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Darda S, Zughaib ME, Alexander PB, Machado CE, David SW, Saba S. Cardiac sarcoidosis presenting as constrictive pericarditis. Tex Heart Inst J 2014; 41:319-23. [PMID: 24955053 DOI: 10.14503/thij-13-3208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In patients with cardiac sarcoidosis, the sarcoid granulomas usually involve the myocardium or endocardium. The disease typically presents as heart failure with ventricular arrhythmias, conduction disturbances, or both. Constrictive pericarditis has rarely been described in patients with sarcoidosis: we found only 2 reports of this association. We report the case of a 57-year-old man who presented with clinical and hemodynamic features of constrictive pericarditis, of unclear cause. He was admitted for treatment of recurrent pleural effusion. After a complicated hospital course, he underwent pericardiectomy. His clinical and hemodynamic conditions improved substantially, and he was discharged from the hospital in good condition. The pathologic findings, the patient's clinical course, and his response to pericardiectomy led to our diagnosis of cardiac sarcoidosis presenting as constrictive pericarditis. In addition to the patient's case, we discuss the nature and diagnostic challenges of cardiac sarcoidosis. Increased awareness of this disease is necessary for its early detection, appropriate management, and potential cure.
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Affiliation(s)
- Saba Darda
- Department of Cardiology, Providence Hospital and Medical Center, South-field, Michigan 48075
| | - Marcel E Zughaib
- Department of Cardiology, Providence Hospital and Medical Center, South-field, Michigan 48075
| | - Patrick B Alexander
- Department of Cardiology, Providence Hospital and Medical Center, South-field, Michigan 48075
| | - Christian E Machado
- Department of Cardiology, Providence Hospital and Medical Center, South-field, Michigan 48075
| | - Shukri W David
- Department of Cardiology, Providence Hospital and Medical Center, South-field, Michigan 48075
| | - Souheil Saba
- Department of Cardiology, Providence Hospital and Medical Center, South-field, Michigan 48075
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Abstract
OBJECTIVES Our aim was to review the clinical records from children with large pericardial effusions of inflammatory origin presenting to a tertiary referral centre over the last 21 years, with emphasis on their clinical presentation, management and outcome. BACKGROUND The common identifiable causes of pericardial effusion in children include prior cardiac surgery, bacterial pericarditis, malignancy, and connective tissue disorders. In a significant number of children, however, despite extensive investigation, it is not possible to identify a clear aetiology. A viral cause is often considered, though rarely confirmed. The clinical course of such large idiopathic pericardial effusions in children has not been extensively reported. METHODS AND RESULTS We reviewed retrospectively the records of all patients seen between 1981 and 2001 with large pericardial effusions of inflammatory origin requiring drainage, excluding the effusions related to cardiac surgery or malignancy. We found 31 patients fulfilling our criterions for study. They could be divided into three groups, with 15 patients having no specific identifiable aetiology despite extensive investigation, 12 patients having evidence of bacterial pericarditis, and four with a probable immunologic disorder. Fever was present in only eight patients (53%) in the idiopathic group. All patients in the other groups had fever. Except for fever and the resultant tachycardia, it was not possible to distinguish on clinical grounds, nor on the presence or otherwise of cardiac tamponade, between those with idiopathic aetiology and those with bacterial infection. Of the patients with presumed bacterial pericarditis, five (42%) had both positive blood and pericardial fluid cultures, three (25%) had positive blood cultures, while a further three patients (25%) had only positive pericardial fluid cultures. All patients required drainage of the pericardial effusion, either under echocardiographic guidance or surgically. None of the patients died. The hospital stay was significantly shorter for those with idiopathic as opposed to bacterial pericarditis. Of those with an idiopathic aetiology, six required readmission due to recurrence of the pericardial effusion, with four patients requiring further surgical drainage. No patients required readmission with a bacterial or immunologic aetiology. No patient developed constrictive pericarditis after a median follow-up of 22 months. CONCLUSION Patients with large idiopathic pericardial effusion had relatively few constitutional symptoms as compared with their gross echocardiographic findings. Those with bacterial pericarditis had more urgent need for treatment. Patients with pericardial effusion of inflammatory origin, when treated appropriately, had an excellent outcome with no mortality or development of constrictive pericarditis.
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Affiliation(s)
- Geoffrey Chi Fung Mok
- Department of Cardiology, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Parkville, Australia
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Ozer N, Aytemir K, Sade E, Oto A, Aksoy S, Engin H, Tokgözoğlu L, Oto A. Cardiac tuberculosis with multiple intracardiac masses: a case report. J Am Soc Echocardiogr 2002; 15:756-8. [PMID: 12094179 DOI: 10.1067/mje.2002.119846] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this report, clinical, echocardiographic, and pathologic findings of a patient with multiple masses caused by tuberculosis both in the left and right side of the heart are presented. After antituberculosis treatment some of the masses disappeared and some became smaller. Although an intracardiac mass caused by tuberculosis is very rare, it should be considered in the list of masses detected by echocardiography.
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Affiliation(s)
- Necla Ozer
- Department of Cardiology, Hacettepe University, School of Medicine, Ankara, Turkey.
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Demaria R, Fortier S, Racine N, Dürrleman N, Albat B, Frapier JM, Chaptal PA. [Chronic constrictive pericarditis in African children: report of a case]. Ann Cardiol Angeiol (Paris) 2001; 50:312-5. [PMID: 12555621 DOI: 10.1016/s0003-3928(01)00038-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The chronic constrictive pericarditis is a rare affection, with multiple etiologies and concerning especially the adult. We report a case of chronic constrictive pericarditis in an African child in whom no etiology was found. A review of the literature raises the characteristics of chronic constrictive pericarditis for a better therapeutic management.
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Affiliation(s)
- R Demaria
- Départements de chirurgie et de cardiologie, institut de cardiologie de Montréal, 5000 Bélanger Est, H1T 1C8, Montréal, Québec, Canada.
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Oh KY, Shimizu M, Edwards WD, Tazelaar HD, Danielson GK. Surgical pathology of the parietal pericardium: a study of 344 cases (1993-1999). Cardiovasc Pathol 2001; 10:157-68. [PMID: 11600333 DOI: 10.1016/s1054-8807(01)00076-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Among 344 cases with surgically resected parietal pericardium, ages ranged from 1 to 87 years (mean, 55), and 64% were male. Causes of pericardial disease included neoplastic (33%), idiopathic (30%), iatrogenic (23%), and others (14%). Pericardial constriction (Group 1) represented the largest group (143 cases, 76% male). Maximal pericardial thickness was 1-17 mm (mean, 4). Fibrotic thickening occurred in 96%. Chronic lymphoplasmacytic inflammation affected 73% (mild or moderate in 97%). Calcification was uncommon (gross in 28%, microscopic in 8%), and granulomas were rare (4%, none tubercular). Constriction was idiopathic in 49% and iatrogenic (postpericardiotomy or postirradiation) in 41%. Neoplasms and cysts (Group 2) represented the second largest group (96 cases). Among 43 cases with secondary pericardial involvement, carcinomas accounted for 53% and lymphomas 21%. Forty cases (Group 3) had pericardial effusions (75% chronic), which were idiopathic in 28% and postpericardiotomy in 23%. Thirty-three cases (Group 4) had acute or recurrent pericarditis clinically, which was idiopathic in 70%. Lastly, 32 cases (Group 5) had pericardial resection for conditions unrelated to primary pericardial disease. In conclusion, pericardial constriction tended to be nontubercular (100%), nongranulomatous (96%), idiopathic or iatrogenic (90%), and noncalcific (64%), and it could occur with normal pericardial thickness (4%). Because considerable overlap in the gross and microscopic features existed among cases with noncalcific pericardial constriction (Group 1), pericardial effusions (Group 3), and pericarditis (Group 4), clinical information was necessary to provide an accurate clinicopathologic interpretation.
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Affiliation(s)
- K Y Oh
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
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Abstract
This article presents the various manifestations of cardiac infections found in the immunosuppressed host. Emphasis is placed on the correlation between specific impairments of host defenses and the occurrence of certain types of pathogens. The effect of immunosuppression on the clinical manifestations of these infections is discussed. Finally, appropriate diagnostic modalities are presented for the major types of infections.
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Affiliation(s)
- J L Brusch
- Department of Medicine, Infectious Disease Service, Cambridge Hospital, Massachusetts, USA
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Ryoke T, Kakukawa H, Kunichika H, Nishimura Y, Sakai H, Minami Y, Fujii T, Matsuzaki M. Subacute tuberculous pericarditis with fibroelastic constriction diagnosed upon pericardiectomy. JAPANESE CIRCULATION JOURNAL 2000; 64:389-92. [PMID: 10834457 DOI: 10.1253/jcj.64.389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A patient with subacute pericarditis showed no evidence suggesting tuberculosis until pericardiectomy was performed because of hemodynamic deterioration. The excised pericardium had a rubbery fibroelastic consistency; histologically, there were granulomatous changes characteristic of tuberculosis. Although tuberculous pericarditis is a difficult diagnosis, this case illustrates the diagnostic and therapeutic importance of early pericardiectomy before myocardial inflammatory infiltration occurs together with end-stage pericardial fibrosis and calcification.
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Affiliation(s)
- T Ryoke
- Department of Cardiovascular Medicine, Konan Saint Hill Hospital, Ube, Yamaguchi, Japan.
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Ling LH, Oh JK, Breen JF, Schaff HV, Danielson GK, Mahoney DW, Seward JB, Tajik AJ. Calcific constrictive pericarditis: is it still with us? Ann Intern Med 2000; 132:444-50. [PMID: 10733443 DOI: 10.7326/0003-4819-132-6-200003210-00004] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The presence of pericardial calcification on a plain radiograph strongly suggests constrictive pericarditis in patients with heart failure. However, calcific constrictive pericarditis is considered rare in the United States since tuberculosis incidence has decreased, and doubt has therefore been raised about the importance of this radiologic finding in modern cardiovascular practice. OBJECTIVE To determine the clinical and prognostic significance of pericardial calcification on radiography in patients with constrictive pericarditis. DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS A consecutive series of 135 patients (mean age +/- SD, 56 +/- 16 years) who from 1985 through 1995 had constrictive pericarditis confirmed surgically (n = 133) or by autopsy (n = 2). Patients were divided into two groups: those with pericardial calcification on chest radiography (group I) and those without (group II). MEASUREMENTS Clinical and diagnostic findings were compared in both groups, and outcome was compared in 132 patients who had pericardiectomy. RESULTS Pericardial calcification was seen in 36 patients (27%). The cause of constrictive pericardial disease was indeterminate in 67% of patients in group I and in 21% of patients in group II (P < 0.001). Patients in group I had had symptoms for a longer period and were more likely to have pericardial knock, larger atrial size, and atrial arrhythmia. Significantly more perioperative deaths were seen in group I, but incidence of late survival and incidence of noncalcific disease were similar in both groups. CONCLUSIONS Pericardial calcification is a common finding in patients with constrictive pericarditis. It is often associated with idiopathic disease and other markers of disease chronicity and is an independent predictor of increased perioperative mortality rates.
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Affiliation(s)
- L H Ling
- Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Affiliation(s)
- A Rozenshtein
- Department of Radiology, St. Luke's/Roosevelt Hospital Center, New York, NY 10003, USA
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Affiliation(s)
- S S Kushwaha
- Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029, USA
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Hurley JP, Subarreddy K, McCarthy J, Wood AE. Video-assisted thoracic surgery for delayed pericardial effusion post-CABG. Chest 1994; 106:1617-9. [PMID: 7956436 DOI: 10.1378/chest.106.5.1617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Delayed-onset pericardial effusion following coronary artery bypass grafts can give rise to significant morbidity in its presentation and in its management by traditional surgical techniques. A video-assisted thoracoscopic technique to create a pericardial window, with the advantage of a minimally invasive approach combined with excellent visualization in such a patient is described.
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Affiliation(s)
- J P Hurley
- Department of Cardiothoracic Surgery, Mater Hospital, Dublin, Ireland
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 2-1994. A 31-year-old man with a previous pericardiectomy for constrictive pericarditis and mitral regurgitation. N Engl J Med 1994; 330:126-34. [PMID: 8018143 DOI: 10.1056/nejm199401133300209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Doig JC, Hilton CJ, Reid DS. Salmonella: a rare cause of subacute effusive-constrictive pericarditis. BRITISH HEART JOURNAL 1991; 65:296-7. [PMID: 2039677 PMCID: PMC1024635 DOI: 10.1136/hrt.65.5.296] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 36 year old woman had emergency pericardectomy because of subacute effusive-constrictive pericarditis. The pericardial fluid and tissue culture showed that this was caused by infection with Salmonella enteritidis. Cardiac involvement with salmonella does not usually present in such an aggressive manner and it has not previously been reported to cause this rare type of cardiac constriction.
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Affiliation(s)
- J C Doig
- Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne
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Escalante A, Kaufman RL, Quismorio FP, Beardmore TD. Cardiac compression in rheumatoid pericarditis. Semin Arthritis Rheum 1990; 20:148-63. [PMID: 2287940 DOI: 10.1016/0049-0172(90)90056-l] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Rheumatoid pericarditis occurs in approximately one third of rheumatoid arthritis (RA) patients. However, clinically apparent rheumatoid pericarditis is infrequent. The authors found clinical pericarditis in 12 of 960 patients admitted for RA, 5 of whom had manifestations of cardiac compression. These 5 had longer duration of RA, worse functional class, and more extraarticular features than the patients without cardiac compression. Presenting features of cardiac compression included dyspnea, edema, chest pain, and pulsus paradoxus. Treatment of patients with cardiac compression due to rheumatoid pericarditis may include a trial of systemically administered corticosteroids, but this should not delay surgical intervention for impending tamponade. Pericardiocentesis should only be performed as an emergency, life-saving procedure. It may be followed by intrapericardiac injection of corticosteroids, but this does not prevent recurrence. Longer-lasting benefit is obtained by surgical decompression. Two-year mortality in patients with cardiac compression was 100%. The literature on the subject is reviewed.
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Affiliation(s)
- A Escalante
- Arthritis Service, Rancho Los Amigos Medical Center, Downey, CA 90242
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Abstract
Chronic constrictive pericarditis may complicate both rheumatoid arthritis and systemic lupus erythematosus. To our knowledge, however, this is the first time it has been described in a patient with dermatomyositis. This association should be kept in mind as constrictive pericarditis should be considered in the differential diagnosis of liver cirrhosis and Budd-Chiari syndrome in rheumatic diseases.
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Affiliation(s)
- R Tamir
- Division of Clinical Immunology and Allergy, Beilinson Medical Center, Petach Tikvah, Israel
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Bashi VV, John S, Ravikumar E, Jairaj PS, Shyamsunder K, Krishnaswami S. Early and late results of pericardiectomy in 118 cases of constrictive pericarditis. Thorax 1988; 43:637-41. [PMID: 3175976 PMCID: PMC461401 DOI: 10.1136/thx.43.8.637] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The medical records of 118 patients (86 male, 32 female, age 10-50 (mean 27) years) who underwent pericardiectomy for constrictive pericarditis at the Christian Medical College Hospital, Vellore, from 1954 to 1985 were reviewed. All had appreciable pericardial constriction. Preoperatively 97 of the 118 were in class III or IV of the New York Heart Association classification and 100 had peripheral oedema or ascites. Tuberculosis was proved as the cause in 72 patients. Pericardiectomy was accomplished through a standard anterolateral thoracotomy (107 cases), median sternotomy (3 cases), or bilateral thoracotomy (8 cases). Postoperatively an apparent low cardiac output state was seen in 34 patients, 12 of whom died. Hospital mortality in the last 12 years was 11%. Mortality was higher in NYHA class III and IV patients. The improved surgical results recently may be related to increased use of inotropic support and prolonged ventilation. At follow up there were 72 patients in whom functional capacity could be assessed; 63 were in class I or II. The poor results of pericardiectomy in some patients are likely to be related to advanced preoperative disability and early pericardiectomy is therefore recommended.
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Affiliation(s)
- V V Bashi
- Department of Thoracic and Cardiovascular Surgery, Christian Medical College and Hospital, Vellore, South India
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Cardiovascular Tuberculosis. Tuberculosis (Edinb) 1988. [DOI: 10.1007/978-1-4684-0305-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Keogh BE, Oakley CM, Taylor KM. Chronic constrictive pericarditis caused by self-mutilation with sewing needles. A case report and review of published reports. BRITISH HEART JOURNAL 1988; 59:77-80. [PMID: 3277655 PMCID: PMC1277078 DOI: 10.1136/hrt.59.1.77] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 34 year old woman with a history of self-mutilation developed severe constrictive pericarditis with sterile, calcified intrapericardial abscess cavities as a result of inserting sewing needles into her chest seven years previously. After pericardiectomy she made a good recovery.
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Affiliation(s)
- B E Keogh
- Department of Cardiac Surgery, Royal Postgraduate Medical School, London
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Restrictive cardiomyopathy or constrictive pericarditis? Lancet 1987; 2:372-4. [PMID: 2886826 DOI: 10.1016/s0140-6736(87)92387-7] [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: 01/03/2023]
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Abstract
Constrictive pericarditis is an unusual complication of rheumatoid arthritis, and its development appears to be uninfluenced by second-line therapy. Five patients are described who developed the disease, with possibly two more. Medical treatment is ineffective: the treatment of choice is surgical, and the postoperative prognosis is good. The crude prevalence rate for the association is 0.64% for males and 0.06% for females.
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