 DOI: 10.3390/diagnostics12071620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Chest pain and dyspnea are common symptoms in patients presenting to the emergency room (ER); oftentimes it is not possible to clearly identify the underlying cause, which may cause the patient to have to return to the ER. In other cases, while it is possible to identify the underlying cause, it is necessary to perform a large number of tests before being able to make a diagnosis. Over the last twenty years, emergency medicine physicians have had the possibility of using ultrasound to help them make and rule out diagnoses. Specific ultrasound tests have been designed to evaluate patients presenting with specific symptoms to ensure a fast, yet complete, evaluation. In this paper, we examine the role of ultrasound in helping physicians understand the etiology behind chest pain and dyspnea. We analyze the different diseases and disorders which may cause chest pain and dyspnea as symptoms and discuss the corresponding ultrasound findings.
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Affiliation(s)
- Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
- Correspondence:
| | - Laura Franza
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
| | - Federico Rosa
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
| | - Federica Manca
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
| | - Giulia Pignataro
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
| | - Lucia Salvatore
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
| | - Benedetta Simeoni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (L.S.); (B.S.); (M.C.); (M.C.); (F.F.)
- Facoltà di Medicina e Chirurgia, Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.F.); (F.R.); (F.M.)
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21
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Ingber RB, Al-Roubaie M, Lodhi U, Greben C. CT-Guided Pericardial Drainage: A Safe and Viable Alternative to Ultrasound-Guided Drainage. Semin Intervent Radiol 2022; 39:329-333. [PMID: 36062228 PMCID: PMC9433151 DOI: 10.1055/s-0042-1751284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ross B. Ingber
- Division of Vascular and Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Mustafa Al-Roubaie
- Division of Vascular and Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Umairullah Lodhi
- Division of Vascular and Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Craig Greben
- Division of Vascular and Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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22
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Mehdizadegan N, Mohammadi H, Amoozgar H, Pournajaf S, Edraki MR, Naghshzan A, Yazdani MN. Pericardial effusion among children: Retrospective analysis of the etiology and short-term outcome in a referral center in the south of Iran. Health Sci Rep 2022; 5:e652. [PMID: 35620532 PMCID: PMC9125871 DOI: 10.1002/hsr2.652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/09/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Aims We reinvestigated the causes, symptoms, and management of childhood pericardial effusion (PE) and its gradual changes during recent years in a referral pediatric cardiology center in the south of Iran. Methods We retrospectively analyzed the profile of PE patients who were under 18 years old from 2015 to 2020. The patient's demographic, clinical, and paraclinical information was extracted and analyzed using SPSS software. Result In general, 150 out of 63,736 admitted patients (0.23% of the total pediatric admissions) were diagnosed with PE (male/female 1:1.17). The median age was 3.25 years (range:\ 2 days to 18 years; interquartile range: 9.5), and 50% of them were under 3 years of age. 32.6% had moderate to severe PE. Most patients presented with acute symptoms (68%) and respiratory problems, as the most common symptoms (30.6%). Tamponade signs were presented in 2% (n = 3) of the patients, and 80.7% (n = 121) were in a stable hemodynamic condition. In total, renal failure (22%) and parapneumonic effusion were the leading etiologies. Viral (7%) and bacterial (5%) pericarditis were the seventh and eighth causes; however, in severe cases, renal failure (22%) and bacterial pericarditis (14%) were dominant. In total, 14.1% (n = 21) of the patients needed pericardiocentesis that increased to 78.3% (n = 18) in severe cases. Only 6% had persistent PE for more than 3 months. Conclusion Childhood PE is mostly a result of renal failure and noninfectious causes. True pericarditis cases are not common, except in severe cases. It is more common in less than 3-year-old patients, and chronicity is rare. Severe cases had a high chance of pericardiocentesis, but other cases were mainly managed by treatment of the underlying causes.
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Affiliation(s)
- Nima Mehdizadegan
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Hamid Mohammadi
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Hamid Amoozgar
- Neonatology Research CenterShiraz University of Medical SciencesShirazIran
| | - Samira Pournajaf
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Mohammad Reza Edraki
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Amir Naghshzan
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
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Wilder-Smith AJ, Yang S, Weikert T, Bremerich J, Haaf P, Segeroth M, Ebert LC, Sauter A, Sexauer R. Automated Detection, Segmentation, and Classification of Pericardial Effusions on Chest CT Using a Deep Convolutional Neural Network. Diagnostics (Basel) 2022; 12:diagnostics12051045. [PMID: 35626201 PMCID: PMC9139725 DOI: 10.3390/diagnostics12051045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 01/15/2023] Open
Abstract
Pericardial effusions (PEFs) are often missed on Computed Tomography (CT), which particularly affects the outcome of patients presenting with hemodynamic compromise. An automatic PEF detection, segmentation, and classification tool would expedite and improve CT based PEF diagnosis; 258 CTs with (206 with simple PEF, 52 with hemopericardium) and without PEF (each 134 with contrast, 124 non-enhanced) were identified using the radiology report (01/2016−01/2021). PEF were manually 3D-segmented. A deep convolutional neural network (nnU-Net) was trained on 316 cases and separately tested on the remaining 200 and 22 external post-mortem CTs. Inter-reader variability was tested on 40 CTs. PEF classification utilized the median Hounsfield unit from each prediction. The sensitivity and specificity for PEF detection was 97% (95% CI 91.48−99.38%) and 100.00% (95% CI 96.38−100.00%) and 89.74% and 83.61% for diagnosing hemopericardium (AUC 0.944, 95% CI 0.904−0.984). Model performance (Dice coefficient: 0.75 ± 0.01) was non-inferior to inter-reader (0.69 ± 0.02) and was unaffected by contrast administration nor alternative chest pathology (p > 0.05). External dataset testing yielded similar results. Our model reliably detects, segments, and classifies PEF on CT in a complex dataset, potentially serving as an alert tool whilst enhancing report quality. The model and corresponding datasets are publicly available.
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Affiliation(s)
- Adrian Jonathan Wilder-Smith
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Shan Yang
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
| | - Thomas Weikert
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Martin Segeroth
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
| | - Lars C. Ebert
- 3D Center Zurich, Institute of Forensic Medicine, University of Zürich, 8057 Zürich, Switzerland;
| | - Alexander Sauter
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Raphael Sexauer
- Division of Research and Analytical Services, University Hospital Basel, 4031 Basel, Switzerland; (A.J.W.-S.); (S.Y.); (T.W.); (M.S.); (A.S.)
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
- Correspondence: ; Tel.: +41-613-286-584
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Corsini I, Leardini D, Carfagnini F, Pession A, Lanari M. Massive Pericardial Effusion in a 14-Year-Old Girl with Mild Fatigue and Neck Pain. Pediatr Rep 2022; 14:8-12. [PMID: 35076583 PMCID: PMC8788428 DOI: 10.3390/pediatric14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 02/01/2023] Open
Abstract
Pericardial effusion is rare in pediatric patients and is characterized by a variable clinical presentation. Mild symptoms may be present despite severe effusion. We here report the case of a patient with massive pericardial effusion with mild clinical presentation. Our case points out the need not to exclude this diagnosis in patients with mild general impairment. This clinical suspicion can be lifesaving.
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Affiliation(s)
- Ilaria Corsini
- Unit of Pediatrics Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.C.); (M.L.)
| | - Davide Leardini
- Specialty School of Pediatrics, University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-214-4665
| | - Filomena Carfagnini
- Unit of Pediatric Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Pession
- Unit of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Marcello Lanari
- Unit of Pediatrics Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.C.); (M.L.)
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Rao S, Olatunde O, Sunkara A, Vyas V, Weinberg A. A Significant Pericardial Effusion Leading to Bronchial Compression: A Case Report. J Investig Med High Impact Case Rep 2021; 9:23247096211005064. [PMID: 33764182 PMCID: PMC8767651 DOI: 10.1177/23247096211005064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Commonly, pericardial effusions can cause suboptimal heart contractility. Larger pericardial effusions can lead to compression of structures that surround in the heart in the mediastinum. Our patient presented with dyspnea that required mechanical ventilation. Bronchoscopy revealed compression of the bronchus from an external source. Echocardiogram showed a large circumferential pericardial effusion, which compressed the left main stem bronchus causing left lung atelectasis and persistent respiratory failure. A subxiphoid pericardial window was performed, which led to an improvement in her oxygen requirements. This case portrays the importance of including pericardial effusions in patients who present with respiratory failure refractory to antibiotic treatment and intervention with bronchoscopy. Although our patient passed away, recognition and earlier appropriate management with a pericardial window or pericardiocentesis could have prevented this adverse event.
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Affiliation(s)
- Suman Rao
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | | - Vrinda Vyas
- SUNY Upstate Medical University, Syracuse, NY, USA
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Hanson MG, Chan B. The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study. Ultrasound J 2021; 13:2. [PMID: 33538920 PMCID: PMC7862446 DOI: 10.1186/s13089-021-00205-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.
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Affiliation(s)
- Matthew G Hanson
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Barry Chan
- Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada.
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Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Abstract
Abstract
Purpose of Review
To review the latest developments and the current role of the cardiac magnetic resonance (CMR) in pericardial diseases and their complications.
Recent Findings
Cardiac Magnetic Resonance (CMR) has the ability to incorporate anatomy, physiology, and “virtual histology” strategies to achieve the most accurate diagnosis for even the most demanding, pericardial diseases.
Summary
Acute, chronic, recurrent, and constrictive pericarditis as well as pericarditis related complications, pericardial masses and congenital pericardial defects are commonly encountered in clinical practice with relatively significant morbidity and mortality. Owing to the challenging diagnosis, CMR imaging is often employed in confirming the diagnosis and elucidating the underling pathophysiology. In this review we outline the common CMR techniques and their expected diagnostic outcomes.
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29
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Rosario J, Mangal R, Houck J, Slome MC, Ganti L. Pericardial effusion with tamponade: bedside ultrasonography saves another life. Int J Emerg Med 2020; 13:3. [PMID: 31992190 PMCID: PMC6988296 DOI: 10.1186/s12245-019-0257-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/25/2019] [Indexed: 11/10/2022] Open
Abstract
In these video clinical images, the authors present the cause for an elderly gentleman’s shortness of breath. It was presumed to be an exacerbation of chronic obstructive pulmonary disease, a condition for which he was in the process of being evaluated. However, bedside ultrasonography revealed a large pericardial effusion with tamponade. This timely diagnosis resulted in the patient being taken expeditiously to the operating room and saving his life.
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Affiliation(s)
- Javier Rosario
- Envision Physician Services, Nashville, TN, USA.,UCF HCA Emergency Medicine Residency Program of Greater Orlando, University of Central Florida College of Medicine, Orlando, FL, USA
| | | | | | - Mary Cate Slome
- Envision Physician Services, Nashville, TN, USA.,UCF HCA Emergency Medicine Residency Program of Greater Orlando, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Latha Ganti
- Envision Physician Services, Nashville, TN, USA. .,UCF HCA Emergency Medicine Residency Program of Greater Orlando, University of Central Florida College of Medicine, Orlando, FL, USA.
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30
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Buoro S, Seghezzi M, Baigorria Vaca MDC, Manenti B, Moioli V, Previtali G, Simon C, Cugola D, Brucato A, Ottomano C, Lippi G. Comparison between optical microscopy and automation for cytometric analysis of pericardial fluids in a cohort of adult subjects undergoing cardiac surgery. J Clin Pathol 2019; 72:493-500. [DOI: 10.1136/jclinpath-2019-205788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 01/04/2023]
Abstract
AimsLimited information is available on number and type of cells present in the pericardial fluid (PF). Current evidence and has been garnered with inaccurate application of guidelines for analysis of body fluids. This study was aimed at investigating the performance of automate cytometric analysis of PF in adult subjects.MethodsSeventy-four consecutive PF samples were analysed with Sysmex XN with a module for body fluid analysis (XN-BF) and optical microscopy (OM). The study also encompassed the assessment of limit of blank, limit of detection and limit of quantitation (LoQ), imprecision, carryover and linearity of XN-BF module.ResultsXN-BF parameters were compared with OM for the following cell classes: total cells (TC), leucocytes (white blood cell [WBC]), polymorphonuclear (PMN) and mononuclear (MN) cells. The relative bias were −4.5%, 71.2%, 108.2% and −47.7%, respectively. Passing and Bablok regression yielded slope comprised between 0.06 for MN and 5.8 for PMN, and intercept between 0.7 for PMN and 220.3 for MN. LoQ was comprised between 3.8×106 and 6.0×106 cells/L for WBC and PMN. Linearity was acceptable and carryover negligible.ConclusionsPF has a specific cellular composition. Overall, automated cell counting can only be suggested for total number of cells, whereas OM seems still the most reliable option for cell differentiation.
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Singh H, Pannu AK, Suri V, Bhalla A, Kumari S. Pericardial effusion and electrical alternans. QJM 2019; 112:135-136. [PMID: 30165695 DOI: 10.1093/qjmed/hcy191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - A K Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
| | - S Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India
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Nasser K, Joshi K, Starobinska E. Pericardial effusion as a complication of chronic graft versus host disease. BMJ Case Rep 2018; 11:11/1/e227507. [PMID: 30567271 DOI: 10.1136/bcr-2018-227507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 24-year-old man with previous matched unrelated donor allogenic bone marrow transplant for aplastic anaemia and chronic graft versus host disease on steroid taper presented with progressively worsening anasarca. CT revealed large pericardial effusion, while echocardiogram was concerning for early tamponade physiology. He underwent emergent pericardiocentesis with pericardial drain placement. Extensive rheumatological and infectious work-up was unrevealing with patient's presentation attributed to pericardial graft versus host disease. This highlights the need of physicians to be aware of pericardial serositis as a complication of graft versus host disease due to its life-threatening complications, which require immediate intervention.
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Affiliation(s)
- Keaton Nasser
- Internal Medicine, Banner University Medical Center, Tucson, Arizona, USA
| | - Kshipra Joshi
- Internal Medicine, Banner University Medical Center, Tucson, Arizona, USA
| | - Ella Starobinska
- Internal Medicine, Banner University Medical Center, Tucson, Arizona, USA
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Sinnaeve PR, Adriaenssens T. A contemporary look at pericardiocentesis. Trends Cardiovasc Med 2018; 29:375-383. [PMID: 30482483 DOI: 10.1016/j.tcm.2018.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022]
Abstract
Percutaneous drainage is the default strategy for evacuating a pericardial effusion. A pericardiocentesis can be necessary or required in a wide variety of clinical settings ranging from urgent tamponade to relieve in iatrogenic hemorrhagic effusions in the electrophysiology or catheterization room, to planned diagnostic procedures in patients with suspected or known malignancy or infections. With the help of several procedural improvements over the past decades, echocardiography and fluoroscopy-guided percutaneous pericardiocentesis has become the standard intervention for evacuating pericardial effusions, as well as an essential tool in the diagnostic work-up of an unexplained pericardial effusion. When performed by skilled physicians assisted by appropriate imaging it is a very safe procedure, and provided that an indwelling catheter is placed, it is also very effective with an acceptably low risk of recurrences. In this review, the indications and standard techniques for pericardiocentesis are discussed, as well as their consequences for patients with iatrogenic and malignant effusions.
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Affiliation(s)
- P R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium.
| | - T Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium
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Volk L, Ikegami H, Lee LY, Lemaire A. Pericardial windows have limited diagnostic success. J Cardiothorac Surg 2018; 13:87. [PMID: 30021617 PMCID: PMC6052520 DOI: 10.1186/s13019-018-0774-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/10/2018] [Indexed: 12/31/2022] Open
Abstract
Background Pericardial effusion (PE) is a common finding in patients who have chronic cardiac failure, who had undergone cardiac surgery, or who have certain other benign and malignant diseases. Pericardial drainage procedures are often requested for both diagnostic and therapeutic purposes. The perceived benefit is that it allows for diagnosis of malignancy or infection for patients with PEs of unclear etiology. The purpose of the study is to determine the diagnostic yield of surgical drainage procedures. Methods We conducted a retrospective chart review of patients who underwent surgical drainage procedures of PEs from July 1st, 2011 to January 1st, 2017 at a single institution. The variables included data on preoperative, intraoperative, and postoperative findings; morbidity; and survival. Results A total of 145 patients with an average age of 61 ± 5 and primarily men (53%) were evaluated. All of the surgical drainage procedures were performed through the sub-xiphoid approach. Twenty-five of the 145 patients (17.2%) had diagnostic findings in either the pericardial tissue or fluid. The cytology alone was diagnostic in 4.8% (N = 7) of patients with mixed findings including adenocarcinoma of the lung and breast. The pathology was diagnostic for cancer in 1.4% (N = 2) of patients with Melanoma and Lung cancer identified. The cytology and pathology were concordant in 4.0% (N = 6) identifying cancers that included mesothelioma and adenocarcinoma. Infection was identified in the pericardial fluid in 6.9% (N = 10) of the patients. Conclusion Surgical pericardial drainage procedures allow for removal of PE that may lead to tamponade physiology and potential mortality. Although there is therapeutic benefit from these procedures there is only a small diagnostic benefit.
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Affiliation(s)
- Lindsay Volk
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Hirohisa Ikegami
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Anthony Lemaire
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA.
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Prada G, Vieillard-Baron A, Martin AK, Hernandez A, Mookadam F, Ramakrishna H, Diaz-Gomez JL. Echocardiographic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care. J Cardiothorac Vasc Anesth 2018; 33:1559-1583. [PMID: 30077562 DOI: 10.1053/j.jvca.2018.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 02/03/2023]
Abstract
Proficiency in echocardiography and lung ultrasound has become essential for anesthesiologists and critical care physicians. Nonetheless, comprehensive echocardiography measurements often are time-consuming and technically challenging, and conventional 2-dimensional images do not permit evaluation of specific conditions (eg, systolic anterior motion of the mitral valve, pneumothorax), which have important clinical implications in the perioperative setting. M-mode (motion-based) ultrasonographic imaging, however, provides the most reliable temporal resolution in ultrasonography. Hence, M-mode can provide clinically relevant information in echocardiography and lung ultrasound-driven approaches for diagnosis, monitoring, and interventional procedures performed by anesthesiologists and intensivists. Although M-mode is feasible, this imaging modality progressively has been abandoned in echocardiography and is often underutilized in lung ultrasound. This article aims to comprehensively illustrate contemporary applications of M-mode ultrasonography in the anesthesia and critical care medicine practice. Information presented for each clinical application will include image acquisition and interpretation, evidence-based clinical implications in the critically ill and surgical patient, and limitations. The present article focuses on echocardiography and reviews left ventricular function (mitral annular plane systolic excursion, E-point septal separation, fractional shortening, and transmitral propagation velocity); right ventricular function (tricuspid annular plane systolic excursion, subcostal echocardiographic assessment of tricuspid annulus kick, outflow tract fractional shortening, ventricular septal motion, wall thickness, and outflow tract obstruction); volume status and responsiveness (inferior vena cava and superior vena cava diameter and respiratory variability [collapsibility and distensibility indexes]); cardiac tamponade; systolic anterior motion of the mitral valve; and aortic dissection.
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Affiliation(s)
- Gabriel Prada
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin En Yvelines, France; INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ.
| | - Jose L Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
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