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Veil-Picard M, Rival G, Aupècle B, Laluc F, Maitre J, Seronde MF, Dalphin JC. [Unilateral transudative pleural effusion and constritive pericarditis]. Rev Mal Respir 2015; 32:58-65. [PMID: 25618206 DOI: 10.1016/j.rmr.2014.07.002] [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: 09/11/2013] [Accepted: 06/14/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Constrictive pericarditis is associated with thickening, fibrosis or inflammation of the pericardium which can lead to signs of right ventricle dysfunction. It is usually a chronic process which can present in a variety of ways. We present two cases of constrictive pericarditis discovered during the investigation of a left-sided pleural effusion. OBSERVATION The cases represent two sorts of constrictive pericarditis, chronic and due to pericardial effusions. Their common feature was an increase in dyspnoea and a new pleural effusion on the left side. Their difference lies in the presence of a thickened calcified pericardium in one case and the presence of a pericardial effusion in the other. In both cases, non-invasive investigation failed to diagnose any cardiac disease. The presence of constrictive pericarditis was confirmed by right heart catheterization. Treatment by subtotal pericardectomy was effective. CONCLUSION The thoracic manifestations of constrictive pericarditis are most commonly recurring bilateral pleural effusions. The mode of presentation may be an exudative, or transudative effusion. Unilateral pleural involvement, fibrosis, chylothorax or tumour like presentations may occur. A diagnosis of constrictive pericarditis should be considered in these clinical contexts and an examination of the pericardium performed. Cardiac catheterization can help in the differential diagnosis.
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Affiliation(s)
- M Veil-Picard
- Service de pneumologie, CHU de Besançon, 4, boulevard Fleming, 25000 Besançon, France.
| | - G Rival
- Service de pneumologie, CHU de Besançon, 4, boulevard Fleming, 25000 Besançon, France; Service de réanimation, centre hospitalier de Montélimar, 26200 Montélimar, France
| | - B Aupècle
- Service de chirurgie thoracique, CHU de Besançon, 25000 Besançon, France
| | - F Laluc
- Service de chirurgie thoracique, CHU de Besançon, 25000 Besançon, France
| | - J Maitre
- Service de pneumologie, CHU de Besançon, 4, boulevard Fleming, 25000 Besançon, France
| | - M-F Seronde
- Service de cardiologie, CHU de Besançon, 25000 Besançon, France
| | - J-C Dalphin
- Service de pneumologie, CHU de Besançon, 4, boulevard Fleming, 25000 Besançon, France
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Tokuda Y, Miyata H, Motomura N, Araki Y, Oshima H, Usui A, Takamoto S. Outcome of Pericardiectomy for Constrictive Pericarditis in Japan: A Nationwide Outcome Study. Ann Thorac Surg 2013; 96:571-6. [DOI: 10.1016/j.athoracsur.2013.04.054] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
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Özer N, Shehu V, Aytemir K, Övünç K, Emre S, Kes S. Echocardiographic findings of pericardial involvement in patients with malignant pleural mesothelioma with a history of environmental exposure to asbestos and erionite. Respirology 2008. [DOI: 10.1111/j.1440-1843.2000.00272.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Veprim Shehu
- Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | - Salih Emre
- Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Abejie BA, Chung EH, Nesto RW, Kales SN. Grand rounds: asbestos-related pericarditis in a boiler operator. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:86-89. [PMID: 18197304 PMCID: PMC2199309 DOI: 10.1289/ehp.10354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 09/10/2007] [Indexed: 05/25/2023]
Abstract
CONTEXT Occupational and environmental exposures to asbestos remain a public health problem even in developed countries. Because of the long latency in asbestos-related pathology, past asbestos exposure continues to contribute to incident disease. Asbestos most commonly produces pulmonary pathology, with asbestos-related pleural disease as the most common manifestation. Although the pleurae and pericardium share certain histologic characteristics, asbestos-related pericarditis is rarely reported. CASE PRESENTATION We present a 59-year-old man who worked around boilers for almost 30 years and was eventually determined to have calcific, constrictive pericarditis. He initially presented with an infectious exacerbation of chronic bronchitis. Chest radiographs demonstrated pleural and pericardial calcifications. Further evaluation with cardiac catheterization showed a hemodynamic picture consistent with constrictive pericarditis. A high-resolution computerized tomography scan of the chest demonstrated dense calcification in the pericardium, right pleural thickening and nodularity, right pleural plaque without calcification, and density in the right middle lobe. Pulmonary function testing showed mild obstruction and borderline low diffusing capacity. DISCUSSION Based on the patient's occupational history, the presence of pleural pathology consistent with asbestos, previous evidence that asbestos can affect the pericardium, and absence of other likely explanations, we concluded that his pericarditis was asbestos-related. RELEVANCE TO CLINICAL PRACTICE Similar to pleural thickening and plaque formation, asbestos may cause progressive fibrosis of the pericardium.
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Affiliation(s)
- Belayneh A. Abejie
- Department of Environmental Health (Environmental & Occupational Medicine and Epidemiology), Harvard School of Public Health, Boston, Massachusetts, USA
| | - Eugene H. Chung
- Department of Cardiovascular Medicine, Lahey Clinic, Burlington, Massachusetts, USA
| | - Richard W. Nesto
- Department of Cardiovascular Medicine, Lahey Clinic, Burlington, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Stefanos N. Kales
- Department of Environmental Health (Environmental & Occupational Medicine and Epidemiology), Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Employee Health & Industrial Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Luus K. Asbestos: mining exposure, health effects and policy implications. Mcgill J Med 2007; 10:121-6. [PMID: 18523609 PMCID: PMC2323486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this paper is to review research in the health effects and risks associated with exposure to asbestos and then to use this scientific evidence to analyze the implications of Canada's current policy on the use, manufacturing and export of asbestos. The review begins with a brief historical introduction to asbestos, and then moves on to look at the risks associated with asbestos exposure. Epidemiological and in vitro studies are then analyzed to determine the health risks of asbestos, with a specific focus on the different effects of serpentine and amphibole asbestos fibres. The paper then concludes with an analysis of Canadian policy in light of established scientific evidence and with a discussion of the possible implications of a gap between scientific knowledge and public policy.
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Affiliation(s)
- Kristina Luus
- *To whom correspondence should be addressed: Kristina Luus, 1173 Wellington Street Apt. 33, Halifax, NS B3H 3A2,
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Weir NA, Gerstenhaber B. A case of pleural mesothelioma with effusive-constrictive pericarditis. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2001; 74:159-63. [PMID: 11501711 PMCID: PMC2588717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- N A Weir
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
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Ozer N, Shehu V, Aytemir K, Ovunc K, Emre S, Kes S. Echocardiographic findings of pericardial involvement in patients with malignant pleural mesothelioma with a history of environmental exposure to asbestos and erionite. Respirology 2000. [DOI: 10.1046/j.1440-1843.2000.00272.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Various diagnostic advances over the years enable us to differentiate between these two conditions. This review begins with a case report of constrictive pericarditis, followed by a brief history and discussions of etiologies. Clinical features, radiologic, electrocardiographic, angiographic findings, and hemodynamics of constrictive pericarditis are reviewed. The echocardiographic findings are detailed and the recent advances in Doppler flow velocity patterns of pulmonary, mitral, tricuspid valves and hepatic veins are reported. Nuclear ventriculograms depict rapid ventricular filling in constrictive pericarditis and differentiate it from restrictive cardiomyopathy. Endomyocardial biopsy helps further in recognizing the various types of restrictive cardiomyopathies. Computed tomography and magnetic resonance imaging delineate abnormal pericardial thickness in constrictive pericarditis. Association of characteristic hemodynamic changes and abnormal pericardial thickness > 3 mm usually confirms the diagnosis of constrictive pericarditis. Effusive and occult varieties of constrictive pericarditis are briefly described. This review concludes with emphasizing the importance of pericardial resection.
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Affiliation(s)
- A Mehta
- Department of Medicine, West Virginia University School of Medicine, Morgantown, USA
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Trogrlic S, Gevenois PA, Schroeven M, De Vuyst P. Pericardial effusion associated with asbestos exposure. Thorax 1997; 52:1097-8. [PMID: 9516906 PMCID: PMC1758473 DOI: 10.1136/thx.52.12.1097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The case history is presented of a 60 year old man who developed a pericardial effusion. Chest radiography showed pleural thickening and calcification. Pericardiotomy was performed and revealed nonspecific inflammatory lesions. Occupational exposure to asbestos and exclusion of other causes led to the diagnosis of benign asbestos pericardial effusion.
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Affiliation(s)
- S Trogrlic
- Departments of Radiology and Chest Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Affiliation(s)
- M Cooper
- Department of Radiological Sciences, Royal Brisbane Hospital, Queensland, Australia
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Affiliation(s)
- S G Pauker
- Division of Clinical Decision Making, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
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Abstract
The diagnosis of constrictive pericarditis remains a challenge because it is often mimicked by restrictive cardiomyopathy. The last few years have seen numerous advances in our ability to differentiate between these two conditions which often have similar physical findings and hemodynamics. This review begins with a brief history of constrictive pericarditis; this is followed by an extensive discussion of newer etiologies, and then the classical clinical history and physical examination findings are described. Radiologic, electrocardiographic, and angiographic findings are discussed. The hemodynamics of constrictive pericarditis are reviewed. Recent results of echocardiographic and echo-Doppler investigations are presented. Emphasis is placed upon the limitations of M-mode echocardiography in the diagnosis of constrictive pericarditis. The value of echocardiographic Doppler studies of mitral and tricuspid flow velocity patterns, as well as of those in the pulmonary veins and hepatic veins, is described. Nuclear ventriculograms and angiocardiograms tend to show more rapid ventricular filling in constrictive pericarditis than in restrictive cardiomyopathy. Although only a small number of patients has been studied, these evaluations seem to have merit in separating restrictive cardiomyopathy from constrictive pericarditis. The role of computed tomography scanning and magnetic resonance imaging studies of pericardial thickness in confirming the presence of constrictive pericarditis is discussed. Abnormal pericardial thickening (> 3 mm) confirms the diagnosis of constrictive pericarditis, but only if the characteristic hemodynamic pattern is present. The usefulness of endomyocardial biopsy in recognizing specific varieties of restrictive cardiomyopathy is presented.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N O Fowler
- Department of Medicine, University of Cincinnati College of Medicine, Ohio, 45267, USA
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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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Sandén A, Järvholm B, Larsson S. The importance of lung function, non-malignant diseases associated with asbestos, and symptoms as predictors of ischaemic heart disease in shipyard workers exposed to asbestos. BRITISH JOURNAL OF INDUSTRIAL MEDICINE 1993; 50:785-790. [PMID: 8398871 PMCID: PMC1061310 DOI: 10.1136/oem.50.9.785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The mortality from ischaemic heart disease was studied in a prospective cohort of 1725 shipyard workers exposed to asbestos. The analyses were stratified for age and smoking habits and restricted to men. In agreement with other findings, men with impaired lung function had a significantly higher risk (relative risk (RR) = 3.5) of dying from ischaemic heart disease than men with normal lung function. Men with asbestosis or suspected asbestosis had a significantly higher risk (RR = 3.1) of dying from ischaemic heart disease than men without asbestosis. Thus asbestosis or suspected asbestosis also seemed to be a risk factor for ischaemic heart disease. This finding was independent of respiratory function. There was no increased risk for ischaemic heart disease in men with compared with men without pleural plaques. Men with production of phlegm or sputum and wheezing or whistling had no increased risk for ischaemic heart disease compared with men without these symptoms. In the group with normal lung function men with dyspnoea had a significantly higher risk of dying from ischaemic heart disease than men without dyspnoea. The findings for men with asbestosis or suspected asbestosis indicated a further risk factor besides impaired lung function, in persons exposed to asbestos. Perhaps this risk factor is due to lesions of the pericardium with consequences for heart function.
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Affiliation(s)
- A Sandén
- Department of Occupational Medicine, Sahlgrenska Hospital, Göteborg, Sweden
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Abstract
Magnetic resonance imaging was performed in four male asbestos workers in whom the chest radiograph revealed pleural but not pulmonary or pericardial disease. Patients underwent thoracic multislice spin echo imaging, with measurement of left and right ventricular volumes at end-diastole and end-systole, and a study of the flow in the superior vena cava as an indirect measure to the filling of the right ventricle. Patients also underwent respiratory function tests and high-resolution computed tomography (HRCT). Magnetic resonance, but not HRCT, showed pericardial thickening in two patients. Magnetic resonance demonstrated reduced diastolic flow in the superior vena cava in one patient, reflecting impaired right ventricular filling. All other magnetic resonance measurements of cardiac function were normal. HRCT demonstrated mild asbestosis in three patients in which neither the chest radiograph nor magnetic resonance showed signs of parenchymal disease, and pericardiac calcification without thickening in one patient. It is concluded that magnetic resonance is superior to HRCT in identifying pericardial thickening, but that HRCT is superior to magnetic resonance in identifying asbestos-related pleural and pulmonary disease.
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