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Abstract Background: Pericardial effusion is a relatively common finding and can progress to cardiac tamponade; etiological diagnosis is important for guiding treatment decisions. With advances in medicine and improvement in the social context, the most frequent etiological causes have changed. Objectives: To evaluate the clinical and laboratory characteristics, etiology, and clinical course of patients with pericardial effusion and cardiac tamponade. Materials and methods: Patients with pericardial effusion classified as small (< 10 mm), moderate (between 10-20 mm), or severe (> 20 mm) were included. Data from the clinical history, physical examination, laboratory tests, and complementary tests were evaluated in patients with pericardial effusion and cardiac tamponade. The significance level was set at 5%. Results: A total of 254 patients with a mean age of 53.09 ± 17.9 years were evaluated, 51.2% of whom were female. A total of 40.4% had significant pericardial effusion (> 20 mm). Pericardial tamponade occurred in 44.1% of patients. Among pericardial effusion patients without tamponade, the most frequent etiologies were: idiopathic (44.4%) and postsurgical (17.6%), while among those with tamponade, the most frequent etiologies were postsurgical (21.4%) and postprocedural (19.6%). The mean follow-up time was 2.2 years. Mortality was 42% and 23.2 in those with and without tamponade, respectively (p=0.001). Conclusions: There is an etiological difference between pericardial effusion patients with and without cardiac tamponade. An idiopathic etiology is more common among those without tamponade, while postinterventional/postsurgical is more common among those with tamponade. The tamponade group had a higher mortality rate.

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Los linfomas cardíacos primarios son un subtipo muy poco frecuente de tumor en los cuales la lesión primaria se encuentra en el corazón. Los tumores suelen ser infiltrantes y se localizan en la aurícula derecha, seguidos del pericardio. Su mortalidad es notablemente alta y el diagnóstico tardío es el principal factor para su mal pronóstico. Describimos el caso de un paciente que presentó shock obstructivo por derrame pericárdico profuso causado por un tipo raro de tumor cardíaco primario, un linfoma pericárdico de células T/NK.

Primary cardiac lymphomas are a rare subtype of lymphomas in which the primary lesion is in the heart. The tumors are usually located in the right atria, followed by the pericardium and are frequently infiltrative. Mortality is remarkably high in this group and the delayed diagnosis is the main factor for its poor prognosis. We describe the case of a patient that presented with obstructive shock due to profuse pericardial effuse caused by a rare kind of primary cardiac tumor, a T/NK cell pericardial lymphoma.

Os linfomas cardíacos primários são um subtipo de tumor muito raro, no qual a lesão primária está no coração. Os tumores geralmente são infiltrativos e localizam-se no átrio direito, seguidos pelo pericárdio. Sua mortalidade é notavelmente alta e o diagnóstico tardio é o principal fator que produz seu mau prognóstico. Descrevemos o caso de um paciente que apresentou choque obstrutivo devido a um derrame pericárdico profuso causado por um tipo raro de tumor cardíaco primário, um linfoma pericárdico de células T/NK.

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BACKGROUND: Cardiac tamponade is a medical emergency that occurs when fluid accumulates in the pericardial space, its prompt diagnosis and treatment can prevent a fatal outcome. OBJECTIVES: We describe a case of cardiac tamponade in a medicine Ward and its subsequent resolution. CLINICAL CASE: 56-year-old male patient with dyspnoea and edematous síndrome, managed with partial response depletive therapy. Echocardiographic study reveals a large pericardial effusion with signs of cardiac tamponade. Inmediate management with ultrasound-guided pericardiocentesis and subsequent surgical resolution. DISCUSSION: The knowledge of the clinical-hemdynamic manifestations and their subsequent pathophysiological background are important in the diagnostic suspicion and management considerations. Echocardiography is a critical component for the final diagnosis, since given its sensitivity and specificity it allows to complete the characterization of the pericardial effusion. In addition, it contributes to reducing the morbidity associated with its drainage.

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Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by chest pain associated often with peculiar electrocardiographic changes and, at times, accompanied by pericardial effusion. Acute pericarditis is generally self-limited and not life-threatening; yet, it may cause significant short-term disability, be complicated by either a large pericardial effusion or tamponade, and carry a significant risk of recurrence. The mainstay of treatment of pericarditis is represented by anti-inflammatory drugs. Anti-inflammatory treatments vary, however, in both effectiveness and side-effect profile. The objective of this review is to summarize the up-to-date management of acute and recurrent pericarditis.

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OBJECTIVE: to determine the incidence of pericardial effusion with cardiac tamponade in preterm infants in a pediatric intensive care unit, with emphasis on the relationship between pericardial effusion and peripherally inserted central catheter, and to evaluate the role of bedside ultrasound in approaching these cases. METHODS: we conducted a retrospective analysis of patients admitted to a pediatric intensive care unit between July 2014 and December 2016, who presented pericardial effusion with hemodynamic repercussion, evaluated by ultrasonography. RESULTS: we studied 426 patients admitted to the five beds of the neonatal unit. In the period, there were 285 bedside ultrasound exams. We found six cases of pericardial effusion, four of which with obstructive shock and need for pericardial drainage. There was no procedure-related mortality, and all patients evolved with hemodynamic improvement after the procedure. The incidence of pericardial effusion was 2.4 cases per year. CONCLUSION: the incidence of pericardial effusion is low in neonates, but early diagnosis is fundamental due to high morbidity and mortality, especially in cases of abrupt onset. All cases were diagnosed by bedside ultrasonography, demonstrating its importance in the screening of these cases, especially in shocks of uncertain etiology and neonates with sudden onset hemodynamic instability who are using central venous access.

OBJETIVO: determinar a incidência de derrame pericárdico com tamponamento cardíaco em recém-natos prematuros em uma unidade de terapia intensiva pediátrica, com ênfase na relação entre o derrame pericárdico e a inserção de cateter central de inserção periférica, e avaliar o papel da ultrassonografia à beira do leito na abordagem desses casos. MÉTODOS: análise retrospectiva dos pacientes internados em unidade de terapia intensiva pediátrica, entre julho de 2014 e dezembro de 2016, que apresentaram derrame pericárdico com repercussão hemodinâmica, avaliados por ultrassonografia. RESULTADOS: foram estudados 426 pacientes admitidos na unidade neonatal de cinco leitos, com realização 285 ultrassonografias à beira do leito. Foram encontrados seis casos de derrame pericárdico, sendo quatro casos com choque obstrutivo e necessidade de realização de drenagem pericárdica, sem mortalidade relacionada ao procedimento e com melhora hemodinâmica em todos os pacientes após o procedimento. A incidência de derrame pericárdico foi de 2,4 casos por ano. CONCLUSÃO: a incidência de derrame pericárdico é baixa em neonatos, porém o diagnóstico precoce é fundamental devido à alta morbimortalidade, especialmente nos casos de instalação abrupta. Todos os casos foram diagnosticados pela ultrassonografia à beira do leito, demonstrando sua importância no rastreio desses casos, especialmente em nos quadros de choque de etiologia incerta e neonatos com instabilidade hemodinâmica de início súbito que estão em uso de acesso venoso central.

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RESUMO Objetivo: determinar a incidência de derrame pericárdico com tamponamento cardíaco em recém-natos prematuros em uma unidade de terapia intensiva pediátrica, com ênfase na relação entre o derrame pericárdico e a inserção de cateter central de inserção periférica, e avaliar o papel da ultrassonografia à beira do leito na abordagem desses casos. Métodos: análise retrospectiva dos pacientes internados em unidade de terapia intensiva pediátrica, entre julho de 2014 e dezembro de 2016, que apresentaram derrame pericárdico com repercussão hemodinâmica, avaliados por ultrassonografia. Resultados: foram estudados 426 pacientes admitidos na unidade neonatal de cinco leitos, com realização 285 ultrassonografias à beira do leito. Foram encontrados seis casos de derrame pericárdico, sendo quatro casos com choque obstrutivo e necessidade de realização de drenagem pericárdica, sem mortalidade relacionada ao procedimento e com melhora hemodinâmica em todos os pacientes após o procedimento. A incidência de derrame pericárdico foi de 2,4 casos por ano. Conclusão: a incidência de derrame pericárdico é baixa em neonatos, porém o diagnóstico precoce é fundamental devido à alta morbimortalidade, especialmente nos casos de instalação abrupta. Todos os casos foram diagnosticados pela ultrassonografia à beira do leito, demonstrando sua importância no rastreio desses casos, especialmente em nos quadros de choque de etiologia incerta e neonatos com instabilidade hemodinâmica de início súbito que estão em uso de acesso venoso central.

ABSTRACT Objective: to determine the incidence of pericardial effusion with cardiac tamponade in preterm infants in a pediatric intensive care unit, with emphasis on the relationship between pericardial effusion and peripherally inserted central catheter, and to evaluate the role of bedside ultrasound in approaching these cases. Methods: we conducted a retrospective analysis of patients admitted to a pediatric intensive care unit between July 2014 and December 2016, who presented pericardial effusion with hemodynamic repercussion, evaluated by ultrasonography. Results: we studied 426 patients admitted to the five beds of the neonatal unit. In the period, there were 285 bedside ultrasound exams. We found six cases of pericardial effusion, four of which with obstructive shock and need for pericardial drainage. There was no procedure-related mortality, and all patients evolved with hemodynamic improvement after the procedure. The incidence of pericardial effusion was 2.4 cases per year. Conclusion: the incidence of pericardial effusion is low in neonates, but early diagnosis is fundamental due to high morbidity and mortality, especially in cases of abrupt onset. All cases were diagnosed by bedside ultrasonography, demonstrating its importance in the screening of these cases, especially in shocks of uncertain etiology and neonates with sudden onset hemodynamic instability who are using central venous access.

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Umbilical venous catheter (UVC) is widely used in neonatal intensive care units. Pericardial effusion is an uncommon but life-threatening complication; and tamponade have been reported in 3% of neonates having such catheters. We present a case of cardiac tamponade as a complication of venous catheter in a neonate. The patient was diagnosed at the appropriate time by echocardiography and the pericardiocentesis was performed, and after removal of the complete pericardial effusion,an improvement of the critical condition was achieved. It is important to document the optimal positioning of UVC before the start of infusions.

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La tuberculosis pericárdica es una presentación poco frecuente de infecciones causadas por especies de Micobacterias. Se presenta el caso de una paciente femenina de 43 años de edad con antecedentes de Leucemia linfocítica aguda en remisión completa, en fase de mantenimiento con Dasatinib durante cuatro años: había derrame pleural derecho como efecto secundario, y consultó por presentar disnea progresiva, concomitante fiebre de 39ºC precedida por escalofríos, sin patrón horario asociándose a las 72 horas exacerbación del patrón de disnea hasta la ortopnea y disminución del volumen urinario motivo por el cual es traída a nuestro centro. Durante su estancia hospitalaria se realiza TC de tórax hallándose de manera incidental la existencia de derrame pericárdico, se realiza ecoscopia donde se visualiza derrame pericárdico importante a predominio posterior, de 27 mm de volumen con colapso de cavidades cardíacas derechas, estableciéndose el diagnóstico de taponamiento cardíaco. Se realiza pericardiocentesis con obtención de 720 cc de liquido pericárdico turbio. 72 horas posterior al procedimiento presenta nuevo episodio de taponamiento cardíaco realizándose ventana pleuropericárdica; el ADA de líquido pericárdico reportó valores 2 veces superior a limite de corte; el resultado de la biopsia de pericardio reportó fibrosis pericárdica. En vista de hallazgos clínicos y paraclínicos se planteó el diagnóstico de Pericarditis tuberculosa.

Pleuropericardial tuberculosis is a rare presentation of infections caused by Micobacterias. The case of a 43 years - old female patient with a history of acute lymphocytic leukemia in complete remission in the maintenance phase with dasatinib for four years with right pleural effusion is presented. She consulted for progressive dyspnea; there was also fever (39ºC) and chills. Within 72 hours orthopnoea and decreased urine volume appeared. During her hospital stay a chest CT showed the existence of pericardial effusion, and endoscopy confirmed severe pericardial effusion of 27 mm with right-sided heart collaps, and because the diagnosis of cardiac taponade was made pericardiocentesis was performed, obtaining 720 cc of pericardial turbid fluid; after s 72 hours after a new episode of cardiac taponade occurred, so that a pleuropericardial window was done. ADA values reported 2 times higher cutting; pericardial biopsy reported pericardial fibrosis. In view of these findings, clinical and laboratory diagnosis of tuberculous pericarditis was established.

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El taponamiento cardíaco es un evento grave que requiere un rápido diagnóstico y tratamiento, sus causas no siempre son evidentes, aunque, los procesos neoplásicos y en particular los de pulmón, deben tenerse siempre en cuenta. El objetivo de este trabajo fue ejemplificar que el taponamiento cardíaco puede ser la forma de manifestación de un cáncer de pulmón. Se presentó un paciente de 58 años de edad, fumador por 45 años, portador de un taponamiento cardíaco, con antecedentes de derrame pericárdico previo y anemia, con disnea de esfuerzo, acompañado de tos seca. Se realizó pericardiotomia, drenando 2 750 ml de líquido serohemático. El proceder quirúrgico confirmó el diagnóstico etiológico de adenocarcinoma mixto moderadamente diferenciado de pulmón bilateral difuso, con metástasis en pericardio visceral y parietal. Las neoplasias producen con frecuencia derrames hemorrágicos o serohemáticos y taponamiento cardíaco, frecuentemente recidivantes tras la pericardiocentesis, como sucedió en este paciente.(AU)

The cardiac tamponade is a serious event that requires a quickly diagnose and treatment. Its causes not always are evident, even though, neoplastic processes and in particular the ones related to lungs, should be taken into account. The objective of this work was to provide that the cardiac tamponade could be a way that a lung cancer be manifested. A fifty eight –year- old patient, with a history of smoking for 45 years with a cardiac tamponade, history of previous pericardial stroke, anaemia and hacking cough was presented in this article. A pericardiotomy was performed to drain 2750 millilitres of serohematic fluid. The surgical procedure confirmed the existence of a mixed moderately differentiated, lung adenocarcinoma, with metastasis in the parietal and visceral pericardium. The neoplasia produce frequently hemorrhagic and serohematic bleeding, as well as cardiac tamponade, frequently after pericardiocenthesis, as occurred with this patient.(AU)

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La perforación coronaria es una rara complicación de la intervención coronaria percutánea, pero puede desencadenar un taponamiento cardiaco potencialmente letal. Esta complicación ha sido reportada en 0,1 -3.0 por ciento de los procedimientos. Este reporte describe un caso de hemopericardio y taponamiento cardiaco posterior a una intervención percutánea en un paciente anticoagulado con warfarina y con síndrome coronario agudo sin elevación del segmento ST. Una rápida intervención aseguró una excelente evolución clínica del paciente.

Coronary perforation is a rare complication of percutaneous coronary intervention, but can trigger potentially lethalcardiac tamponade. This complication has been reported in 0,1 – 3,0 % of procedures. This report describes a case ofhemopericardium and cardiac tamponade after percutaneous intervention in an warfarin anticoagulated patient withacute coronary syndrome without ST segment elevation. A rapid intervention ensured an excellent clinical evolution ofthe patient.

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El objetivo del presente trabajo es determinar la frecuencia la presentación clínica, tratamiento, evolución y pronóstico alejado en pacientes con Derrame Pericárdico Crónico Severo Idiopático (DPCSI)

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Ischemic hepatitis is an infrequent entity, usually associated with low cardiac out put. We present a case of a 57 year-old man with chronic renal failure and cardiac tamponade who developed elevation of serum alanine transferase level of 5,054 U/L, aspartate transferase level of 8,747 U/L and lactate dehydrogenasa level of 15,220 U/L. The patient developed hepatic encephalopathy and hypoglycemia. Liver Doppler ultrasound was normal. He was seronegative for HBV and HCV, drugs list was scrutinized for the names of known hepatotoxins. Ischemic hepatitis was diagnosed. The hypoglycemia and encephalopathy were solved and the patient was discharged with normal transaminase levels. Ischemic hepatitis is typically preceded by hypotension, hypoxemia, or both. As one would expect, the most common cause of sustained systemic hypotension is cardiovascular disease. Liver biopsy is usually not necessary. The best treatment is support measures and correct the underlying condition.

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We describe a newborn with acute respiratory distress syndrome, subjected to mechanical ventilatory assistance with high level of peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP), who developed cardiac tamponade due to pneumopericardium. Tension pneumopericardium produces the same physiological derangement as cardiac tamponade secondary to accumulated blood or other fluids. This life-threatening complication demands immediate diagnosis and treatment.

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O acometimento cardíaco no Lupus Eritematoso Sistêmico ocorre em cerca de 15 a 50 por cento dos pacientes.A pericardite é a manifestação mais freqüente. O tamponamento cardíaco é extremamente raro, principalmente como manifestação inicial da doença. Nesta pesquisa é descrito o caso de uma mulher jovem que apresentou como manifestação inicial do Lupus Eritematoso Sistêmico, tamponamento cardíaco, tendo sido tratada com altas dores de corticosteróides, necessitando ainda de pericardiocentese e instalação de janela pericárdica.

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