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1.
Int J Mol Sci ; 25(15)2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-39125981

RESUMEN

The invasive mucinous adenocarcinoma of the lungs (LIMA) is an uncommon histological subtype of the mucinous adenocarcinoma. In this article, we present the case of a patient with a very high cardiovascular risk profile, diagnosed with LIMA, pericardial tamponade due to secondary dissemination, and pulmonary embolism, whose management rouses many challenges. Despite receiving the correct anticoagulant and antiaggregant therapy, our patient developed repeated acute major cardiovascular events leading to a fatal outcome. To gather additional information on LIMA and the above cluster of pathologies, we performed the first research of the international medical literature for scientific articles published in the last eight years on PubMed, ResearchGate, Clarivate, and Google Scholar. As the first literature research failed to identify any case similar to our patient, we performed a second study of the same databases for subjects with lung adenocarcinoma instead of LIMA and the same comorbidities, and we found 10 cases. LIMA is a less frequent type of adenocarcinoma, with polymorphic radiologic appearances on the chest computed tomography, frequently mimicking pneumonia, and thus delaying the diagnosis and therapy. It has a worse prognosis and higher mortality than the common adenocarcinoma, but information on its secondary dissemination and complications is still required.


Asunto(s)
Adenocarcinoma del Pulmón , Adenocarcinoma Mucinoso , Taponamiento Cardíaco , Neoplasias Pulmonares , Embolia Pulmonar , Humanos , Masculino , Persona de Mediana Edad , Adenocarcinoma del Pulmón/complicaciones , Adenocarcinoma del Pulmón/diagnóstico , Adenocarcinoma del Pulmón/patología , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patología , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Resultado Fatal , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/complicaciones , Embolia Pulmonar/etiología , Tomografía Computarizada por Rayos X
2.
S D Med ; 77(4): 166-170, 2024 04.
Artículo en Inglés | MEDLINE | ID: mdl-38991161

RESUMEN

Large pericardial effusions with associated cardiac tamponade are a rare manifestation of hypothyroidism. We present the case of a 63-year-old female with chronic heart failure and newly diagnosed hypothyroidism, who presented to her primary care physician complaining of progressively worsening dyspnea. Chest radiography showed cardiomegaly and transthoracic echocardiography (TTE) revealed a large pericardial effusion with tamponade physiology. An emergent pericardial window was performed, resulting in an improvement in left ventricular systolic function. Pericardial tissue biopsy was normal. Thyroid function tests were consistent with severe primary hypothyroidism. After inpatient treatment with intravenous levothyroxine and interval resolution of symptoms without recurrence of effusion, the patient was discharged home on oral levothyroxine therapy. Close follow up with surveillance echocardiography was planned. While metabolic disorders are seldom thought of as an etiology, it is imperative for clinicians to recognize hypothyroidism as a cause of the pericardial effusion. It is one of the few reversible causes and delay in treatment can result in fatal sequelae.


Asunto(s)
Hipotiroidismo , Derrame Pericárdico , Tiroxina , Humanos , Derrame Pericárdico/etiología , Derrame Pericárdico/diagnóstico , Hipotiroidismo/complicaciones , Femenino , Persona de Mediana Edad , Tiroxina/uso terapéutico , Tiroxina/administración & dosificación , Ecocardiografía , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/diagnóstico , Insuficiencia Cardíaca/etiología
3.
World J Surg Oncol ; 22(1): 160, 2024 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-38902721

RESUMEN

BACKGROUND: Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren's syndrome (SjS). SjS is rarely accompanied by serositis. Here, we describe the first case of postoperative cardiac tamponade and acute pleuritis in a patient with thymic MALT lymphoma associated with SjS. CASE PRESENTATION: A 33-year-old woman with SjS presented with an anterior mediastinal mass on chest computed tomography, which was performed for further examination of the condition. Suspecting a thymic MALT lymphoma or thymic epithelial tumor, total thymectomy was performed. The mediastinal mass was histopathologically diagnosed as a thymic MALT lymphoma. The patient was discharged with a good postoperative course but visited the hospital 30 days after surgery for dyspnea. Cardiac tamponade was observed and drainage was performed. Four days after pericardial drainage, chest radiography revealed massive left pleural effusion, and thoracic drainage was performed. The patient was diagnosed with serositis associated with SjS and treated with methylprednisolone, which relieved cardiac tamponade and pleuritis. CONCLUSIONS: Surgical invasion of thymic MALT lymphomas associated with SjS may cause serositis. Postoperative follow-up should be conducted, considering the possibility of cardiac tamponade or acute pleuritis due to serositis as postoperative complications.


Asunto(s)
Taponamiento Cardíaco , Linfoma de Células B de la Zona Marginal , Pleuresia , Complicaciones Posoperatorias , Síndrome de Sjögren , Neoplasias del Timo , Humanos , Linfoma de Células B de la Zona Marginal/complicaciones , Linfoma de Células B de la Zona Marginal/cirugía , Linfoma de Células B de la Zona Marginal/patología , Femenino , Adulto , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Taponamiento Cardíaco/diagnóstico , Síndrome de Sjögren/complicaciones , Pleuresia/etiología , Neoplasias del Timo/cirugía , Neoplasias del Timo/complicaciones , Neoplasias del Timo/patología , Complicaciones Posoperatorias/etiología , Timectomía/efectos adversos , Pronóstico , Tomografía Computarizada por Rayos X , Enfermedad Aguda
4.
Prenat Diagn ; 44(6-7): 876-878, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38752660

RESUMEN

Fetal pericardial teratomas are rare. They present with pericardial effusion and hydrops. The definitive management is postnatal resection of the tumor. The exact antenatal management is not known due to its rarity. We present a case of fetal pericardial teratoma with pericardial tamponade. Pericardiocentesis performed at 31 weeks significantly relieved the venous compression, leading to resolution of hydrops and prolonging the gestational age for the definitive management.


Asunto(s)
Neoplasias Cardíacas , Pericardiocentesis , Teratoma , Humanos , Teratoma/cirugía , Teratoma/complicaciones , Teratoma/diagnóstico , Teratoma/diagnóstico por imagen , Pericardiocentesis/métodos , Femenino , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/cirugía , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico , Embarazo , Adulto , Ultrasonografía Prenatal , Derrame Pericárdico/cirugía , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Taponamiento Cardíaco/diagnóstico , Hidropesía Fetal/etiología , Hidropesía Fetal/diagnóstico , Hidropesía Fetal/cirugía , Enfermedades Fetales/cirugía
6.
Am J Cardiol ; 223: 100-108, 2024 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-38740164

RESUMEN

In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.


Asunto(s)
Amiloidosis , Derrame Pericárdico , Humanos , Amiloidosis/complicaciones , Amiloidosis/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/diagnóstico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/diagnóstico , Pericarditis Constrictiva/diagnóstico , Pericarditis Constrictiva/etiología , Cardiomiopatías/diagnóstico , Cardiomiopatías/etiología , Cardiomiopatías/complicaciones , Cardiomiopatías/terapia , Ecocardiografía , Imagen por Resonancia Cinemagnética/métodos , Pericardio/diagnóstico por imagen , Pericardio/patología
8.
J Cardiothorac Surg ; 19(1): 50, 2024 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-38310296

RESUMEN

BACKGROUND: Chylopericardium is a rare condition characterized by the accumulation of chyle in the pericardial space. It is most commonly caused by thoracic duct injury. Chylopericardium following esophagectomy is extremely rare but can cause life-threatening complications. This report presents a case of chylopericardium post-esophagectomy, resulting in cardiac tamponade and cardiac arrest. A systematic literature review was also conducted to facilitate the understanding of this rare condition. CASE PRESENTATION: A 41-year-old male was admitted to our hospital with intermediate to highly differentiated squamous cell carcinoma of the mid-thoracic esophagus (clinical T4NxM0). He underwent thoracoscopic-laparoscopic esophagectomy with cervical anastomosis. On postoperative day 1, patient had a cardiac arrest secondary to cardiac tamponade, requiring emergency ultrasound-guided drainage. The drained fluid was initially serous but became chylous after the administration of enteral nutritional emulsion. As a result of significant daily pericardial drainage, patient subsequently underwent thoracic duct ligation. The amount of drainage was substantially reduced post-thoracic duct ligation. Over a period of 2 years and 7 months, patient recovered well and tolerated full oral diet. A comprehensive literature review was conducted and 4 reported cases were identified. Among these cases, three patients developed pericardial tamponade secondary to chylopericardium post-esophagectomy. CONCLUSION: Chylopericardium is a rare but serious complication post-esophagectomy. Prompt echocardiography and thorough pericardial fluid analysis are crucial for diagnosis. Thoracic duct ligation has been shown to be an effective management approach for this condition.


Asunto(s)
Taponamiento Cardíaco , Paro Cardíaco , Derrame Pericárdico , Masculino , Humanos , Adulto , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/cirugía , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Esofagectomía/efectos adversos , Mediastino , Conducto Torácico/cirugía , Ligadura/efectos adversos , Paro Cardíaco/cirugía
9.
Cardiol Young ; 34(4): 924-926, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38250798

RESUMEN

We present the case of a premature neonate with pericardial effusion secondary to extravasation of total parenteral nutrition from a mispositioned/migrated umbilical venous catheter. Emergency pericardiocentesis was complicated by an intrapericardial thrombus, which was managed conservatively with spontaneous resolution within 24 hours. This case illustrates that the rare complication of an intrapericardial thrombus after pericardiocentesis can be successfully managed conservatively with close monitoring in haemodynamically stable paediatric patients.


Asunto(s)
Taponamiento Cardíaco , Derrame Pericárdico , Trombosis , Humanos , Recién Nacido , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Pericardiocentesis/efectos adversos , Trombosis/etiología , Trombosis/complicaciones
11.
Tex Heart Inst J ; 50(6)2023 12 07.
Artículo en Inglés | MEDLINE | ID: mdl-38087478

RESUMEN

Endoscopic ultrasonography-guided transesophageal pericardiocentesis was performed for a posteriorly located effusion not amenable to transthoracic drainage in a 58-year-old woman with a history of recurrent breast adenocarcinoma who presented with dyspnea. The patient had a pericardial effusion that resulted in cardiac tamponade. Transthoracic pericardiocentesis was unsuitable because of the posterior location of the effusion. Pericardiocentesis via the transesophageal route was performed. The pericardial sac was punctured with a 19-gauge needle, and 245 mL of pericardial fluid were aspirated, resulting in the resolution of the tamponade physiology. Endoscopic ultrasonography-guided transesophageal drainage is a novel and promising therapeutic option for posteriorly located pericardial effusions.


Asunto(s)
Taponamiento Cardíaco , Derrame Pericárdico , Femenino , Humanos , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/terapia , Pericardiocentesis/métodos , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Pericardio , Agujas/efectos adversos
12.
BMJ Case Rep ; 16(12)2023 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-38087490

RESUMEN

Cardiac tamponade is a rare but life-threatening complication of umbilical venous catheter (UVC) placement in neonates. Mortality rates are high; therefore, early diagnosis is important. We present a case of a preterm infant with a UVC in situ who underwent a laparotomy on the first day of life for pneumoperitoneum secondary to meconium ileus. The operation was uneventful; however, 2 hours after surgery, the patient developed cardiac tamponade, requiring resuscitation and pericardiocentesis. In retrospect, near-infrared spectroscopy (NIRS) showed a gradual decline in cerebral oxygenation (crSO2) in the 30 min prior to the cardiac arrest, while other vital signs were within normal ranges. Our case demonstrates that cerebral NIRS monitoring can serve as an additional clinical marker for early recognition of impending cardiac tamponade.


Asunto(s)
Taponamiento Cardíaco , Espectroscopía Infrarroja Corta , Humanos , Recién Nacido , Taponamiento Cardíaco/diagnóstico , Recien Nacido Prematuro , Oxígeno , Pericardiocentesis , Resucitación , Espectroscopía Infrarroja Corta/métodos
13.
Ter Arkh ; 95(11): 965-969, 2023 Dec 22.
Artículo en Ruso | MEDLINE | ID: mdl-38158953

RESUMEN

A description of a COVID-19 patient with the development of exudative pericarditis complicated by cardiac tamponade is provid. A peculiarity of this case is the presence of an underlying disease in the patient (chronic lymphocytic leukemia), which was in remission for 1.5 years after chemotherapy. Another feature of the patient was the relatively small area of lung damage and the hemorrhagic nature of the pericardial effusion, which persisted for a long time. The insignificant activity of inflammatory markers was noteworthy. Possible mechanisms of development and features of the course of exudative pericarditis in the described patient, issues of diagnosis and treatment of this category of patients are discusse.


Asunto(s)
COVID-19 , Taponamiento Cardíaco , Derrame Pericárdico , Pericarditis , Humanos , COVID-19/complicaciones , COVID-19/diagnóstico , Pericarditis/diagnóstico , Pericarditis/etiología , Pericarditis/terapia , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/terapia , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/terapia
14.
Medicine (Baltimore) ; 102(43): e35779, 2023 Oct 27.
Artículo en Inglés | MEDLINE | ID: mdl-37904403

RESUMEN

RATIONALE: Peripherally inserted central catheter (PICC)-related pericardial effusion/cardiac tamponade is a rare but fatal complication which cause a high mortality if not timely diagnosed and treated. However, the atypical manifestations and the rapid deterioration present challenges for neonatologists, and there has been limited investigation reported globally to date. Furthermore, a systematic review and comprehensive summary of clinical management are lacking. The significance of this article lies in emphasizing the importance of maintaining vigilance in high-risk neonates and implementing effective management strategies for PICC-related pericardial effusion/cardiac tamponade, thereby contributing to saving more lives. PATIENT CONCERNS: In the current report, we discuss 2 cases of neonatal pericardial effusion/cardiac tamponade following PICC catheterization. DIAGNOSIS: The first case was diagnosed based on forensic autopsy and the second case was diagnosed by bedside echocardiography. INTERVENTIONS AND OUTCOMES: The first case was treated conservatively and the second case underwent pericardiocentesis, unfortunately both were died. LESSONS: Once sudden hemodynamic or respiratory abnormalities are detected in neonates with PICC placement, particularly in the preterm infants, prompt diagnosis by cardiac ultrasound is required to verify pericardial effusion/cardiac tamponade and immediate pericardiocentesis or pericardiotomy is necessary to improve survival.


Asunto(s)
Taponamiento Cardíaco , Cateterismo Periférico , Derrame Pericárdico , Lactante , Recién Nacido , Humanos , Derrame Pericárdico/etiología , Derrame Pericárdico/terapia , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/terapia , Taponamiento Cardíaco/diagnóstico , Recien Nacido Prematuro , Cateterismo Periférico/efectos adversos , Catéteres/efectos adversos
15.
BMJ Case Rep ; 16(10)2023 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-37899079

RESUMEN

A male patient in his 20s with a medical history of common variable immunodeficiency disorder, non-compliant with therapy, presented to the emergency department with respiratory distress and severe hypoxaemia. Chest radiography demonstrated extensive bilateral infiltrates and an increased cardiothoracic ratio. Streptococcus pneumoniae urine antigen test was positive. ECG demonstrated diffuse ST-segment elevation. An arterial line was placed and demonstrated pulsus paradoxus. Transthoracic echocardiography revealed an extensive pericardial effusion, with echocardiographic signs of cardiac tamponade. Emergency subxiphoid pericardiocentesis was performed with an initial drainage of 750 mL of purulent fluid consistent with pyopericardium. Immediate haemodynamic improvement was observed. The patient required a second pericardiocentesis for drainage of a relapsing pericardial effusion. The course was complicated by effusive-constrictive pericarditis requiring anterior interphrenic pericardiectomy. Treatment with intravenous immunoglobulin and antibiotics led to a complete recovery.


Asunto(s)
Taponamiento Cardíaco , Inmunodeficiencia Variable Común , Derrame Pericárdico , Pericarditis , Masculino , Humanos , Derrame Pericárdico/diagnóstico , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Inmunodeficiencia Variable Común/complicaciones , Inmunodeficiencia Variable Común/diagnóstico , Pericarditis/complicaciones , Pericardiocentesis/efectos adversos
16.
J Cardiothorac Surg ; 18(1): 279, 2023 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-37817243

RESUMEN

Thoracoscopic lobectomy is a common surgical procedure for the treatment of lung cancer. With the continuous development of surgical techniques and medical devices, complications after thoracoscopic lobectomy are less and less, and cardiac tamponade is even rarer. This case is a 62-year-old woman who underwent thoracoscopic left upper lobectomy for a left upper lobe nodule. The patient developed acute cardiac tamponade on postoperative day 2, and symptoms resolved after pericardiocentesis. However, 20 h later, the patient underwent emergency surgery for re-developed acute cardiac tamponade, which was found to be a coronary tear. A review of the literature suggested that cardiac tamponade is more common in left lung surgery than right lung surgery. Pericardiocentesis can resolve initial acute cardiac tamponade, but pericardiotomy may be urgently needed after recurrence.


Asunto(s)
Taponamiento Cardíaco , Procedimientos Quirúrgicos Pulmonares , Femenino , Humanos , Persona de Mediana Edad , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Pulmón , Pericardiectomía , Pericardiocentesis , Procedimientos Quirúrgicos Pulmonares/efectos adversos
17.
J Clin Lab Anal ; 37(19-20): e24968, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37803881

RESUMEN

BACKGROUND: Candida pericardial infection is a rare clinical entity usually related to recent cardiothoracic surgery and chronic debilitating conditions. During the COVID-19 pandemic, invasive fungal infections have been on the rise, likely due to a combination of factors such as immunosuppression, underlying conditions like diabetes, and surgical procedures. CASE PRESENTATION: Herein, we report a 67-year-old diabetic woman with a history of COVID-19 infection who received a high dose of corticosteroids a few months before admission, and previous myocardial infarction for more than 12 years. The patient had a positive cardiac tamponade with signs of dyspnea, chest pain, and low blood pressure. Echocardiographic data were more in favor of constrictive pericarditis. The patient underwent urgent echocardiography-guided pericardiocentesis and then broad-spectrum antibiotic treatment was prescribed. Repeated echocardiography implied a persistent pericardial effusion 10 days later. Subxiphoid aspirates and biopsied tissues showed budding yeast cells and yeast colonies grew on culture media identified as Candida albicans. CONCLUSION: This report should bring to the attention of physicians toward the possibility of Candida pericardial infection presenting with cardiac tamponade after COVID-19 infection and cardiothoracic surgery. Echocardiographic assessment, prompt pericardiotomy, molecular-based identification of causative agent, and early administration of appropriate antifungal treatment should improve the patient's survival.


Asunto(s)
COVID-19 , Candidiasis , Taponamiento Cardíaco , Pericarditis , Femenino , Humanos , Anciano , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/cirugía , Candida albicans , Pandemias , COVID-19/complicaciones , Candidiasis/complicaciones , Pericarditis/complicaciones , Pericarditis/diagnóstico , Pericarditis/microbiología
18.
BMJ Case Rep ; 16(8)2023 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-37648281

RESUMEN

Idiopathic hypereosinophilic syndrome is characterised by the overproduction of eosinophils with tissue infiltration, leading to multiorgan dysfunction. Its heterogenous presentation makes the diagnosis challenging and easy to miss. A woman in her 70s was admitted with chest pain and shortness of breath. Diagnostic testing showed elevated cardiac enzymes, an ejection fraction of 45% and pericardial effusion. Pericardiocentesis helped her symptoms significantly. Cardiac catheterisation revealed patent coronary arteries. She was diagnosed with myopericarditis and discharged on non-steroidal anti-inflammatory drugs. She returned the following week with worsening chest pain, dyspnoea and diarrhoea. Chest imaging showed bilateral infiltrates. Diagnostic testing showed eosinophilic predominance in peripheral blood (59%), pericardial fluid (37%) and bronchoalveolar lavage (31%). After a negative infectious workup, she was started on glucocorticoids and responded favourably. She was discharged on steroids. Mepolizumab was initiated outpatient, and steroids were discontinued. Mepolizumab was discontinued after 2 years while monitoring her symptoms and eosinophil counts.


Asunto(s)
Taponamiento Cardíaco , Derrame Pericárdico , Femenino , Humanos , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Derrame Pericárdico/etiología , Antiinflamatorios no Esteroideos , Lavado Broncoalveolar , Dolor en el Pecho , Disnea/etiología
19.
Medicine (Baltimore) ; 102(32): e34822, 2023 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-37565852

RESUMEN

RATIONALE: Remimazolam, a benzodiazepine drug, has recently been developed and is currently used for the induction and maintenance of anesthesia. Remimazolam provides hemodynamic stability during anesthesia induction. However, in patients with cardiac tamponade, it is unclear how hemodynamic stability is maintained during the induction and maintenance of general anesthesia with remimazolam. PATIENT CONCERNS: An 88-year-old male patient had developed hemopericardium due to penetration of a pigtail catheter into the left ventricle during pericardiocentesis, which was performed to treat massive pericardial effusion. DIAGNOSES: The patient was diagnosed with acute cardiac tamponade and a hemothorax. Hemopericardium and hemothorax were confirmed on chest radiography and computed tomography performed immediately after pericardiocentesis. INTERVENTIONS: Decompressive pericardiostomy was performed through a left anterolateral thoracotomy with 1-lung ventilation under general anesthesia. Remimazolam was administered for total intravenous anesthesia. OUTCOMES: Severe hypotension and bradycardia occurred during the induction of anesthesia with remimazolam (6 mg/kg/hours). LESSONS: Remimazolam may induce severe hemodynamic instability during induction of general anesthesia in patient with cardiac tamponade.


Asunto(s)
Taponamiento Cardíaco , Derrame Pericárdico , Masculino , Humanos , Anciano de 80 o más Años , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Taponamiento Cardíaco/diagnóstico , Derrame Pericárdico/etiología , Hemotórax/complicaciones , Benzodiazepinas
20.
Medicine (Baltimore) ; 102(31): e34410, 2023 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-37543825

RESUMEN

RATIONALE: Cardiac tamponade, a condition in which the heart is compressed by pericardial fluid retention, is easy to diagnose; however, identifying the cause may be challenging since it can be caused by a variety of conditions, including trauma and pericardial disease. PATIENT CONCERNS: A 22-year-old man was admitted to the intensive care unit with respiratory failure. He had previously received allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia and developed chronic graft-versus-host disease (cGvHD) that was treated with a corticosteroid. At this time, he developed bilateral femur head necrosis and underwent surgery after discontinuation of the corticosteroid but developed respiratory failure postoperatively. The initial diagnosis was cardiac failure, which temporarily improved with treatment; however, eosinophilia and pericardial effusions became prominent. DIAGNOSES: Pericardial effusion gradually progressed, resulting in cardiac tamponade. INTERVENTIONS: Pericardiocentesis was performed. Eosinophilia could be the cause of cardiac tamponade; thus, corticosteroid was administered. OUTCOMES: Pericardial effusion improved remarkably after corticosteroid administration. The corticosteroid dose was gradually tapered, and the patient was discharged. LESSONS: This case presented with cardiac tamponade associated with eosinophilia, probably owing to graft-versus-host disease. This is an unusual condition associated with a history of hematologic neoplasms; although evaluation is challenging, appropriate assessment could help save the patient's life.


Asunto(s)
Taponamiento Cardíaco , Eosinofilia , Insuficiencia Cardíaca , Derrame Pericárdico , Insuficiencia Respiratoria , Masculino , Humanos , Adulto Joven , Adulto , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/terapia , Taponamiento Cardíaco/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/terapia , Eosinofilia/complicaciones , Eosinofilia/tratamiento farmacológico , Pericardio , Insuficiencia Cardíaca/complicaciones , Corticoesteroides/uso terapéutico , Insuficiencia Respiratoria/complicaciones
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