An unusual cardiac manifestation in autosomal dominant polycystic kidney disease

Autosomal Dominant Polycystic Kidney Disease and Pericardial Effusion

The autosomal dominant polycystic kidney disease (ADPKD) accounts for one out of 400-1000 live births, being a hereditary disorder with cystic and noncystic manifestations as well as extrarenal involvement. The pericardial effusion (PE) in the context of a patient with ADPKD is complex, and it is not entirely defined. Several theories have been proposed. The most accepted, so far, is linked to mutations in the PKD1 gene which can entail an abnormal production of matrix components, matrix-degrading enzymes, and inhibitors of metalloproteinases, and defects in connective tissue which would lead to an abnormal distensibility of the connective tissue. We report the case of a 35-year-old female Moroccan patient with the diagnosis of ADPKD associated with arterial hypertension who came into the Emergency Department with lower abdominal pain lasting for five days being diagnosed as salpingitis. Abdominal computed tomography scan with contrast showed both kidneys with several cystic images with a thin wall. A transthoracic echocardiogram revealed the presence of moderate PE more in the anterior aspect. A greater set of standard tests to rule out collagen vascular disease, rheumatoid diseases, autoimmune disorders, and malignancies was ordered. These tests yielded no abnormality. The association of ADPKD with PE is rare. The awareness of this connection by the emergency physicians is key to prevent misplaced concern.

Left Ventricular Cleft Detected by Transthoracic Echocardiography in a Patient with Autosomal Dominant Polycystic Kidney Disease

Recently, the presence of left ventricular clefts has been identified frequently with the advancement of cardiac imaging modalities such as cardiac magnetic resonance imaging and computed tomography. Here we report a rare case of left ventricular cleft that was incidentally diagnosed with the ECG changes that imitated the presence of LMCA stenosis and diagnosed by transthoracic echocardiography in a patient with autosomal dominant polycytic kidney disease.